The Antibiotic Resistance Laboratory Network

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Antibiotic Resistance in the United States

• Sickens >2 million people per year• Kills at least 23,000 people each year

Plus 15,000 each year from C. difficile

• >$20B/year in healthcare costs• Threatens modern medicine

If we lose antibiotics, we lose the ability to treat patients with sepsis, cancer, provide organ transplants, and save victims of burns and trauma

• Need to act now or even drugs of last resort will soon be ineffective

Examples of Emerging AR Threats

• Pan-Resistant Gram-Negative Bacilli• Enterobacteriaceae• Acinetobacter spp.• Pseudomonas aeruginosa

• Untreatable Neisseria gonorroheae

• Multi-Drug Resistant Candida spp.• C. glabrata• C. auris

Preventing AR Infections Works

Prevention Works

Prevention Guidelines

Coordinated Prevention Works Best

State HAI/AR Prevention Programs• Core capacity in all 50 states to detect, respond

to, protect against HAI/AR threats

• Across all healthcare settings, networks of facilities in 25 states and 3 large cities working with health departments to: Better detect and respond to AR threats Prevent infections across healthcare

http://www.cdc.gov/vitalsigns/stop-spread

Detection Before Prevention

Lab Capacity Supported by the AR Solutions Initiative:Regional Labs

Healthcare Labs State/Local Labs Regional Labs CDC

ARLN Data for Action

Carbapenem-R Enterobacteriaceae (CRE)• Interrupting CRE transmission in healthcare settings• More accurate assess the burden of CRE• Detect new or new trends in CRE types

Carbapenem-R Pseudomonas aeruginosa and Acinetobacter spp.• Detect plasmid-mediated carbapenemases

ESBL-producing Enterobacteriaceae• Detect mcr-1-mediated colistin resistance

ARLN Data for ActionSalmonella spp.• Measure the impact of antibiotic use in food-producing on human

infections

Neisseria gonorrhoeae• Develop more accurate treatment guidelines

• Enhanced “detect and response” for new resistance in N. gonorrhoeae to identify and respond to outbreaks

ARLN Data for Action

Candida spp.• Detect resistance in strains that are not commonly

• Identification of C. auris and outbreak response

Streptococcus pneumoniae• Identify vaccine-escape strains

Mycobacterium tuberculosis• WGS to detect resistance and characterize transmission dynamics

Leveraging ARLN When New Threats Occur

More Resistant Bacteria and Bacteria that are Resistant to More Drugs

An Example:• 70 yo female hospitalized for an

infection in her hip• The patient recently traveled to

India and was hospitalized for treatment of a hip fracture

• Infecting isolate: NDM-producing Klebsiella pneumoniae that was pan-resistant

• The patient developed septic shock and died

Leveraging technology and ARLN to identify therapeutic options for resistant infections.

Improved Communication of New AR

Sends isolates with unusual resistance to ARLN Confirms & characterizes resistance.

Initiates local prevention efforts CDC issues a national alert & sends alert to WHO

WHO sends a global alert

In Conclusion

EARLY SUCCESSES• 556 suspected CRE Isolates: 194 Confirmed, 2

mcr-1 cases

• 5 CRE Colonization point prevalence surveys

• National infrastructure for detecting C. auris

• 1500 gonorrhea isolates: 300 sequenced, resistance trend tracking

• Nationally representative feasibility study of CIDT reflex culture

• Novel C. difficile data to interrupt transmission

• Enhancing national capacity for S. pneumoniae testing

ARLN in Action

• Strategy and coordination for increased and sustained capacity

• Enhanced epi/lab collaboration at all levels

• Clinical lab partners for isolate sharing

• Improved communication among partners

• Improved coordination at CDC

• Rapid response for AR prevention

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National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB)

National Action Plan for CARB called for a CDC response to: Detect and -respond to resistant pathogens Prevent spread of resistant infections Encourage innovation for new strategies

FY16: $160M appropriation will address AR with an ambitious, transformative approach, implementing CARB activities by 2020

For more information on CDC’s key investments to combat antibiotic resistant bacteria, see: https://wwwn.cdc.gov/arinvestments

Thank YouJean Patel

jpatel1@cdc.gov