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AR Surveillance in the U.S.
Jean B. Patel, PhD, D(ABMM)
Division of Healthcare Quality Promotion
National Center for Emerging and Zoonotic Infectious Disease
Centers for Disease Control and Prevention
The findings and conclusions are those of the presenter and do not necessarily
represent the view of the Centers for Disease Control and Prevention.
National Center for Emerging and Zoonotic Infectious Diseases
Division of Healthcare Quality Promotion
CDC’s Public Health Portfolio
for Antibiotic Resistance
• Track antibiotic use,
especially in healthcare
settings
• Provide research tools
and guidance on
improving antibiotic use
• Improve consumer and
provider education
Surveillance
• Develop evidence-based
guidelines
• Assist in outbreak
response
• Implement prevention
strategies with states and
partners
• Conduct applied research
to inform prevention
Stewardship
Prevention
Three core activities across AR threats
(healthcare-associated, foodborne, and community pathogens)
• Implement real-time data
systems for tracking and
quality improvement
• Define risk populations
• Provide national and
international laboratory
expertise, testing, and
diagnostic capacity
CDC Surveillance for AR Bacteria
NARMS
Salmonella
Shigella
EIP & NHSN
Campylobacter
Enterobacteriaceae
Streptococcus
Enterococcus
Staphylococcus P. aeruginosa
Staphylococcus
Candida
Acinetobacter
GISP
Neisseria gonorrhoeae
Human Infections:
Three Sources of AR Surveillance Data
Program Name
Description
National Healthcare Safety
Network (NHSN)
Collection of data from healthcare facilities via web
entry or electronic transfer
Emerging Infections Network
(EIP)
State-based collaborative between the local public
health department and healthcare facilities (10
states)
Public Health Labs
Data collection from state, city or county labs
submitted to CDC, the national lab
Pubic Health Laboratory Testing
Expanding Capacity in FY2016

CRE & Salmonella testing in
all 50 states
 CRE tested for mechanism of
resistance
 All Salmonella tested by whole
genome sequencing, 1/20
testing at CDC by phenotypic
methods


Reference testing for multiple
pathogens in 7-8 regional labs
Strategic and technical
support for other public
health labs
National Antimicrobial Resistance Monitoring System (NARMS)
humans
CDC/NCEZID
retail meats
FDA/CVM
animals
USDA/FSIS
54 health departments:
isolates from patients
grocery stores in 14 states:
ground beef, chicken,
ground turkey, pork chops
slaughter and processing
facilities: cattle, chicken,
turkeys, swine
Cephalosporin-R Neisseria gonorrhoeae in the U.S.
New England Journal of Medicine
Emerging Infections Program (EIP)



A flexible surveillance platform for long-term surveillance
and time-limited studies to fill a data gap
EIP Programs in 10 states
Surveillance capabilities
 Population based surveillance
 Data collection from medical records
 Isolate collection & characterization

A few surveillance programs





FoodNet
HAI point prevalence survey
MDRO gram negative bacteria
Clostridium difficile
MRSA serious infections
EMERGING
INFECTIONS
PROGRAMS
Population-Based Surveillance in EIP

An estimated C. difficile infection incidence of 453,000 cases
CDC’s National Healthcare Safety Network (NHSN)
• NHSN is a national surveillance and quality improvement system tracking
infections in over 17,000 healthcare facilities nationwide
• NHSN is used by:
– Facilities across healthcare to track HAIs and antimicrobial resistance, and
direct prevention activities
– States for public reporting and regional prevention
– CMS for quality reporting and prevention initiatives
– HHS to measure national progress
Tackling AR with a Coordinated Approach


Public health departments
should track and alert health
care facilities to drugresistant outbreaks in their
area
Health care facilities should
work together and with
public health authorities to
implement shared infection
control actions
NHSN: Public Data Queries
CDC’s AR Leadership: Looking Forward
 Comprehensive
Tracking
Detect &
Respond
•
•
•
•
Outbreaks
EIP
NARMS
NHSN
Protect
Innovate
• State AR
Prevention
Programs
• Healthcare
networks
• Stewardship
• Prevention
Epi-Centers
• Private sector
 Effective Prevention
 Rapid Detection
 Faster Outbreak
Response
 Insights for Research
Innovation
 Improved Prescribing
Better Patient Outcomes
Thank you
For more information please contact Centers for Disease Control and
Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
National Center for Emerging and Zoonotic Infectious Diseases