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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