Lab Matters Fall 2023 | Page 97

APHL 2023 POSTER ABSTRACTS to understand any trends in the resistance profile of these fungal pathogens over the last few years and identify the gaps within surveillance testing within the DC region . This will eventually help us to develop better programs to control Candida infections and decrease the rate of antifungal resistance .

Presenter : Athulaprabha Murthi , amurthi @ gmail . com

AWaRe Classification : Increasing use of Access Antibiotics as a Stewardship Tool . Assessing its Effectiveness in Decreasing Resistance Patterns – A Retrospective Study

M . Gomaa , V . W . Aoki , P . Dykema ; Washington State Public Health Laboratory

Background : Antibiotic resistance is contributing to the burden on healthcare infrastructure worldwide . As an antibiotic stewardship initiative to combat antibiotic resistance , the World Health Organization ( WHO ) introduced the Access , Watch , and Reserve ( AwaRe ) classification for antibiotics . This classification is based on the spectrum and potential of antibiotic classes to induce resistance . In 2021 , WHO recommended increasing the use of the Access group of antibiotics and set a target for at least 60 % of the total antibiotics consumed . The present study evaluates the effectiveness of this recommendation . Methods : Using the WHONET / Backlink software , antibiotic resistance trends of specimens submitted to the Washington State Public Health Laboratory ( WA PHL ) were analyzed for the past ten years . For each bacterial species , the antibiotic resistance rate was expressed as the percentage of resistant isolates to all isolates from the same specimen type . Individual submitters were contacted to provide data for antibiotics consumed by the healthcare facility . The trends of antibiotic consumption were analyzed using the WHO Anatomical Therapeutic Classification / Defined Daily Dose ( ATC / DDD ) methodology and then categorized according to their AWaRe group . Results : Both antibiotic resistance and consumption patterns will be matched to examine the possible effect of increasing Access antibiotic consumption on antibiotic resistance in a retrospective way . Conclusion : Special consideration for the WHO AWaRe classification when designing stewardship programs for antibiotic use would be recommended based on the outcome of this work .

Presenter : Mohamed Gomaa , spockegypt @ gmail . com

Bordetella pertussis Exhibits Genomic Diversity within Patients and Laboratory Culture

E . Bouda 1 , M . Williams 1 , P . Cassidy ( ret .) 1 , T . Skoff 1 , M . Weigand 1 , Y . Peng 1 , L . Pawloski 1 , H . Ju 1 , K . Xavier 2 , D . Santoro 3 , M . Cavanaugh 4 , K . Mitchell 5 , M . L . Tondella 1 ; 1 US Centers for Disease Control and Prevention , 2 Colorado State Public Health Laboratory , 3 Connecticut Department of Public Health , 4 Oregon Public Health Division , 5 New York State Department of Health , Wadsworth Center

Whole genome sequencing ( WGS ) showed that although Bordetella pertussis ( BP ) exhibits little genetic variation , genomes from clinical isolates frequently differ in gene order through rearrangement between insertion sequences ( ISs ). To better understand rates of genome rearrangement and single nucleotide polymorphism ( SNP ) in BP , genomic diversity within patients was examined at select sites within the Enhanced Pertussis Surveillance / Emerging Infections Program Network ( EPS ). Between 2016 and 2020 , five US states submitted sets ( 2 – 7 isolates each ) of BP isolates , following diagnostic culture confirmation , to the US Centers for Disease Control and Prevention for characterization by pulsed-field gel electrophoresis ( PFGE ), WGS and vaccine antigen production screening . Analysis of 128 sets revealed only rare SNP variation , while 26 sets included evidence of genomic variations such as rearrangement or duplication within a single patient specimen . We further investigated the frequency and stability of one type of observed genomic variation during laboratory culture . Five replicate cultures of one pair of isolates ( J766 , J767 ) selected from a set exhibiting duplication variation were maintained for eight serial passages on Regan-Lowe Charcoal Agar media . Genomic DNA was extracted from passages for shotgun sequencing on an Illumina MiSeq . WGS revealed the stable maintenance of gene duplication in culture , both for mutations present at passage 1 ( J767 ) and for those becoming dominant at intermediate passages ( J766 ). All five replicates of J766 developed the same duplicated genomic region at identical intermediate passages . In summary , these data suggest that BP can not only exhibit genomic diversity within a single patient specimen but can also acquire or accumulate genomic variations during serial laboratory passages . However , this study cannot rule out the possibility that the emerged variation was present within the patient or isolate at a very low frequency prior to the passage experiment . These findings underscore the importance of minimizing the laboratory manipulation of clinical isolates used for infectious disease surveillance during genomic characterization .

Presenter : Emilie Bouda , tqi7 @ cdc . gov

Characterization of US Urogenital and Extragenital Meningococcal Isolates Collected through the Enhanced Gonococcal Isolate Surveillance Project

G . Mustafa , S . Sharma , D . Marasini , S . Oliver , S . Hariri , S . Crowe , I . Berry , S . C . Sancta , L . Quilter , C . Cubenas , Henju Marjuki ; US Centers for Disease Control and Prevention

Neisseria meningitidis ( Nm ) is a Gram-negative diplococcus that colonizes the nasopharynx and can cause invasive meningococcal disease ( IMD ), including bacterial meningitis and septicemia . Nm is closely related to Neisseria gonorrhoeae , a common cause of genitourinary infections , and has been infrequently reported to cause urethritis that is clinically indistinguishable from gonococcal urethritis . Some Nm urethritis-associated strains form a distinct phylogenetic clade known as “ U . S . Nm nongroupable ( NmNG ) urethritis clade .” These isolates have acquired gonococcal genes ( aniA and norB ) that allow for improved survival in anaerobic environments . A possible mode of Nm urethritis transmission is hypothesized to be oral sex from persons colonized with typically commensal Nm strains in the upper respiratory tract . We characterized urogenital ( urethral , endocervical ) and extragenital ( rectal , pharyngeal ) meningococcal isolates collected from 12 sexually transmitted disease ( STD ) clinics participating in an enhanced Gonococcal Isolate Surveillance Project ( eGISP ). Suspected Nm isolates collected during 2017 – 2019 were tested by real-time PCR , slide agglutination and / or whole genome sequencing ( WGS ) to determine species , serogroups and genomic diversity . Isolates were cultured from urethral swabs ( from symptomatic males ), cervical swabs ( from symptomatic females or females with suspected exposure to N . gonorrhoeae ) and pharyngeal and rectal swabs from asymptomatic and symptomatic persons with