Lab Matters Fall 2024 | Page 55

APHL 2024 POSTER ABSTRACTS isolates . Further , the analysis highlights the critical public health efforts conducted by the TX DSHS , the AR Lab Network and other partners to slow antimicrobial resistance .

Presenter : Brady Ryan , Brady . Ryan @ dshs . texas . gov

Building Capacity for Rapid Neisseria gonorrhoeae Gradient Strip Antimicrobial Susceptibility Testing at State and Local Public Health Labs with SHARP

J . Reimche , J . Cartee , C . Pham , E . Kersh , M . Schmerer , Centers for Disease Control and Prevention

Neisseria gonorrhoeae ( GC ), the causative pathogen of gonorrhea , evolves to develop antimicrobial resistance mechanisms rapidly . Azithromycin was removed from the Centers for Disease Control and Prevention ’ s sexually transmitted infection treatment guidelines in 2020 leaving ceftriaxone as the last remaining recommended treatment for uncomplicated gonorrhea . With the possibility of cephalosporin minimum inhibitory concentrations ( MICs ) rising in response to monotherapy , more rapid antimicrobial susceptibility testing ( AST ) for GC using gradient strips ( Etest ® ) can aid in investigating suspected treatment failures , performing test of cure and managing other complications such as cephalosporin allergies or disseminated gonococcal infections . Part of the American Rescue Plan , Strengthening Hospital Acquired Infection / Antimicrobial Resistance Program Capacity or SHARP , allowed state public health laboratories to receive funding to implement GC Etest ® .

Laboratories that wrote workplans for GC Etest ® were guided to implement CLIA compliant procedures for ceftriaxone , cefixime , azithromycin and ciprofloxacin Etest ® and to report back to submitters , provide submitters with specimen collection and / or transport materials , participate in a semi-annual proficiency testing program from the Wisconsin State Laboratory of Hygiene and regularly report deidentified MIC data to CDC with alerts ( ceftriaxone MIC ≥0.125 µ g / mL and / or cefixime MIC ≥0.25 µ g / mL ) reported within 24 hours . An optional activity was to conduct whole genome sequencing ( WGS ) for GC isolates . Sites were encouraged to do outreach through-out their state to increase specimen submission . Submission / testing criteria was not defined by the SHARP GC Etest ® program team at CDC , however guidance was provided . Decisions about how best to accomplish the goals of SHARP GC Etest ® and fulfill the needs of their jurisdiction were made at the discretion of the state public health laboratories .

Sixteen jurisdictions participated in the first year ( 8 / 3 / 2022 – 8 / 3 / 2023 ) of the GC component of SHARP . Of those , eight began testing in the first year or were already testing ( independently or as a part of Strengthening the United States Response to Resistant Gonorrhea ( SURRG )); the remaining labs were in various stages of the validation process . In the first year , the eight labs performed Etest ® on 746 GC isolates . Only two alert isolates were reported , both from one site from the same patient , which were investigated as a collaboration between the site and CDC . Each testing lab received specimens from three to 20 distinct submitters . Four labs have been performing WGS on the GC isolates , with others looking to begin in the future .

GC Etest ® implemented under SHARP has expanded GC culture and Etest ® capacity to jurisdictions that did not already participate in CDC GC surveillance programs ( e . g ., The Gonococcal Isolate Surveillance Project ( GISP ) or SURRG ). As the sites continue to build capacity for this activity , we anticipate an increase in alert isolates being identified as GC remains an urgent antimicrobial resistance threat . These rapid detection efforts will be crucial for helping to guide treatment , understanding treatment failure cases should they arise and potentially intercepting possible resistant-gonorrhea outbreak situations .

Presenter : Jennifer Reimche , nkv3 @ cdc . gov

Comparison of Specimen Sources for Carbapenemaseproducing Acinetobacter Colonization Screening

S . Tracey , J . Dale , A . Gross , P . Snippes Vagnone , Minnesota Department of Health Public Health Laboratory

The growing threat of antimicrobial resistance in the United States is a multifaceted issue , which makes controlling and preventing its spread difficult . Despite the implementation of various infection prevention and control ( IPC ) practices , healthcare-associated infections ( HAIs ) still occur . Carbapenem-resistant Acinetobacter ( CRA ) are known to cause HAIs , which highlights the importance of conducting point-prevalence surveys ( PPSs ) to screen at-risk individuals for carbapenemase-producing CRA ( CP-CRA ). PPSs aid containment efforts by detecting individuals who are colonized with the bacterium of concern but may not be experiencing an active infection . Herein , we discern whether there is an optimal screening source based on surveillance data from January 2022 to November 2023 . During this time , 3,536 PPS specimens from 1,259 patients were collected from 46 facilities in seven states within the Antimicrobial Resistance Laboratory Network Central Region . Specimen sources included rectal ( 1,064 ), skin [ axilla , groin , axilla / groin ] ( 2,372 ), wound ( 80 ) and respiratory ( 20 ). The specimens were screened using a culture-based method , which utilized both selective and non-selective agar media and real-time PCR for blaOXA-23 , blaOXA-24 and blaOXA-58 ; genes which may be harbored by CP-CRA . Of the 3536 specimens , 142 from 106 patients tested positive , the majority of which were positive for blaOXA-24 . Of all positive specimens , 80 / 142 ( 56 %) came from a skin source , followed by 49 / 142 ( 35 %) rectal , 11 / 142 ( 8 %) wound and 2 / 142 ( 1 %) respiratory . Of the positive individuals , 71 / 106 ( 67 %) had more than one source collected . Fifty-eight of those 71 individuals ( 82 %) had dual rectal and skin collections , in which 20 / 58 ( 34 %) had both swabs test positive , 18 / 58 ( 31 %) only rectal positive and 20 / 58 ( 34 %) only skin positive . The remaining 13 individuals had other combinations of sources collected . These data demonstrate that of the positive specimens , there was not a single source type that was consistently positive , accordant with a previous analysis performed by our lab ( 2019-2021 , data not shown ). Data from this study and the previous study do not suggest a single optimal screening source . Out of 912 instances where multiple sources were collected per individual and the rectal swab was negative , there were 21 instances of another source testing positive . Likewise , of the 932 instances of multiple source collections per individual that had a skin source test negative , 26 instances showed another source was positive . Therefore , single source collection of only rectal or skin could miss 2 % ( 21 / 912 ) or 3 % ( 26 / 932 ) of positive specimens , respectively . The number and types of specimens collected per person should be dependent on patient factors , index cases , facility types and IPC challenges , all of which should be considered when determining the appropriate collection . Given there may be refusals from an individual for certain collection sites ( e . g ., rectal swab ), it is important to provide options