INFECTIOUS DISEASES
Antimicrobial Resistance Fellows Contribute
to CRE Identification in Maryland and Minnesota
Jessica Plemmons
Maryland Public Health Laboratory
I have gained experience in both hospital
and molecular epidemiology from working
as a laboratory scientist and Master’s level
training in a hospital setting. Knowing
several facets of public health is an asset
in working with epidemiologists and
microbiologists. I wanted to incorporate
both areas into my research project at the
Maryland Department of Health (MDH)
Public Health Laboratory as an APHL-CDC
Antimicrobial Resistance Fellow in the
Antibiotic Resistance Laboratory Network
(AR Lab Network). The flexibility of the
program encouraged several divisions to
collaborate and answer important public
health questions that we face in antibiotic
resistance every day.
I developed a culture-based method
to recover carbapenemase-resistant
Enterobacteriaceae (CRE) from rectal
swabs at the MDH Public Health
Laboratory. I also collected clinical
specimens with the MDH epidemiologists
during CRE colonization screenings
at healthcare facilities within the
Mid-Atlantic region to understand the full
process of CRE colonization screenings
from specimen collection to data
reporting.
CRE is a major public health concern
because it is highly resistant to
conventional treatment and consequently
there is an elevated mortality rate for
those who become infected. We receive
rectal swabs from CRE colonization
screenings and run a molecular test to
screen swabs for CRE markers. If a CRE
marker is detected in a swab, I recover
the CRE organism using the culture-based
method.
Before the development of the culture-
based method, we only knew if a
CRE marker was present in the swab
specimen. Now, after recovering CRE
organisms from rectal swabs, we are
able to investigate transmission events
between patients in a facility using
whole genome sequencing. This is crucial
10
LAB MATTERS Summer 2019
Carbapenemase-resistant Enterobacteriaceae (CRE)
when there are many patients with CRE
organisms in a facility. We can determine
if their presence is a result of a facility-
acquired transmission event or from
an unrelated source. This culture-based
method will improve CRE surveillance
within healthcare facilities and help in
the fight against antibiotic resistance
transmission.
Bradley Craft
Minnesota Public Health Laboratory
I never thought that my Master’s in
Public Health Microbiology and Emerging
Infectious Disease at the George
Washington University would lead me
to the work I’ve been able to do through
the APHL-CDC Antimicrobial Resistance
Fellowship. Many of the things I learned
about disease—its impacts on quality of
life as well as the transmission and risk
factors—were put into perspective as I
worked hands-on with testing and public
health outreach. It has been rewarding
to be able to make a difference and to be
on the front line of cutting-edge research
regarding screening and detection of
disease.
As a fellow, I conducted routine testing of
CRE using traditional mCIM and real-time
PCR testing. My main project focus for the
duration of my fellowship was expanding
this testing through the utilization
of a new HP D300e Digital Dispenser
Bioprinter, and having this printer become
another application of technology for
direct patient testing of hard-to-treat
infections. As both a state public health
laboratory and a member of the AR Lab
Network, the Minnesota Public Health
laboratory tests a variety of isolates for
antibiotic resistance. The use of these
bioprinters helps to cut down testing time
and increase precise data results for a
more rapid response.
Major learnings from this fellowship
include how to perform numerous
innovative assays, and the incredible
amount of time and effort put in by those
in and out of the laboratory to maintain
and advance public health. A valuable
insight I gained from participating in
implementation of the bioprinter was that
we can improve and expand testing by
taking familiar technology and applying it
in new ways. While new technologies are
often needed, we can examine what we
already have and see if we can use it in
alternative ways to improve lives. n
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