Antimicrobial Resistance( AR) is a growing concern in the US and globally. In addition to the thousands of related deaths each year, AR threatens modern medicine through the inability to manage infectious complications from patients undergoing routine medical procedures. In 2016, the Centers for Disease Control and Prevention( CDC) established the Antibiotic Resistance Laboratory Network( ARLN). The ARLN, part of the CDC’ s Antibiotic Resistance Solutions Initiative, will expand testing activities for antimicrobial resistant pathogens providing improved surveillance at the state and national level.

The ARLN comprises seven regional laboratories with the infrastructure and specialized capabilities to allow for faster detection and response, improved tracking of resistance and better data to prevent and combat future AR threats.

The role of the regional labs [ in the ARLN ] is vital to ensuring improved and more consistent coordination and tracking of resistance threats at all levels.

Honor, Responsibility and Roadblocks in Washington State

“ It’ s a prestigious honor; we distinguished ourselves as having the expertise and resources to perform the work,” says medical epidemiologist Marisa D’ Angeli, MD, MPH of the Washington State Public Health Laboratory( WA PHL), which will be serving as the Western regional lab.“ It’ s also a great responsibility to prove that we are up to the task, investing the hours and identifying the necessary resources to be successful at this huge undertaking.”

To qualify as a regional laboratory, multiple prerequisites had to be met in order to provide the capabilities the ARLN required. However WA PHL was up to the task and has been working hard to get ready for the launch of the ARLN. Preparations have included building out new lab space, verifying and validating new testing methods, hiring additional staff and organizing trainings for PHLs in the Western region. They credit their success in this enterprise to the extensive planning efforts by all staff. Moreover, effective communications between WA PHL and ARLN contacts at CDC, as well as feedback from other jurisdictions, have proven instrumental in providing the support needed.

As in all major ventures, there were roadblocks that presented significant challenges. One obstacle was the implementation of required electronic reporting elements, which is a big undertaking within an individual lab, let alone over a region. This was compounded by the fact that WA PHL had previously been behind other states in electronic technology. APHL’ s Informatics team collaborated with Washington PHL’ s IT team to successfully increase electronic reporting capacity.

The ARLN will provide nationwide surveillance, filling existing data gaps and informing prevention and response efforts. The role of the regional labs is vital to ensuring improved and more consistent coordination and tracking of resistance threats at all levels.

" We are being counted on to develop new lab capabilities and roll out support to a number of states in the region,” says Brian Hiatt, WA PHL’ s office director for microbiology.“ We hope that our lab’ s selection will lead to increased awareness, improved prevention capabilities and a better overall understanding of drug resistant organisms throughout the region.”

ARLN Regional Laboratories:

Northeast Region

• Wadsworth Center( NY)

Mid-Atlantic Region

• Maryland Public Health Laboratory

Southeast Region

• Tennessee State Public Health Laboratory

Midwest Region

• Wisconsin State Laboratory of Hygiene

Central Region

• Minnesota Department of Health Public Health Laboratory

Mountain Region

• Texas Department of State Health Services Laboratory

Western Region

• Washington State Public Health Laboratory

Lead Microbiologist Mike Tran of the Washington State Public Health Laboratory uses MALDI-TOF mass spectrometry to confirm microbial identification

PublicHealthLabs

@ APHL

APHL. org

Winter 2017 LAB MATTERS 27

Lab Matters Winter 2017 | Page 29

Introducing the Antibiotic Resistance Laboratory Network