Lab Matters Winter 2021 | Page 21

INFECTIOUS DISEASES

The Antibiotic Resistance Laboratory Network ( AR Lab Network ) was established in 2016 to support nationwide laboratory capacity to rapidly detect antimicrobial resistance ( AR ), identify emerging threats and inform public health response efforts to prevent the spread of new infections . Since its establishment , testing has increased within the network in response to AR trends seen in the United States and globally . The increased laboratory capacity addresses growing concerns of infections within the community , which puts more people at risk and is more difficult to contain , as well as concerns of the emergence of new forms of resistance that can be spread in the environment . Two pilot programs were introduced in 2020 to tackle such threats .

Drug-Resistant Gonorrhea

Over the last 40 years , recommended treatment regiments for gonorrhea have changed due to emerging resistance . Penicillin , tetracycline , ciprofloxacin and fluoroquinolones , while once prescribed , are no longer recommended , leaving a single regimen as the recommended treatment for gonorrhea in the US . Unfortunately , there has been recent emergence of Neisseria gonorrhoeae isolates displaying resistant phenotypes to this treatment option in Europe and Australia , necessitating the need to enhance detection of drug-resistant gonorrhea in the US .

In recent years , there has been a shift from culture-based testing to nucleic acid amplification tests in many clinical laboratories . In the absence of an approved US Food and Drug Administration ( FDA ) assay for molecular detection of drug resistance , there is a need to have access to antibiotic susceptibility testing ( AST ) results as quickly as possible for certain circumstances , including assessing for treatment failure . Gradient strip AST methods are relatively simple to perform and have a short turnaround time following growth of an isolate . In the new

Aspergillus

pilot program , the Maryland Public Health Laboratory will conduct gradient strip AST on cultured isolates in compliance with Clinical Laboratory Improvement Amendments ( CLIA ) regulations to provide gonococcal AST results to healthcare providers for suspected treatment failure patients . This new addition to testing performed by the AR Lab Network was added in anticipation of the increased need for testing for clinical management .

Azole-Resistant Aspergillus

Aspergillus is a common mold that most people come into contact with on a daily basis . However it has the potential to cause different types of infections , with Aspergillus fumigatus causing the most human infections . A growing concern is azole-resistant A . fumigatus , an emerging pathogen in the US that originates from the environment . As there are only three types of antifungal drugs , with azoles being the most commonly used class of antifungals , resistance can severely

Neisseria gonorrhoeae

The AR Lab Network has strengthened the domestic infrastructure to detect , track and contain AR threats . This has put the US in a better position to respond to this public health threat and improve health outcomes . Additionally , by continuing to adopt new testing strategies , the AR Lab Network will generate the data to allow public health experts to stay ahead of new threats across healthcare , agriculture and the community .

limit treatment options and is especially concerning for patients with invasive fungal infections .

While further research to determine disease prevalence and resistance mechanisms is needed , most laboratories do not have the capability to perform antifungal susceptibility testing for A . fumigatus . This is where the AR Lab Network steps in . In this new pilot program , the Tennessee and Maryland public health laboratories will collect , confirm and characterize A . fumigatus isolates from hospitals , commercial , clinical and public health laboratories within the Mid-Atlantic and Southeast regions of the US . This addition to the AR Lab Network testing directory is an expansion of testing that the US Centers for Disease Control and Prevention has been conducting in its own laboratories for over a decade and will enhance understanding of azole resistance in this pathogen . n