AR Lab Network

Mountain Region

The Antimicrobial Resistance Laboratory Network (AR Lab Network), established by the Centers for Disease Control (CDC) in 2016, supports nationwide lab capacity to rapidly detect antibiotic resistance and inform local responses to prevent spread and protect people.

UPHL proudly serves as the Mountain States Regional Laboratory within the AR Lab Network.

AR lab, Mountain Region Report 2021-2023 (Q1 &Q2)

Read the AR Lab, Mountain Region Report 20-21

Mountain Region ARLN Newsletter 11/21

CRE/CRPAs

Isolates sent in to UPHL, from participating that are resistant to meropenem, doripenem, ertapenem and/or imipenem are tested for:

Phenotypic detection via mCIM
Gene specific testing by PCR for kpc, ndm, imp, vim, and oxa-48
Antimicrobial Susceptibility Testing (AST) performed on a broad panel of antibiotics using broth microdilution testing method

Whole Genome Sequencing (WGS) is utilized for suspect novel and emerging carbapenemase detection.
Suspect novel and emerging carbapenemase detection are defined as

Phenotypically Detected as a Carbapenemase Producer (mCIM positive)
PCR negative for kpc, ndm, imp, vim and oxa-48

For suspect novel/emerging carbapenemase please notify UT ARLN at [email protected]. For additional information please refer to CDC Testing Guidance for CRE and CRPAs opens in a new tab

CRAB

Isolates sent in to UPHL from participating facilities, that are resistant to meropenem, doripenem, ertapenem and/or imipenem are tested for carbapenemase production using Whole Genome Sequencing. For additional information, please refer to CDC's Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE)

Candida auris is an emerging multidrug-resistant fungal pathogen that can be easily misidentified by conventional mycology methods. UPHL offers

Candida auris rule out identification via MALDI-TOF
Fungal Antimicrobial Drug Susceptibility Testing
Free of charge C. auris colonization screening for facilities via PCR and culture-based methods

(see below)

For current C. auris needs contact us at [email protected]

Highly resistant CRE isolates that are MDROs can be tested for new-to-market antibiotics for treatment purposes.

This new technology 3D prints the plates using the Hewlett-Packard D300e Digital Dispenser.

This method tests isolates susceptibility to aztreonam/avibactam, a new to market combination drug that has shown to be effective against metallo-beta-lactamase producing infections. Organisms available for this testing are Enterobacteriaceaethat are

resistant to ceftazidime/avibactam and the carbapenem antibiotics

and

produces metallo-beta-lactamase (IE-NDM, IMP, VIM)

Pre-authrization is required for isolate testing, found here AR Expanded AST Authorization Request Form opens in a new tab
For current ExAST needs contact us at [email protected]

Colonization screening is performed for CRE/CRPA, CRAB and Candida auris using both culture and PCR based methods. Colonization screening is performed in collaboration with public health officials (state HAI coordinator), healthcare facilities, infection preventionists, and epidemiologists, all of whom can request colonization screening of high-risk patients. Detecting CPO colonization helps prevent transmission within and among facilities. This service is offered to facilities to conduct screening as part of a public health response for the detection of epidemiologically important MDROs.

For any colonization screening needs or questions, please contact UPHL at [email protected]

Resources

The Utah Public Health Laboratory- ARLN is now offering CLIA-compliant susceptibility antimicrobial susceptibility testing (AST) for Neisseria gonorrhoeae using Etest gradient strips (azithromycin, cefixime, ceftriaxone, and ciprofloxacin).

The test is performed at no cost, to assist in the management of patients with suspected treatment failure or disseminated gonorrhea infections.

We are currently able to accept only bacterial isolates and will start accepting primary specimens in the near future.

All test requests require preauthorization via emailing [email protected].

After obtaining approval, isolates need to be submitted with the attached test request form. Results are reported within 10 days of receipt.

Please refer to the attached isolate shipment guidelines and suspected treatment failure determination guidelines.

Isolate shipment guidelines for Neisseria gonorrhoeae gradient strip AST

Gonorrhea treatment failure management

Sample Submission Guide

CRO Isolate Testing

Organism Tested	Carbapenem Resistant Enterobacteriecae, Pseudomonas aeruginosa andAcinetobacter baumannii
Method	Maldi, Modified Carbapenem Inactivation Method (mCIM for CRE and CRPA only), PCR for detection of KPC, NDM, OXA-48, VIM, and IMP, Whole Genome Sequencing (select isolates only), and Antibiotic Susceptibility testing
Specimen Collection	Pure isolate of the organism on nutrient media slant or plate that supports organism growth
Transport	2-8⁰C or Ambient

CPO Colonization Screening

Organism Tested	Carbapenem Resistant-Enterobacteriecae (CRE), Pseudomonas aeruginosa (CRPA) and Acinetobacter baumannii (CRAB)
Method	Culture and RT-PCR
Specimen Collection	Rectal Swab (Copan Dual Rectal Swab) - CRE, CRPA and CRAB CRAB only Axilla-Groin Swabs (Puritan Sponge Swabs) and Wound and Sputum (Copan E-Swab) Swabs should be parafilmed and in individual specimen bags with the corresponding test request form attached
Transport	2-8⁰C or Ambient**
Stabilit	Swabs are stable for up to five days after date of collection
	** Samples are not accepted if frozen

AR Lab Mountain Region Test Request Form