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.

Read the AR Lab, Mountain Region Report 20-21

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 arlnutah@utah.gov. For additional information please refer to CDC Testing Guidance for CRE and CRPAs

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 ARLNutah@utah.gov

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 Enterobacteriaceae that 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
For current ExAST needs contact us at ARLNutah@utah.gov

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 ARLNutah@utah.gov

Resources

Sample Submission Guide

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

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**
Stability	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