Jean B. Patel, PhD, D(ABMM) Division of Healthcare Quality Promotion National Center for Emerging and Zoonotic Infectious Disease Centers for Disease Control and Prevention AR Surveillance in the U.S. National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion The findings and conclusions are those of the presenter and do not necessarily represent the view of the Centers for Disease Control and Prevention.

CDC’s Public Health Portfolio for Antibiotic Resistance Prevention Develop evidence- based guidelines Assist in outbreak response Implement prevention strategies with states and partners Conduct applied research to inform prevention Stewardshi p Track antibiotic use, especially in healthcare settings Provide research tools and guidance on improving antibiotic use Improve consumer and provider education Surveillanc e Implement real-time data systems for tracking and quality improvement Define risk populations Provide national and international laboratory expertise, testing, and diagnostic capacity Three core activities across AR threats (healthcare-associated, foodborne, and community pathogens)

CDC Surveillance for AR Bacteria GISP NARMS EIP & NHSN Neisseria gonorrhoeae Enterococcus Streptococcus Staphylococcus Salmonella Campylobacter Shigella P. aeruginosa Candida Acinetobacter Enterobacteriaceae

Human Infections: Three Sources of AR Surveillance Data Program NameDescription National Healthcare Safety Network (NHSN) Collection of data from healthcare facilities via web entry or electronic transfer Emerging Infections Network (EIP) State-based collaborative between the local public health department and healthcare facilities (10 states) Public Health LabsData collection from state, city or county labs submitted to CDC, the national lab

Pubic Health Laboratory Testing Expanding Capacity in FY2016  CRE & Salmonella testing in all 50 states  CRE tested for mechanism of resistance  All Salmonella tested by whole genome sequencing, 1/20 testing at CDC by phenotypic methods  Reference testing for multiple pathogens in 7-8 regional labs  Strategic and technical support for other public health labs

humans CDC/NCEZID 54 health departments: isolates from patients retail meats FDA/CVM grocery stores in 14 states: ground beef, chicken, ground turkey, pork chops animals USDA/FSIS slaughter and processing facilities: cattle, chicken, turkeys, swine National Antimicrobial Resistance Monitoring System (NARMS)

Cephalosporin-R Neisseria gonorrhoeae in the U.S. New England Journal of Medicine

Emerging Infections Program (EIP)  A flexible surveillance platform for long-term surveillance and time-limited studies to fill a data gap  EIP Programs in 10 states  Surveillance capabilities  Population based surveillance  Data collection from medical records  Isolate collection & characterization  A few surveillance programs  FoodNet  HAI point prevalence survey  MDRO gram negative bacteria  Clostridium difficile  MRSA serious infections

Population-Based Surveillance in EIP  An estimated C. difficile infection incidence of 453,000 cases

CDC’s National Healthcare Safety Network (NHSN) NHSN is a national surveillance and quality improvement system tracking infections in over 17,000 healthcare facilities nationwide NHSN is used by: – Facilities across healthcare to track HAIs and antimicrobial resistance, and direct prevention activities – States for public reporting and regional prevention – CMS for quality reporting and prevention initiatives – HHS to measure national progress

 Public health departments should track and alert health care facilities to drug- resistant outbreaks in their area  Health care facilities should work together and with public health authorities to implement shared infection control actions Tackling AR with a Coordinated Approach

NHSN: Public Data Queries

CDC’s AR Leadership: Looking Forward Detect & Respond Outbreaks EIP NARMS NHSN Protect State AR Prevention Programs Healthcare networks Stewardship Innovate Prevention Epi-Centers Private sector Comprehensive Tracking Effective Prevention Rapid Detection Faster Outbreak Response Insights for Research Innovation Improved Prescribing Better Patient Outcomes

For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases Thank you