Overview of US National Strategy for Combating Antimicrobial Resistant Bacteria (CARB) Robert D. Kirkcaldy, MD, MPH Epidemiology Research Team, Division of STD Prevention STAR STI CTG 2017 Programmatic Meeting on Antimicrobial Resistance in Neisseria gonorrhoeae 13 April, 2017

Overview US National Strategy and Action Plan for CARB CDC Antibiotic Solutions Initiative Neisseria gonorrhoeae CARB activities

Antibiotic Resistance Threats in the United States, 2013 Neisseria gonorrhoeae designated one of 3 “urgent” antibiotic resistance threats (with CRE and C. difficile)

National Action Strategy and Action Plan National Strategy Goals (9/2014) Slow emergence and prevent spread of resistance Strengthen surveillance Advance development/use of rapid/innovative diagnostics* Accelerate research on antibiotics, therapeutics, vaccines* Improve international collaboration* * N. gonorrhoeae specifically mentioned https://www.cdc.gov/drugresistance/pdf/carb_national_strategy.pdf https://obamawhitehouse.archives.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf

National Action Strategy and Action Plan National Strategy Goals (9/2014) National Action Plan (3/2015) Slow emergence and prevent spread of resistance Build local capacity for rapid response to resistant GC Strengthen surveillance Create regional public health lab network Create isolate bank of resistant strains Advance development/use of rapid/innovative diagnostics* Develop/validate new rapid diagnostics for resistance Accelerate research on antibiotics, therapeutics, vaccines* Improve international collaboration* https://www.cdc.gov/drugresistance/pdf/carb_national_strategy.pdf https://obamawhitehouse.archives.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf

National Action Strategy and Action Plan National Strategy Goals (9/2014) National Action Plan (3/2015) National Targets Maintain prevalence of ceftriaxone-resistant N. gonorrhoeae <2% by 2020 https://www.cdc.gov/drugresistance/pdf/carb_national_strategy.pdf https://obamawhitehouse.archives.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf

CDC Antibiotic Resistance Solutions Initiative Funded by Congress to support implementation of National Action Plan Antibiotic Resistance Laboratory Network Rapid Response to Resistant Gonorrhea

Antibiotic Resistance Lab Network (ARLN) Purpose Provide infrastructure and lab capacity for 7 regional labs to detect and support response to resistant organisms, like AR GC How the ARLN works 7 state public health labs funded to be regional labs Referral antimicrobial resistance testing of multiple pathogens and specialized testing of clinical specimens Conduct GC agar dilution testing for GISP and GC rapid response sites Planned integration of whole genomic sequencing

Antibiotic Resistance Lab Network (ARLN)

Strengthening United States Response to Resistant Gonorrhea (SURRG) To establish capacity to rapidly detect resistant GC and implement response activities in selected local jurisdictions (in collaboration with state/project area) To enhance lab, epi analytic, informatics, and response capacity Methods Competitive application process through ELC cooperative agreement (5 year project) Expanded collection of specimens for culture in STD clinic and other clinics Rapid susceptibility testing by AST on all isolates Interviews of patients with resistant/reduced susceptibility strains, and interviewing of/specimen collection from partners and partners of partners Expanded data collection to facilitate epi and network analyses

North Carolina (Guilford County) Washington (Seattle-King County) Wisconsin (Milwaukee) New York City Colorado (Denver County) California (San Francisco) North Carolina (Guilford County) Indiana (Marion County) Georgia (Fulton County) Hawaii (Honolulu)

CDC CARB funding also supports activities and sustainability of GISP STD Surveillance Network (supports monitoring of GC treatment in random sample of GC in participating jurisdictions)

Conclusions National Strategy and Action Plan outline vision and objectives for responding to AR threat CARB funding strengthens capacity to maintain GISP and SSuN surveillance ARLN establishes greater capacity to conduct GC AST and eventually WGS SURRG building capacity in selected local jurisdictions to rapidly identify and response to AMR GC, identify best practices

Acknowledgments Epi & Statistics Branch Karen Schlanger Shacara Johnson Kyle Bernstein Surveillance & Data Management Branch Lizzi Torrone Alesia Harvey LaZetta Grier Rodney Presley Hillard Weinstock Laboratory Reference & Research Branch Cau Pham Evelyn Nash Kevin Pettus Samera Sharpe John Papp Ellen Kersh Policy Team Jennifer Ludovic

hgl8@cdc.gov (404) 639-8659 Questions?