1. 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

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

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

4. 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

5. 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*

6. 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

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

8. 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

9. Antibiotic Resistance Lab Network (ARLN)

10. 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

11. 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)

12. 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)

13. 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

14. 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

15.
(404)
Questions?