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T he Growing Threat of Antibiotic Resistance

T he Growing Threat of Antibiotic Resistance

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T he Growing Threat of Antibiotic Resistance

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  1. The Growing Threat of Antibiotic Resistance Lilian Peake, MD, MPH State Epidemiologist Office of Epidemiology Virginia Department of Health September 2019

  2. Burden of Antibiotic Resistance • 2 million Americans infected with bacteria resistant to antibiotics every year • 23,000 die • National priority • U.S. National Strategy for Combating Antibiotic-Resistant Bacteria • United Nations General Assembly High-Level Meeting on Antimicrobial Resistance

  3. National Goals • Slow the emergence of resistant bacteria • Strengthen One-Healthsurveillance • Advance development of laboratory testing • Accelerate development of new drugs and vaccines • Improve international collaboration and capacity

  4. National Strategies • Improve antibiotic stewardship in healthcare settings • Eliminate use of medically-important antibiotics for growth promotion in food animals • Improve lab testing, research and surveillance • Create regional public health laboratory network • Establish a specimen repository and sequence database

  5. Surveillance • 2016 - CDC Antibiotic Resistance (AR) Laboratory Network • Rapidly detect AR in healthcare, food and community • Inform local response to prevent spread • 7 regional public health laboratories • Mid-Atlantic = Maryland

  6. Emerging Pathogens Incidencein Virginia • 1. Carbapenemase-producing organisms • 214 clinical cases (April 2018 – June 2019) • 2. Candida auris • 1 clinical case (2018), 1 colonized case (2019) • 3. Vancomycin-resistant Staphylococcus aureus • 4. Organisms with novel resistance mechanisms • 5. Pan-resistant organisms

  7. Carbapenemase-Producing Organisms • Carbapenem • “Last-line” antibiotic class - usually reserved for severe or multi-drug resistant infections Carbapenemase • Enzyme that some bacteria produce • 5 carbapenemase genes have been discovered in bacteria • Enzyme inactivates carbapenem antibiotics

  8. Candida auris Type of fungus (yeast) • Discovered in 2009 • Causes serious infections Lack of knowledge among providers Limited treatment options • >90% are resistant to first-line drug • 2 pan-resistant cases (US) Transmission • Persists for weeks on surfaces • Colonizes skin, other sites • Typical cleaning solutions not effective • Can spread readily in healthcare settings Virginia case – 2018 • Delays in diagnosis and reporting

  9. Public Health Approach System to ensure adherence to infection control measures

  10. Benefit of Public Health Approach No Containment Strategy Containment Strategy % E.coli and K. pneumoniaewith extended spectrum beta-lactamases % E. coli and K. pneumoniaeresistant to carbapenems 15% 2%

  11. VDH Actions • Added Candida auris and CPOs to list of reportable conditions • Implementing CDC guidance - Public Health Response to Contain Novel or Targeted Multidrug-resistant Organisms • Specimens tested at DCLS Regional ARLN • Proactive onsite infection control assessments at healthcare facilities • Guidance – website, newletters, Clinician letter • U.S. Antimicrobial Resistance Challenge