prepared to detect and respond to resistant infections. APHL supports public health laboratories in combatting antimicrobial resistance by assessing capability and capacity, conducting training and liaising with clinical laboratory partners. APHL also participates in multi-organizational efforts to release guidance, develop educational materials for laboratories and sponsors forums for public health and clinical laboratories to foster a seamless exchange of specimens and information.
Breakpoint Implementation Toolkits
The APHL-ASM Antimicrobial Resistance (AR) Laboratory Workgroup is a collaboration between public health and clinical laboratories whose goal is to identify and develop initiatives to improve the detection and reporting of AR while fostering the relationship between clinical and public health laboratories. This group developed a
toolkit that laboratories can utilize to guide them through the verification study needed to implement the updated clinical breakpoints for performing antimicrobial susceptibility testing (AST) for carbapenem-resistant organisms (CROs). Specifically, the first iteration focuses on carbapenem breakpoints for
Enterobacterales.
The workgroup also collaborated with members of the Clinical Laboratory Standards Institute (CLSI), American Society for Microbiology (ASM), College of American Pathologists (CAP) and CDC to jointly develop the 2023 Breakpoint Implementation Toolkit. The kit is provided in a streamlined format and designed to guide performance of a verification or validation study required to update breakpoints. Also included are links to other resources that explain the rationale behind breakpoint updates, regulatory requirements for updating breakpoints and detailed instructions for performing an AST breakpoint validation or verification.
Public Health Labs and the AR Laboratory Network
Established in 2016 the CDC's Antimicrobial (AR) Laboratory Network, is comprised of 56 public health laboratories (50 states, five large cities, and Puerto Rico) and seven of the public health laboratories were designated as regional laboratories to provide nationwide coverage for complex antimicrobial resistance testing. Using conventional and advanced methods to detect and characterize antimicrobial resistant organisms, the AR Lab Network detects changes in resistance and helps identify outbreaks of antimicrobial diseases. The AR Lab Network also includes the National Tuberculosis Molecular Surveillance Center located at the Michigan Department of Health and Human Services which performs genotyping for all TB cases in the US.
APHL supports the AR Lab Network with communications, fellowships and liaising with public health and laboratory partners. APHL also supports electronic test ordering and resulting from regional labs back to submitters and to CDC and provides technical assistance in implementing electronic laboratory reporting protocols.
AR Lab Network Regional Laboratories
Northeast Region: Wadsworth Center (NY)
Mid-Atlantic Region: Maryland Public Health Laboratory
Southeast Region: Tennessee State Public Health Laboratory
Midwest Region: Wisconsin State Laboratory of Hygiene
Central Region: Minnesota Department of Health Public Health Laboratory
Mountain Region: Utah Public Health Laboratory
West Region: Washington Public Health Laboratory
Workgroups
The Council for Outbreak Response: Healthcare-Associated Infections and Antimicrobial-Resistant Pathogens (CORHA)
The Antimicrobial Resistance Surveillance Task Force (ARSTF)
AR Resources
Quarterly Newsletters
Educational Resources
APHL Communications