The Growing Threat of Antibiotic Resistance: Strategies and Surveillance in Virginia
Antibiotic resistance poses a significant threat globally, with millions affected and thousands dying each year. In Virginia, efforts are focused on national goals and strategies to combat this challenge, including surveillance, emerging pathogen tracking, and addressing specific issues like carbapenemase-producing organisms and Candida auris infections.
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The Growing Threat of Antibiotic Resistance Lilian Peake, MD, MPH State Epidemiologist Office of Epidemiology Virginia Department of Health September 2019
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
National Goals 1. Slow the emergence of resistant bacteria 2. Strengthen One-Health surveillance 3. Advance development of laboratory testing 4. Accelerate development of new drugs and vaccines 5. Improve international collaboration and capacity
National Strategies 1. Improve antibiotic stewardship in healthcare settings 2. Eliminate use of medically-important antibiotics for growth promotion in food animals 3. Improve lab testing, research and surveillance Create regional public health laboratory network Establish a specimen repository and sequence database
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
Emerging Pathogens Incidence in 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
Carbapenemase-Producing Organisms Carbapenem Last-line antibiotic class - usually reserved for severe or multi-drug resistant infections Carbapenemase Enzyme that some bacteria produce o 5 carbapenemase genes have been discovered in bacteria Enzyme inactivates carbapenem antibiotics
Candida auris Type of fungus (yeast) Discovered in 2009 Causes serious infections Transmission Persists for weeks on surfaces Colonizes skin, other sites Typical cleaning solutions not effective Can spread readily in healthcare settings Lack of knowledge among providers Limited treatment options >90% are resistant to first- line drug 2 pan-resistant cases (US) Virginia case 2018 Delays in diagnosis and reporting
Public Health Approach System to ensure adherence to infection control measures Environmental cultures Laboratory surveillance Contact investigation Healthcare investigation Initial response measures
Benefit of Public Health Approach No Containment Strategy Containment Strategy % E.coli and K. pneumoniae with extended spectrum beta-lactamases % E. coli and K. pneumoniae resistant to carbapenems 15% 2%
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
