Global Antimicrobial Resistance Laboratory and Response Network

Purpose

CDC's Global AR Lab & Response Network supports partners in detecting and responding to antimicrobial resistance across the One Health spectrum.

Every country has varying levels of resources and might face different AR threats. For example, some countries have limited capacity to diagnose and track antimicrobial-resistant germs in healthcare facilities, which adds to the difficulty of implementing effective treatment and prevention programs.

Network impact

The Global AR Lab & Response Network improves the detection of existing and emerging AR threats and identifies risk factors that drive the emergence and spread of resistance across healthcare, community, and environmental settings. These settings are impacted by many types of pathogens, including healthcare-associated, sexually transmitted, fungal, enteric, and invasive bacterial and respiratory. This global network also supports response to AR threats and informs global prevention strategies. This work:

• Improves patient outcomes and public health.
• Reduces illness and death.
• Lowers healthcare costs.

Since its launch, more than 20 organizations have implemented collaboration in nearly 50 countries as part of the Global AR Lab & Response Network, tackling threats including:

• Bordetella pertussis
• Candida auris (C. auris)
• Carbapenem-resistant Enterobacterales
• Carbapenem-resistant Acinetobacter baumannii
• Neisseria gonorrhoeae (gonorrhea)
• Neisseria meningitidis
• Salmonella Typhi and non-Typhi, and other resistant diarrheal pathogens
• Streptococcus pneumoniae

Success Stories

How it's funded

CDC's antimicrobial resistance investments, collectively known as the Antimicrobial Resistance Solutions Initiative (AR Solutions Initiative), support the AR Lab Network. The AR Solutions Initiative combats antimicrobial resistance by investing in national infrastructure to detect, respond, contain and prevent resistant infections across healthcare settings, communities, the food supply and the environment (water, soil).

Funded partners and programs

Addressing AR in health care

The Antibiotic Resistance in Communities and Hospitals (ARCH) research consortium aims to better understand the burden, molecular epidemiology, and drivers of resistant bacteria in humans in multiple low- and middle-income countries by tracking colonization (carrying and potentially spreading harmful pathogens without infection) in communities and healthcare settings. Researchers are using whole genome sequencing to explore isolate relatedness, transmission (spread) dynamics, and patterns of resistance across the community and hospital environments. The data from the studies will improve our understanding of the source of new resistance threats, how prevalent or widespread the threat is, and how we can tailor prevention strategies to mitigate the impact. Additional collaborative work is happening through CDC's Global Action in Healthcare Network to address emerging threats in healthcare settings through rapid detection and response.

icddr,b

Bangladesh

icddr,b is the principal investigator for the project in Bangladesh working to carry out study activities in Dhaka. This work is also supported by the CDC-Bangladesh Country Office.

Universidad del Desarrollo (UDD)

Chile

UDD is the principal investigator for the project in Chile, carrying out study activities in multiple sites across the country. This work is also supported by the CDC-South America Regional Office.

University of Pennsylvania

Botswana

The University of Pennsylvania is the principal investigator for the ARCH project in Botswana. They work with the University of Botswana to carry out project activities in Gaborone and Francistown. This work is also supported by the CDC-Botswana Country Office.

Washington State University (WSU)

Kenya and Guatemala

WSU is the principal investigator for projects in Kenya and Guatemala. In Kenya, the team works with the University of Nairobi to carry out ARCH activities in informal settlements in Nairobi. This work is also supported by the CDC-Kenya Country Office. In Guatemala, the WSU team works with Universidad del Valle de Guatemala to carry out activities in Quetzaltenango, a city in the western highlands. This work is also supported by the CDC-Central America Regional Office.

Improving tracking for drug-resistant gonorrhea

World Health Organization (WHO)

Strengthening global and national surveillance systems of Neisseria gonorrhoeae through the Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP)

Experts are expanding the Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP), a CDC and WHO initiative monitoring trends in antimicrobial susceptibility of Neisseria gonorrhoeae. Gonorrhea is a sexually transmitted disease that can spread easily and has progressively developed resistance to the antibiotics used to treat it. Data from EGASP sites will strengthen understanding of how drug-resistant gonorrhea spreads in geographically diverse areas and inform national and international clinical treatment guidelines.

Enabling efforts to combat drug-resistant fungi

FIOTEC

Strengthening a national surveillance system for antimicrobial-resistant Candida in Brazil

Experts are expanding the Brazilian Antimicrobial Resistance Surveillance System (BR-GLASS) to improve monitoring of antimicrobial-resistant Candida speciesin Brazil. This work enhances infection prevention and control strategies, improves patient outcomes and protects the healthcare workforce.

icddr,b

Building capacity for sentinel fungal disease surveillance at hospitals in Bangladesh

Experts are building capacity for sentinel fungal disease surveillance at hospitals in Bangladesh through improved laboratory and clinical capacity to identify and treat priority fungal diseases, including antifungal-resistant germs. Experts are also assessing infection prevention and control (IPC) baseline capacity and providing trainings tailored to existing resources and capacity, as well as trainings on best practices for IPC measures pertaining to Candida auris.

Instituto Nacional de Salud

Building and improving laboratory capacity to identify Candida species in Colombia

Experts are strengthening national fungal reference laboratory capacity to identify invasive fungal bloodstream infections caused by Candida species in Colombia. This will enhance surveillance for emerging drug-resistant Candida species.

Northwestern University

Surveillance of antimicrobial-resistant Candida auris in a Pakistan healthcare system

Experts are building local capacity to detect, track, and report antimicrobial-resistant Candida auris and other antimicrobial-resistant Candida species at Aga Khan University Hospital in Pakistan with an emphasis on a description of molecular mechanisms of antimicrobial resistance. This work will inform the response when threats are detected and put into place the mechanisms for molecular detection of outbreaks.

National Center for Disease Control and Public Health of Georgia (Georgia NCDC)

Strengthening laboratory capacity to detect Candida species in Georgia

Experts are helping Georgia's Richard M. Lugar Center for Public Health Research expand national and regional capacity to test and detect resistance to antifungals at sentinel laboratories and hospitals. This project focuses on the detection of Candida infections. Georgia NCDC will assess its current ability to test for antifungal resistance. Then they will create a national plan to track candidemia, which is a bloodstream infection with Candida. The national plan will integrate candidemia surveillance into existing antimicrobial resistance surveillance systems. Georgia NCDC will also increase laboratory capacity to identify Candida and perform antimicrobial susceptibility testing. To better protect patients in healthcare settings, experts will create materials to support infection prevention and control practices of Candida auris. These activities will guide national efforts against antimicrobial resistance and reporting through the Global Antimicrobial Resistance and Use Surveillance System (GLASS), an initiative led by the World Health Organization.

National Institute of Health, Pakistan

Monitoring and preventing antimicrobial-resistant Candida auris in Pakistan

Experts are improving the capacity to detect, monitor, and control emerging antimicrobial-resistant Candida auris in Pakistan healthcare settings. This work will enhance infection prevention and control strategies, improving patient outcomes, and protecting the healthcare workforce.

University of Nairobi

Monitoring and preventing antimicrobial-resistant Candida auris in Kenya (MAP-AMR Kenya)

Experts are improving the capacity to detect, monitor, and control emerging antimicrobial-resistant Candida auris in Kenya's healthcare settings. This work will enhance infection prevention and control strategies, improving patient outcomes and protecting the healthcare workforce.

Wits Health Consortium

Building regional surveillance capacity for antifungal-resistant germs in Southern Africa

Experts are building regional surveillance capacity for antifungal-resistant germs, with priority on Candida species and Cryptococcus species. Experts are also building capacity for fungal bioinformatics and whole genome sequencing in South Africa, with plans to incorporate data from South Africa and regional country partner labs into FungiNet Global.

Strengthening tracking for resistant enteric (intestinal) pathogens

Association of Public Health Laboratories (APHL)

Improving detection of enteric (gut) pathogens including those that are resistant to antimicrobials across PulseNet Asia Pacific

There is limited information in the Asia Pacific region on the occurrence and severity of enteric disease outbreaks and associated antimicrobial susceptibility patterns. APHL works with PulseNet International across Australia, Bangladesh, China, Hong Kong, India, Japan, Korea, Malaysia, New Zealand, Philippines, Taiwan, Thailand, Vietnam to increase enteric disease data and facilitate data sharing between countries. Experts are also working on expanding whole genome sequencing (WGS). WGS is a laboratory test used to identify an organism's unique DNA. This will help scientists and public health professionals in these countries better understand the spread of enteric bacterial disease and antimicrobial resistance to stop the spread of disease and better protect communities.

US Civilian Research and Development Fund (CRDF Global) [PulseNet International]

Improving detection of enteric (gut) pathogens including those that are resistant to antimicrobials across PulseNet Middle East

There is little information available on the occurrence and severity of enteric disease outbreaks in the Middle East and North Africa (MENA) region. Specifically, more information is needed about extensively drug-resistant (XDR) Salmonella Typhi and resistant Vibrio cholera. CRDF Global is working with PulseNet International to increase data collection and sharing between countries in the region. Experts are also working on expanding whole genome sequencing (WGS). WGS is a laboratory test used to identify an organism's unique DNA. This will help scientists and public health professionals in these countries better understand the spread of enteric bacterial disease and antimicrobial resistance to stop the spread of disease and better protect communities.

Association of Public Health Laboratories (APHL), Family Health International (FHI360), and Washington State University (WSU)

Improving water, sanitation, and hygiene and environmental monitoring in Kenya to address drug-resistant enteric pathogen transmission

Water, sanitation and hygiene (WASH) systems are critical to human health, survival, and development, yet poorly functioning systems may be spreading antimicrobial-resistant enteric pathogens and their genes. In countries challenged in providing adequate sanitation for their entire populations, the role of the environment may be significant in contributing to exposure to antimicrobial-resistant enteric pathogens. In Kenya, APHL, FHI360, and WSU work with local laboratories to improve environmental monitoring of antimicrobial-resistant enteric pathogens—for example in water and wastewater systems—and work to assess risk factors for exposure to those pathogens to understand and improve prevention measures.

Health Security Partners

Improving prevention and response efforts for drug-resistant typhoid in Pakistan

Experts are improving ongoing prevention and response efforts for drug-resistant typhoid in Pakistan by assessing risk factors such as current typhoid case management practices by healthcare providers (i.e., prescribing practices), typhoid conjugate vaccine (TCV) hesitancy and access, as well as water, sanitation, and hygiene practices. Experts are also developing and implementing training materials for typhoid surveillance and outbreak response for the Pakistan Field Epidemiology Training Program. Extensively drug-resistant (XDR) typhoid emergence in Pakistan has limited treatment options and vaccination strategies using TCV can help prevent the further spread of antimicrobial resistant strains and reduce the risk of development of a strain resistant to all available oral antibiotics, which could result in high typhoid-associated mortality in low- and middle-income countries. Continuing to monitor typhoid cases to inform targeted efforts, including TCV vaccination, can help to prevent the spread of XDR typhoid within Pakistan and globally.

Washington State University

Carbapenem-resistant Enterobacterales (CRE) and Extended Spectrum Cephalosporin-resistant Enterobacterales (ESCrE) bacteria (germs) can resist many antibiotics. This makes it difficult to treat the infections they cause, leading to negative health outcomes. Spending time in healthcare settings or taking antibiotics both increase the risk of CRE and ESCrE. Washington State University is working with Universidad del Valle de Guatemala and CDC to learn how bacteria spread, especially within the community. The project focuses on One Health, which recognizes the connection between the health of people, animals, and the environment. Experts will look at individuals who carry these bacteria on or in their bodies but show no symptoms. As part of the project, they will interview people about their interactions with animals, farming, and water treatment practices. They'll also test livestock, pets, milk, and drinking water for CRE and ESCrE. The results of this project will help understand if the risk of CRE and ESCrE colonization is related to interactions with animals or sanitation and hygiene practices contribute to the spread of these bacteria. This information will help experts to recommend effective One Health prevention strategies.

Water Environment Federation

Developing a framework for wastewater and environmental surveillance in low- and middle-income countries

Water Environment Foundation, along with their implementing partners, is leveraging existing work and knowledge, including experience gained from hosting U.S. National Wastewater Surveillance System (NWSS) Communities of Practice (CoPs), to develop a strategic framework for the design and implementation of wastewater and environmental surveillance (WES) CoPs in low- and middle-income countries (LMICs). LMICs, where non-sewered sanitation is often common, face unique challenges for implementing WES and CoPs may be a useful tool to facilitate peer-to-peer learning and resource sharing. This work includes collaborating to develop a guidance document for global WES CoPs that will encompass who to involve; appropriate missions, visions, and goals; suggested platforms for data and resource sharing; pros and cons of various CoP structures (e.g., by country, region, subject matter, language, state of program development), and critical gaps in research. This document will provide strategies and best practices from which funders, Ministries of Health, and non-government organizations can draw upon to establish and expand WES in their countries. Partners will conduct a small-scale CoP utilizing the strategic framework and feedback will be gathered to improve or expand upon this work. WES will allow countries to monitor for emerging public health threats such as antimicrobial resistance and other disease targets in communities and to respond to such threats.

Enhancing response to outbreaks of resistant invasive bacterial and respiratory pathogens

American Society for Microbiology (ASM)

Enhancing global laboratory capacity in Mexico and Brazil to detect, assess, and respond to emerging antimicrobial resistance in Bordetella pertussis

Experts are strengthening laboratory system data reporting and improving antimicrobial resistance detection and response for Bordetella pertussis in Mexico and Brazil. These activities will help identify emerging resistance for this pathogen and help respond when and where outbreaks occur. A vaccine-preventable disease, Bordetella pertussis was recently added to CDC's antimicrobial-resistant Watch List as a potential growing threat.

Global Scientific Solutions for Health

Improving detection and response to antimicrobial-resistant Meningococcal disease in Burkina Faso and Togo

Experts are reinforcing surveillance systems for antimicrobial-resistant Neisseria meningitidis in Burkina Faso and Togo. The data and findings from this project will guide public health decision making and planning for how to track and respond to the threat of meningitis outbreaks in partner countries and the broader region.

Koperasi Jasa Institut Riset Eijkman

Improving capacity to detect and monitor emerging antimicrobial resistance in bacterial respiratory pathogens, with a focus on Streptococcus pneumoniae, in Indonesia

Experts are building on existing work with CDC to enhance capacity of clinical laboratories at select secondary or tertiary hospitals in Indonesia for identification and characterization of antimicrobial-resistant respiratory germs, with a focus on Streptococcus pneumoniae. This project will also create guidelines and opportunities for other regional facilities to replicate the laboratories' successes.

Contacts

Email GARLRN@cdc.gov for more information about the Global Antimicrobial Resistance Laboratory and Response Network.

Resources

Watch the AMR Exchange webinar

In April 2023, CDC hosted their AMR Exchange webinar, highlighting some initiatives from some of our dedicated partners of the Global Antimicrobial Resistance Laboratory and Response Network. These partners form a collaborative network, helping CDC transform how the world addresses antimicrobial resistance threats across One Health. The panel included experts from the Federal University of São Paulo, Association of Public Health Laboratories, The Ohio State University and Centers for Disease Control and Prevention.