About Global Action in Healthcare Network - Antimicrobial Resistance

Why it matters

AR happens when pathogens like bacteria and fungi develop the ability to defeat the drugs designed to kill them. Resistant infections can be difficult, and sometimes impossible, to treat.

Antimicrobial-resistant organisms can rapidly spread locally and globally. Addressing this threat requires continued aggressive action to prevent infections and improved antibiotic and antifungal use to slow the development of resistance.

Core principles

GAIHN-AR healthcare facilities collaborate with laboratory and IPC experts from the local to the global level to prevent AR transmission by improving laboratory detection, communication and IPC action within healthcare settings.

Prevent

The GAIHN-AR Prevention Strategy aims to prevent the spread of AR threats by strengthening IPC practices including:

• Hand hygiene.
• The use of Contact Precautions.
• Environmental cleaning and disinfection.

Detect

GAIHN-AR uses lessons learned from CDC's U.S. Antimicrobial Resistance Laboratory Network and other international networks to support effective detection of AR threats. Clinical and reference laboratories work together to detect and characterize AR threats from clinical isolates obtained as part of routine patient care and colonization screening specimens.

Colonization screening supports early detection and IPC action for patients who are colonized with antimicrobial-resistant organisms. By detecting colonized patients, healthcare providers can monitor the impact of actions to prevent and reduce the spread of AR threats.

Respond

The GAIHN-AR Response Strategy includes rapid IPC action after detecting patients infected or colonized with antimicrobial-resistant threats.

At a minimum, facilities respond by placing these patients on Contact Precautions. If even a single patient carries an emerging or novel antimicrobial-resistant threat, facilities may respond with a containment response. This response uses an aggressive and systematic approach adapted from CDC's U.S.-based Containment Strategy.

Communicate

GAIHN-AR healthcare facilities maintain communication between key partners during prevention, detection and response activities including:

• Communicating feedback to healthcare providers to support IPC quality improvement efforts.
• Immediate communication of results to all relevant parties when laboratorians detect an antimicrobial-resistant threat.
• Communication between laboratories, IPC teams and relevant public health authorities to coordinate containment response activities.

Priorities

Goals

• Implement sustainable programs that limit the spread of AR threats in health care through prevention, detection, communication and response.
• Build global relationships to share experiences, findings, resources and assistance.
• Establish consistent laboratory and IPC strategies across the GAIHN-AR network to standardize data collection.

Focus

The initial focus of GAIHN-AR is carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE). Carbapenemases can rapidly spread in healthcare settings.

Strengthening core IPC practices, detecting carbapenemases accurately and quickly and responding rapidly after detection are crucial to prevent CP-CRE spread.

What we've accomplished

• Found an association between intestinal colonization and an increased risk of bloodstream infections with the same type of bacteria in two hospitals in Greece.1
• Found that infection or colonization with multiple antimicrobial-resistant organisms increased during the COVID-19 pandemic in two hospitals in Greece.2
• Presented on GAIHN-AR tools for monitoring and providing feedback to improve adherence to IPC best practices as part of a WHO Global IPC Strategy Webinar Series deep dive on data for action and advocacy.
• Validated the ability of the Cepheid GeneXpert Carba-R system to detect Klebsiella pneumoniae carbapenemase (KPC) mutants with resistance to ceftazidime/avibactam in Klebsiella spp. circulating in Argentina.3
• Determined that the Cepheid GeneXpert Carba-R system can detect imipenemase metallo-beta-lactamase (IMP)-1 carbapenemase variants circulating in Argentina well but has challenges detecting IMP-8, -13, -16 and -18.4

Success story

Innovation in Argentina to enhance carbapenemase detection

As part of GAIHN-AR, CDC works with the Pan American Health Organization (PAHO), Argentina's National Institute of Infectious Diseases (ANLIS Malbrán) and the Argentina Ministry of Health to prevent the spread of carbapenemase-producing bacteria in healthcare settings.

With partner support, GAIHN-AR hospitals in Argentina introduced new laboratory methods to improve the speed and sensitivity of carbapenemase detection. One of the new laboratory methods detects colonized patients within hours – as opposed to days with traditional methods - so that healthcare providers can take appropriate IPC actions rapidly. Unfortunately, approved swabs required for this method are not available in Argentina.

To overcome this challenge, the hospitals, with support from GAIHN-AR, completed a study showing that a locally available swab performed as well as the approved swabs. This validation study made this laboratory method a feasible option for hospitals in the country.

Funded partners

GAIHN-AR partners support select hospitals in the following countries:

• Johns Hopkins University – India.
• The Ohio State University – Ethiopia.
• Pan American Health Organization – Argentina, Belize, Chile, Costa Rica, Ecuador, Uruguay.
• Vanderbilt University – Greece.

Resources

GAIHN-AR Resources

Combatting AR Globally

Carbapenem-resistant organism (CRO) prevention and control

CDC & FDA Isolate Bank