Session : MDRO Epidemiology and Transmission

155 - Public Health Action-based System for Tracking and Responding to U.S. candida Drug Resistance: AR Lab Network, 2016-2019

Oral Abstract

Location: On Demand

Background: Many U.S. clinical laboratories lack capacity to definitively identify fungi or perform antifungal susceptibility testing (AFST). To expand testing access, CDC’s Antibiotic Resistance Laboratory Network (AR Lab Network) provides Candida species identification and AFST to U.S. facilities for clinical and public health purposes. We describe the first three years of Candida AR Lab Network resistance data.

Methods: Isolates from any body site with species identification and AFST performed July 2016–June 2019 are included. Submissions were based on clinical and public health need. Patients may have multiple isolates. The 7 AR Lab Network regional laboratories used matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) or DNA sequencing for species identification. AFST was performed using broth microdilution for azoles and echinocandins (anidulafungin and micafungin) and Etest for amphotericin B. This analysis focuses on non-albicans Candida species with Clinical and Laboratory Standards Institute M60 minimum inhibitory concentration breakpoints and C. auris, which has CDC-proposed tentative breakpoints.

Results: Participation increased from healthcare facilities from 2 states submitting in 2016 to 35 states in 2019. Species identification was performed on 5,234 non-albicans isolates. AFST was performed on 4,222 (81%) isolates, including 2,395 C. glabrata, 815 C. auris, 267 C. parapsilosis, 125 C. tropicalis, 35 C. guilliermondii, and 32 C. krusei. Of isolates with AFST and body site indicated, 22% (900/4,102) were from blood. We found 85% of C. auris, 8% of C. glabrata, and 5% of C. parapsilosis isolates were resistant to azoles; 33% of C. auris isolates were resistant to amphotericin B; and 2% of C. glabrata, 1% of C. auris, and 1% of C. parapsilosis isolates were resistant to echinocandins. Although intrinsically resistant to fluconazole, C. krusei isolates were not resistant to voriconazole. Multidrug resistance was present in 32% of C. auris and 1% of C. glabrata isolates.

Conclusion: AR Lab Network has expanded access to rapid Candida testing, including AFST, and provides real-time surveillance. Results can be used to detect emerging species and resistance and guide public health action and healthcare practices.

Presenting Author(s)

KF

Kaitlin Forsberg, MPH

Epidemiologist
Centers for Disease Control and Prevention
Atlanta, GA

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Slides Slides and Audio

Co-Author(s)

ML

Meghan Lyman, MD

Medical Epidemiologist
CDC
Atlanta, Georgia

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SC

Sudha Chaturvedi, PhD

Director, Mycology Laboratory
New York State Department of Health Wadsworth Center
Albany, New York

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
ES

Emily C. Schneider, MPH

Regional Epidemiologist
Washington State Department of Health
Shoreline, Washington

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JF

Jill Fischer, MT/ASCP

Bacteriology Laboratory Specialist
Minnesota Department of Health
St. Paul, Minnesota

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DB

Dorothy F. Baynham, BS

Public Health Manager
State of Tennessee
Nashville, Tennessee

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DD

Denise F. Dunbar, M (ASCP)

Manager
Texas Department of State Health Services
Austin, Texas

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MP

Michele Plehn, B.S., M(ASCP)

Laboratory Scientist
Maryland Department of Health
Baltimore, Maryland

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DP

Diane Podzorski, B.S.

Microbiologist
Wisconsin State Laboratory of Hygiene
Madison, Wisconsin

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SG

Stephanie Gumbis, M.S.

Health Scientist
CDC
Atlanta, Georgia

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DS

Dawn Sievert, PhD, MS

Senior Science Advisor for AR Coordination and Strategy
Centers for Disease Control and Prevention
Atlanta, Georgia

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BJ

Brendan R. Jackson, MD, MPH

Medical Epidemiologist
Centers for Disease Control and Prevention
Atlanta, Georgia

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SL

Shawn R. Lockhart, PhD, D(ABMM)

Senior Clinical Laboratory Advisor
Centers for Disease Control and Prevention
Atlanta, Georgia

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EB

Elizabeth L. Berkow, Ph.D.

Laboratory Team Lead
Centers for Disease Control and Prevention
Atlanta, Georgia

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.