Global AR Lab & Response Network Collaborations

In 2022, more than 24 partners have implemented collaborations in more than 42 countries to launch the Global AR Lab & Response Network, tackling threats like:

• Antimicrobial Resistance in Health Care
• Drug-resistant Gonorrhea
• Drug-resistant Fungi
• Resistant Enteric (intestinal) Pathogens (germs)
• Resistant Respiratory Pathogens

Antimicrobial Resistance in Health Care

The Antibiotic Resistance in Communities and Hospitals (ARCH) projects aim 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-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 four 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 three districts across the country: Gaborone, Mochudi, and Molepole. 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 urban (Nairobi) and rural (Siaya) sites. 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.

Drug-resistant Gonorrhea

World Health Organization (WHO)
Strengthening global and national surveillance systems of Neisseria gonorrhoeae through the Enhanced Gonococcal Antimicrobial Surveillance Programme (eGASP) in Thailand, Philippines, Cambodia, and South Africa
WHO will expand 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.

Drug-resistant Fungi

FIOTEC
Strengthening a national surveillance system for antimicrobial-resistant Candida in Brazil
FIOTEC aims to expand the Brazilian Antimicrobial Resistance Surveillance System (BR-GLASS) to improve monitoring of antimicrobial-resistant Candida species in Brazil. This work will expand and enhance infection prevention and control strategies, improving patient outcomes and protecting 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 in Colombia
Experts are building national fungal reference laboratory capacity and improving public health laboratory capacity to identify antifungal-resistant germs in Colombia. Experts are also building bioinformatics and whole genome sequencing capacity as part of FungiNet Global.

Northwestern University
Surveillance of antimicrobial-resistant Candida auris in a Pakistan healthcare system
Northwestern University will build 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.

Pakistan National Institute of Health
Monitoring and preventing antimicrobial-resistant Candida auris in Pakistan
The Pakistan National Institute of Health will improve 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)
The University of Nairobi will improve 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

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.

Resistant Enteric (intestinal) Pathogens (germs)

American University of Beirut
Establishment of MENA regional whole genome sequencing laboratory for reference and research on enteric (gut) pathogens in PulseNet Middle East
There is limited information in the Middle East and North Africa region on the occurrence and severity of typhoid cases, outbreaks, and associated antimicrobial susceptibility patterns. In the U.S., there are an estimated 4,100 drug-resistant cases each year. Most people in the U.S. become infected while traveling to countries where typhoid is common. Researchers will collect samples for 10 months from nine countries (Iraq, Jordan, Palestine, Libya, Morocco, Egypt, Sudan, Pakistan, and Lebanon) to sequence and analyze. After collection, researchers will host training sessions for participating countries to establish surveillance platforms and demonstrate the quality and quantity of data generated from a surveillance program. The data will also be uploaded to the National Center for Biotechnology Information website and available to the public. The information collected will help the scientific community understand the spread of the various typhoid sequence types in these countries.

Association of Public Health Laboratories (APHL)
Improving detection of enteric (gut) pathogens including those that are resistant to antimicrobials in PulseNet International by expanding data collection in Southeast Asia
There is limited information in the Asia Pacific region on the occurrence and severity of enteric disease outbreaks and associated antimicrobial susceptibility patterns. APHL will work 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. The information collected will help the scientific community understand the spread of enteric bacterial disease and antimicrobial resistance in these countries.

Family Health International (FHI360)
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, Family Health International will 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 will also convene a meeting of key stakeholders to identify priorities and key barriers and opportunities related to evidence-based decision-making on typhoid. Work will include developing and implementing training materials for typhoid surveillance and outbreak response to capacitate the Pakistan Field Epidemiology Training Program in this content area. 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.

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

WEF, along with their implementing partners, are 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 (WWES) CoPs in low- and middle-income countries (LMICs). LMICs, where non-sewered sanitation is often common, face unique challenges for implementing WWES 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 WWES 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 WWES 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. WWES 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.

Resistant 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
ASM will work with partners to strengthen laboratory system data reporting and improve antimicrobial resistance detection and response for Bordetella pertussis. A vaccine-preventable disease, Bordetella pertussis,  was recently added to CDC’s antimicrobial-resistant Watch List as a potential growing threat. ASM plans to work with partners in Mexico and Brazil to identify emerging resistance in this pathogen and help respond when and where outbreaks occur.

Global Scientific Solutions for Health
Improving detection and response to antimicrobial-resistant Meningococcal disease in Burkina Faso and Togo
Global Scientific Solutions for Health (GGS) will reinforce surveillance systems for antimicrobial-resistant Neisseria meningitidis in Burkina Faso and Togo and create tailored work plans for each. 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
Koperasi Jasa Institut Riset Eijkman will build on existing work with CDC and 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 research will also create guidelines and opportunities for other regional facilities to replicate the laboratories’ success.

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