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The AMR Challenge

The U.S. government’s Antimicrobial Resistance (AMR) Challenge is a yearlong effort to accelerate the fight against antimicrobial resistance across the globe.

The AMR Challenge is a way for governments, private industries, and non-governmental organizations worldwide to make formal commitments that further the progress against antimicrobial resistance. The Challenge encourages a One Health approach, recognizing that the health of people is connected to the health of animals and the environment.

Challenge Dates

The AMR Challenge launches at the United Nations (UN) General Assembly in September 2018. Organizations can make commitments beginning September 25, 2018 until September 2019.

CDC will feature commitments throughout the year. At the 2019 UN General Assembly, antimicrobial resistance will continue to be a priority topic for world leaders.

Kick-off Event Livestream

The kick-off event was live streamed on Sept. 25. CDC will share the live stream video when available. Find more on social media with #GlobalAMRChallenge.

Join the Challenge: Commitment Areas

Show your organization’s commitment to combating antimicrobial resistance by submitting an actionable commitment for change.

To participate in the AMR Challenge, submit a commitment in at least one of five commitment areas:

Join the Challenge

Is your organization interested in joining the global effort to fight antimicrobial resistance?

Make a commitment.

CDC will feature your commitment on this website, social media, and more.

Email to learn more.

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Tracking and data: Share data and improve data collection

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Infection prevention and control: Reduce the spread of resistant germs

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Antibiotic use: Improve appropriate antibiotic use, including ensuring access to these drugs

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Environment and sanitation: Decrease antibiotics and resistance in the environment, including improving sanitation

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Vaccines, therapeutics, and diagnostics: Invest in development and improved access

Commitment Examples

Examples of commitments include:

  • Tracking and data: Share data that can drive actions that protect people and animals
  • Infection prevention and control: Engage professional networks to take action, such as signing letters of commitment to improve infection control
  • Antibiotic use: Implement best practices across an organization, such as creating programs that work to improve antibiotic use
  • Vaccines, therapeutics, and diagnostics: Invest in innovative projects that accelerate the fight against antimicrobial resistance

Commitments Made to the AMR Challenge

The following commitments were updated on Dec. 3. Visit the site to see new commitments as they are added each month.

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AdvaMedDx is committed to improving patient care and public health through increased access to appropriately used diagnostic tests for early detection of resistant infections, informed prescribing of antibiotics, and surveillance in the fight against antimicrobial resistance (AMR). Representing the world’s largest diagnostics manufacturers, AdvaMedDx will advocate for policies that incentivize and support robust stewardship programs that are informed by diagnostic data; engage with provider and professional organizations to disseminate educational materials that encourage the appropriate use of diagnostics in antibiotic stewardship programs; and continue to engage with policy makers in the U.S. and globally to raise awareness of AMR and to educate them on the benefits of policy changes that incentivize robust antibiotic stewardship programs.

As one of the largest health insurers in the U.S.—with 1.2 million health professionals, more than 5,700 hospitals, and 22.2 million members—Aetna is committed to the dual goals of reducing inappropriate antibiotic prescribing and promoting the appropriate use of vaccinations among its members. We do that by partnering with state health departments to offer feedback to providers about their antibiotic prescribing performance, integrating stewardship metrics in our value-based contracts, and promoting vaccinations.

American Academy of Orthopaedic Surgeons
The American Academy of Orthopaedic Surgeons (AAOS) will increase awareness among its 38,000 members in more than 100 countries of evidence-based strategies to prevent and treat surgical site infections and periprosthetic joint infections. AAOS will also increase awareness of when antibiotics should and should not be used for patients with hip and knee implants who are undergoing dental procedures.

American Association of Avian Pathologists
The American Association of Avian Pathologists (AAAP) commits to maintaining poultry health and welfare by implementing strategies to prevent, control, and treat common diseases by using an evidence-based approach in antimicrobial decisions, then using antimicrobials judiciously and with continual evaluation of the outcomes of therapy while protecting poultry health and ensuring safe, affordable food to the consumer. Also as part of its mission is to promote scientific knowledge to enhance the health, well-being, and productivity of poultry to provide safe and abundant food for the world, AAAP is committed to collecting and tracking on-farm antimicrobial use data by AAAP veterinarians who are assisting with a project to quantify on-farm antimicrobial use within the U.S. poultry industry.

American Cancer Society
The American Cancer Society commits to increasing patient awareness of the importance of infection prevention and control, as well as antibiotic resistance, through website and blog communications materials.

American College of Physicians
With 154,000 members of internal medicine physicians, medical students, residents, and fellows, the American College of Physicians (ACP) will continue incorporating evidence about antibiotic stewardship into clinical policies relevant to antibiotic treatment and prophylaxis, and publish an opinion piece in a peer-reviewed journal to spread awareness of the urgency of the issue.

American Hospital Association
The American Hospital Association (AHA) will work with its members to prevent infections and reduce the spread of germs, and improve the use of antibiotics wherever they are used. Specifically, AHA will support hospital members to improve antibiotic use, solicit commitments to implement targeted assessments for infection prevention (TAP), support containment of emerging resistance with state and local health departments, and provide patient education on antimicrobial resistance. AHA represents nearly 5,000 member hospitals, health systems, and other health care organizations; clinical partners–including more than 270,000 affiliated physicians, 2 million nurses and other caregivers; and 43,000 health care leaders belonging to their professional membership groups.

American Public Health Association (APHA)
The American Public Health Association (APHA) commits to raising awareness through communications channels, The Nation’s Health, in-person events and social media among its 25,000 members of how antibiotic resistance places public health at risk, and what steps public health professionals can take to be part of the solution. APHA advocates for a One Health approach, focusing on human and animal health, and will continue to advocate for increased public health funding on antibiotic resistance.

American Society for Microbiology
With its 30,000 members in 161 countries, the American Society for Microbiology (ASM) is committed to working with global stakeholders to develop and execute a roadmap for surveillance and monitoring of antibiotic use and antibiotic resistance. ASM currently works across countries and sectors to establish, bring to scale, and sustainably maintain such systems by focusing on strengthened laboratory capacity and global health security programs in low resourced settings.

American Society of Health-System Pharmacists
The American Society of Health-System Pharmacists (ASHP) commits to education, practice standards, certification, and consultation related to antibiotic use for its over 45,000 members, including pharmacists, student pharmacists, and pharmacy technicians. ASHP also continues to offer a broad range of education, training, and certification resources at ASHP-hosted conferences and online. In addition, ASHP will create an antibiotic stewardship certificate on developing and optimizing stewardship programs that will be released in 2019. ASHP also offers a consulting service to assist hospitals and health systems with the development or enhancement of stewardship programs.

American Veterinary Medical Association
The American Veterinary Medical Association (AVMA) advocates for stronger veterinary oversight and responsible use of antibiotics to help protect the health of animals and people, animal welfare, and the food supply. With more than 91,000 members, AVMA’s efforts will support common understanding of the critical role of effective antibiotic stewardship in combating the development of antibiotic resistance through: ongoing collaboration with the Food and Drug Administration to achieve enhanced veterinary oversight of antibiotic use; education of the veterinary profession on antibiotic stewardship; assistance with enhanced surveillance of antibiotic use in animals; support for research; and more active engagement with international stakeholders.

AMR Industry Alliance
The AMR Industry Alliance brings together over 100 biotech, diagnostic, generic, and research-based pharmaceutical companies around the shared goal of curbing antimicrobial resistance (AMR) in the world. Alliance companies are committed to contribute to and measure their efforts in fighting AMR across four key areas: research, appropriate use, access, and manufacturing and the environment. Earlier in 2018, AMR Alliance generic and research-based pharmaceutical companies agreed on a framework that promotes responsible antibiotic manufacturing. These companies took a further step by publishing the first list of discharge targets to guide environmental risk assessments for the manufacture of antibiotics. This publication is an important step in the journey as companies work toward achieving these target values. The Alliance companies will continue to take action and share their experiences to reduce environmental impact from the production of antibiotics.

AMR Insights
AMR Insights commits to increasing the public professional awareness of the threat of antimicrobial resistance (AMR) by sharing knowledge and connecting people through their network of up to 50,000 subscribers of their bimonthly newsletter. AMR Insights commits to developing and implementing a globally accessible database with emerging technologies in AMR. They will also convene an annual meeting titled “Emerging Technologies in AMR” with participants from around the world.

Improving patient health by reducing inappropriate use of antibiotics is important to Anthem. By including antimicrobial resistance metrics in their value-based arrangements for both hospitals and physicians, Anthem commits to working with and financially rewarding providers for high and improved performance. This commitment includes working with care delivery transformation teams who interact directly with physicians to improve member education.

Antibiotic Resistance Action Center
The Antibiotic Resistance Action Center (ARAC) at the Milken Institute School of Public Health, George Washington University, commits to advancing knowledge of how antibiotic use in food animals impacts human health and to improving antibiotic prescribing in the urgent care sector. ARAC is studying the impact of new California legislation, which limits the use of antibiotics in livestock, by testing purchased meat and human biological samples from the region for antibiotic-resistant germs that can cause infections. ARAC is also launching an awareness campaign in 24 U.S. urgent care clinics during flu season to reduce inappropriate antibiotic use, assessing the impact of patient education materials through a cluster randomized study, and launching two summits to generate a strategy for urgent care antibiotic use standards.

Antimicrobial Stewardship Collaborative of South Carolina
The Antimicrobial Stewardship Collaborative of South Carolina (ASC-SC), the coordinator of antimicrobial stewardship and infection prevention efforts across the state, commits to collaborating with its partner facilities to advance local antimicrobial stewardship programs by implementing CDC’s Core Elements of Antimicrobial Stewardship. ASC-SC will encourage reporting of antimicrobial use and resistance with a goal of 50 percent increase in the number of acute care hospitals in South Carolina reporting either antimicrobial use or resistance to CDC’s National Health and Safety Network modules by 2020. ASC-SC also commits to improving antimicrobial use in the community by collecting and tracking ambulatory antimicrobial use utilization in South Carolina. ASC-SC will also partner with healthcare providers and professional organizations in ambulatory settings to disseminate educational materials that encourage appropriate use of antimicrobials for community-acquired infections with a goal of 10 percent overall reduction in ambulatory antimicrobial use by 2022.

As the nation’s largest nonprofit health system, Ascension is committed to working on improving antimicrobial use and the cleanliness of the healthcare environment to combat the threat of antimicrobial resistance (AMR) in its healthcare facilities. Ascension will: utilize CDC’s Targeted Assessment for Prevention (TAP) reports as a tool to improve infection prevention and antibiotic use; ensure cleaning and disinfection of the healthcare environment to decrease environmental exposure to antibiotics and resistance; reduce the risk of transmission of resistant germs by implementing appropriate isolation and hand hygiene procedures; utilize electronic health records to support the proper choice of antibiotics; and work with a coalition of health systems to increase the availability of poultry and meat raised without the routine use of antibiotics. Ascension set a goal for fiscal year 2019 is to reach a System Central Line-associated Bloodstream Infection Standardized Infection Ratio target of 0.7, or a reduction of 30 percent.

Asolva, Inc.
Having served as IT professionals in healthcare for nearly 20 years, Asolva, Inc. commits to work with public health agencies to enable antibiotic use reporting at any health care facility regardless of size, geography, infrastructure, and resources. Asolva aims to partner with state health departments to expand antibiotic use reporting to CDC’s National Healthcare Safety Network with the use of their reporting technology that will work with any hospital for a low cost.

Association for Professionals in Infection Control and Epidemiology
The Association for Professionals in Infection Control and Epidemiology (APIC) will work with its more than 15,000 members that save lives in hospitals and other healthcare settings to: increase clinician education and training through updated online and in-person educational programs, a joint position paper between APIC, SHEA, and SIDP, and a new chapter on antimicrobial stewardship in the APIC Text Online; conduct legislative and regulatory advocacy in support of funding for infection prevention and antimicrobial resistance programs; and develop consumer information and education on the proper use of antibiotics.

Association of Public Health Laboratories, Association of State and Territorial Health Officials, Council of State and Territorial Epidemiologists
The Association of Public Health Laboratories (APHL), the Association of State and Territorial Health Officials (ASTHO), and the Council of State and Territorial Epidemiologists (CSTE) commit to engaging with chief health officials, state laboratory directors, and state epidemiologists from all 50 states and the territories to identify state-level commitments in support of the AMR Challenge. Over the next year, we will work with states, territories, and local health departments to identify areas for progress related to antimicrobial resistance across laboratory capacity, infection prevention and control, and antibiotic use. Knowing that resistance does not respect geopolitical borders, these state commitments will collectively lead to a healthier and safer U.S.

Aster DM Healthcare
Aster DM Healthcare—an integrated healthcare service organization with 20 hospitals, 112 clinics, and 213 pharmacies across nine countries—commits to standardization of reporting of multi-drug resistant organisms (MDRO) across the chain of hospitals of Aster DM Group in India, and regular monitoring of MDRO rates across these hospitals with a data review every three months. Aster also commits to regularly monitor and report on the consumption of antibiotics in the World Health Organization’s list of reserve antibiotics, and to proactively reduce consumption of these drugs by at least 20 percent by December 2020. Aster will also pursue the use of molecular diagnostics for rapid and accurate identification of resistance threats, and will review the diagnostics’ utility in rationalizing antibiotic use and reducing consumption.

AtlantiCare Physicians Group
AtlantiCare Health System, a member of Geisinger Health System that includes two hospitals and the AtlantiCare Physician Group with 5,800 employees and more than 900 physicians at nearly 100 locations in Southern New Jersey, commits to decreasing the spread of infection through prevention such as improved hand washing and increased vaccine utilization for AtlantiCare’s employees, patients, and the community. To contribute to solving the problem of inappropriate prescribing and drug resistant organism development, AtlantiCare commits to making hand washing a system wide goal, reminding all patients and employees to wash appropriately to minimize infection. AtlantiCare is also educating patients and staff about antibiotic resistance and appropriate prescribing of antibiotics, and undergoing a rigorous flu vaccination campaign for the community.

Atrium Health
Atrium Health will work with its more than 900 care locations and 44 hospitals to use Targeted Assessment for Prevention (TAP) strategies to reduce the Standardized Infection Ratio by a minimum of 10 percent by 2020. Atrium Health will also increase the number of its acute inpatient facilities that submit antibiotic use data to the National Healthcare Safety Network to 50 percent by 2021. Atrium Health will reduce inappropriate antibiotic prescribing by 10 percent by 2020 through the Atrium Health Outpatient Antimicrobial Stewardship program. Globally, Atrium Health will continue partnerships with two hospitals in Guatemala by assisting them in developing recommendations, educational plans, and facility specific policies to reduce antibiotic resistance.

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BD (Becton, Dickinson and Company) commits to helping slow the spread of antibiotic resistance by improving awareness, surveillance, infection prevention, and stewardship. BD is mobilizing the Antimicrobial Resistance Fighter Coalition campaign to improve awareness; will support surveillance and research by collating, in specific projects, MedMinedTM data with the CDC to help better understand resistance in the U.S. and track regional differences in important resistant pathogens and antimicrobial use; is advancing infection prevention practices by introducing innovative infection control solutions and deploying training programs in collaboration with international organizations and professional societies; and is helping extend the useful life of existing medications through stewardship training and innovative integration of diagnostic testing, microbiology results and medication management workflows.

Bill & Melinda Gates Foundation
The Bill & Melinda Gates Foundation has always prioritized the fight against drug resistance in our infectious disease work, from TB, HIV, diarrheal diseases and malaria to, increasingly, pneumonia and neonatal sepsis. Together with our partners, we will continue to support research and development of vaccines and novel biologics to prevent drug-resistant diseases and protect lives, especially in low- and middle-income countries. We are also committed to investing in research to understand the burden of antimicrobial resistance on vulnerable populations in order to better quantify the impact of vaccines on drug-resistant infections and inform innovative approaches to preventing resistant infections.

bioMérieux, one of the largest in vitro diagnostics companies focusing on infectious diseases, is taking a comprehensive approach to detect, identify, monitor, track, and prevent antibiotic resistance, while also working with agricultural, veterinary, and pharmaceutical companies and various healthcare providers to limit resistance development and maximize the utility of existing and in-development antibiotics. With approximately 75 percent of bioMérieux’s 2018 clinical research and development budget dedicated to products that support the fight against antibiotic resistance, bioMérieux commits to developing assays and systems that allow the rapid and focused choice of the most appropriate antibiotic(s) in order to reduce inappropriate antibiotic use, overall antibiotic administration, and to diminish the global threat of antibiotic-resistant infections. bioMérieux also commits to reducing antibiotic resistance through appropriate patient prescribing, limiting antibiotics in animals, the identification of foodborne pathogens, and the safety of pharmaceutical compounds.

BIOMIN, an animal nutrition firm that harnesses the power of science to support farm animal health and performance naturally, commits to expanding the reduction of non-medically necessary use of antibiotic feed solutions across the agriculture sector globally. The BIOMIN Research Center undertakes considerable scientific research and development to further enhance the sustainability of the livestock and aquaculture industries and to limit or decrease rates of antibiotic resistance on farms. BIOMIN will continue to support this initiative through knowledge sharing of scientific findings and industry best practices along with technical consulting for commercial partners.

Biotia, an artificial intelligence, health tech firm, commits to advancing available technology such as sequencing-based laboratory workflow, software, and databases to help quickly and accurately identify and track antimicrobial resistance in healthcare settings. Biotia will conduct at least three pilots in hospitals to test viability and implementation of AMR products, as well as collect substantial amounts of DNA sequence data of pathogens and resistant germs. These data will build a database to inform work in clinical settings and prevent infections. Biotia will also share the results of this work through at least one peer-reviewed manuscript, the press, scientific meetings, and with Biotia hospital customers.

Bugworks Research, Inc.
Bugworks, a drug discovery company that aims to discover novel pharmaceutical assets for combating AMR, will remain heavily invested into the R&D of novel broad-spectrum antibiotics that will be able to handle the worst global superbugs and be able to save many lives all over the world. We will continue to endeavor to beat superbugs via innovation, while making these products accessible and available to humanity. Bugworks will work closely with the government of India and other countries to promote stewardship of these novel antibiotics, so that these drugs stay effective for many years.

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C Diff Foundation
C Diff Foundation commits to continuing to recognize the serious disease burden and significant economic impact that antimicrobial resistance (AMR) and healthcare-associated infections place on patients, their families, in communities, and the health care systems throughout the world. As a part of the AMR Challenge, the C Diff Foundation will continue to acknowledge and share the importance of AMR stewardship programs; develop or expand ongoing campaigns at national or sub-national levels to promote and improve hand hygiene methods and compliance among health care providers; and make reliable and validated information available on antibiotic use and AMR stewardship programs, infection prevention, environment safety, and vaccines, therapeutics and diagnostics at the community and district levels to encourage best-practices.

CARB-X will invest $80 million globally by December 2019 to support more than 40 antibiotic resistance product developers worldwide, including at least 10 new classes against Gram-negative bacteria, five new diagnostics, and 10 new non-traditional alternatives or vaccines. Given the importance of supporting the proper use of these lifesaving drugs when they are needed most, each award agreement will include commitments to access and stewardship of these new antibiotics, vaccines, and diagnostics.

CarePortMD, LLC
CarePortMD, a platform that connects patients with clinicians in Delaware and Pennsylvania, commits to evidence-based prescribing of antibiotics. CarePortMD will implement a process for educating patients at the time of withholding antibiotics coupled with a protocol for scheduling a brief telemedical follow up assessment within 24-72 hours. This prescribing process provides patients and prescribers with either reassurance regarding the treatment plan, or an opportunity to modify use if a primary bacterial or emerging superinfection is identified.

CDC Foundation
The CDC Foundation is honored to support the U.S. Government’s AMR Challenge. We are committed to mobilizing resources in support of CDC’s work to combat antibiotic resistance through the development of public-private partnerships, creating opportunities for donors—individuals, corporations, foundations and organizations—to contribute, in response to the yearlong AMR Challenge and beyond. Together with our Board of Directors and Corporate Roundtable on Global Health Threats, the CDC Foundation stands with CDC and partners across sectors and around the world to join in the fight against the global threat of AMR. We believe that together our impact is greater.

Rapid and accurate diagnostic tests can help healthcare providers improve antibiotic prescribing decisions. Cepheid commits to develop and market molecular diagnostic products to optimize antimicrobial use in patients; provide diagnostic tests and disease tracking software that facilitates public health surveillance of infectious organisms, allowing for real-time detection of the organisms and drug resistance; collaborate directly with pharmaceutical companies to develop tests that support clinical trials of new antibiotics; and work with academic, industry, and government partners to develop sound public policy regarding the promotion of antimicrobial infection control and antibiotic stewardship programs.

Chicago Area Patient-Centered Outcomes Research Network
The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) is a partnership of research institutions, clinicians, patients, and patient advocates working to improve health care quality, health outcomes, and health equity. CAPriCORN institutions will improve the tracking of inpatient antibiotic use and resistance by generating measures using a common data model from PCORnet, a national research data network. These measures will be made available to local antibiotic stewardship and infection control programs, and shared across CAPriCORN sites to improve antibiotic use and slow spread of resistant infections.

Chicago Prevention and Intervention Epicenter
The Chicago Prevention and Intervention Epicenter will reduce “nightmare bacteria” carbapenem-resistant Enterobacteriaceae (CRE) in Chicago by July 2019. In collaboration with state and local public health departments, Rush will use regional strategies and work with state and local partners to prevent CRE infections and protect the Chicago metropolitan region of 9.5 million from its spread. The Epicenter will also work through the CDC-funded Chicago PROTECT project to improve interfacility communication and reduce spread between high-risk facilities.

Conduent will provide an IT solution that facilitates infection surveillance and antibiotic use data sharing. The Midas Cloud collects and analyzes vaccine, diagnostic, and therapeutic data that can help track antimicrobial resistance (AMR) trends, drive decisions, and accelerate progress against AMR. Conduent is committed to making rapid software enhancements to the Midas Cloud, which can accept data from a number of systems, as AMR threats and priorities emerge.

CVS Health
MinuteClinic, the retail medical clinic of CVS Health and largest provider of retail health care in the U.S., will continue to provide evidence-based and high-quality care of infectious diseases, using rigorous guidelines to support antibiotic prescribing decisions. By June 2019, MinuteClinic will advance efforts to educate patients about the appropriate use of antibiotics, and will support providers by providing the tools necessary to be antimicrobial stewardship leaders. Antibiotic prescribing will continue to be a key component of MinuteClinic’s clinical quality review process, to include safety reviews, ongoing performance measurement, and national benchmarking.

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Doctor on Demand
Doctor On Demand is a national virtual medical care practice providing video-based encounters across all 50 states 24/7/365 days a year, delivering one million face-to-face doctor visits addressing urgent issues, chronic care conditions like hypertension and mental health. Across its hundreds of providers, Doctor on Demand will lower unnecessary antibiotic prescribing by 20 percent by December 2019 for acute upper respiratory infections including bronchitis, sinusitis and pharyngitis and require two hours of continuing education training for all providers.

Duke University and the Duke Center for Antimicrobial Stewardship and Infection Prevention
Duke University and the Duke Center for Antimicrobial Stewardship and Infection Prevention commits to working with colleagues in 20 hospitals throughout the southeastern U.S. to implement the CDC toolkit for C. difficile prevention, including interventions to improve tracking of infection, infection prevention interventions such as hand hygiene and contact precautions, environmental disinfection, and antimicrobial use such as decreased use of fluoroquinolones.

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Ecolab, Inc.
Ecolab provides water, hygiene, and energy technologies and services at nearly 3 million locations in more than 170 countries. Ecolab commits to researching customer food safety and public health risk management by staying current on emerging trends; optimizing Ecolab’s response to emerging research and insights in line with the risks presented; and communicating these findings to promote balanced, risk-based approaches to combating antibiotic resistance through hygiene and sanitation program implementation at scientific and trade conferences and in publications.

Elanco, an animal health company dedicated to developing innovative solutions that protect and enhance animal health, commits to investing at least 50 percent of their food animal research and development budget in projects that will lead to alternatives for medically important antibiotics, including introduction of non-medically important antibiotics to replace colistin use in key emerging markets; engaging in two partnerships to increase access to veterinary and professional oversight in countries with limited resources; improving responsible antibiotic use by expanding data collection and analytics of animal husbandry and health outcomes to inform best practices; and by encouraging implementation of vaccination and nutrition programs to prevent disease.

Emory Antibiotic Resistance Center
The Emory Antibiotic Resistance Center (ARC) commits to hosting interdisciplinary brainstorming and networking sessions to discuss cutting edge research findings and collaborative research opportunities in conjunction with ARC seminars given by invited external experts three times each year. These sessions will feature a seminar presented by a national expert on antibiotic resistance. Participants across the leading research institutions in Georgia, including Georgia Institute of Technology, University of Georgia, Morehouse School of Medicine, and Emory University will share research findings and promote the use of shared infrastructure and collaborations across institutions.

Express Scripts
Express Scripts is the largest independent manager of pharmacy benefits in the U.S. and one of the country’s largest pharmacies. Serving more than 85 million people, Express Scripts commits to leverage prescription drug administrative claims for insights on clinicians prescribing pattern.

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Government of Finland
The Finland Ministry of Social Affairs and Health, National Institute for Health and Welfare (THL), Ministry of Agriculture and Forestry (MMM), and Finnish Food Safety Authority (Evira) commit to developing a real-time notification and reporting system to detect unusual events, including extremely antimicrobial-resistant bacteria, at local, regional, or national level to support outbreak investigations and infection control measures; improving surveillance of human antimicrobial consumption; constructing a system to collect use data on all animal species; and establishing an expert group on antimicrobial resistance (AMR) and antimicrobial consumption in each hospital that follows and controls AMR infections and steers the use of antimicrobials.

First Arabian Drug Information Center
The First Arabian Drug Information Center (FADIC), a professional health care organization in the Middle East, commits to maintaining the appropriate use of antibiotics through antimicrobial stewardship education and by providing certification in antimicrobial stewardship training programs for pharmacists, physicians, nurses, and other healthcare professionals. FADIC will also provide a roadmap for applying antimicrobial stewardship in multiple healthcare settings, including acute-care hospitals, long-term care facilities, ambulatory care settings, and community pharmacies to provide an evidence-based practice. In addition to antimicrobial stewardship, FADIC will research, consult, and promote awareness.

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Global Health Alliance Melbourne
Trends project that by 2050, Asia will have the highest number of deaths attributable to antimicrobial resistance (AMR) on earth. Through 36 member organizations across nine sectoral types, the Global Health Alliance Melbourne (GLHAM) commits to a collective and coordinated multidisciplinary approach to addressing AMR at a national and regional level. GLHAM will take joint action through its AMR community of practice to strengthen regional health security through diagnosis and measurement; preventing transmission of existing resistant strains; and preventing emergence of new resistant strains. GLHAM’s membership ranges from nongovernmental to hospitals, universities, and the private sector.

Global Health Technologies Coalition
The Global Health Technologies Coalition (GHTC), a coalition of more than 30 nonprofit organizations, academic institutions, and aligned businesses, commits to encouraging leadership among our member organizations in developing new diagnostics, vaccines, and therapeutics to combat antimicrobial resistance (AMR). To spur research and development of new antibiotics and other technologies to detect, prevent, and treat resistant pathogens, GHTC will continue to advocate for strengthened funding, new policies, frameworks, and incentive mechanisms, and enhanced coordination. In particular, we will continue to advocate for the Global Health Security Agenda to embrace and support R&D for technologies to combat AMR in its 2019-2024 framework.

GoHealth Urgent Care
GoHealth Urgent Care and Northwell Health are proud to work directly with the CDC and Antibiotic Resistance Action Center (ARAC) on antibiotic stewardship initiatives, and to serve as leaders and champions for antibiotic stewardship in urgent care. One measure of our collective success will be the adoption and practical use of antibiotic stewardship, the CDC’s antibiotic stewardship core elements, and the MITIGATE toolkit in the adult and pediatric emergency and urgent care settings. The ultimate goal of our commitment is to improve overall antibiotic stewardship both in urgent care and more broadly across other ambulatory care settings.

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HCA Healthcare
HCA Healthcare includes 178 hospitals and 119 surgery centers in the U.S. that together provide more than 28 million patient encounters each year. HCA will continue to measure environmental cleaning to help reduce the spread of resistant germs in healthcare facilities; work with CDC to drive use of the days of therapy (DOT) and Standardized Antimicrobial Administration Ratio (SAAR) benchmarking data; and continue to participate in public health research that uncovers new ways to protect people from AMR. HCA will also ensure all of its hospitals enroll in the National Healthcare Safety Network Antibiotic Use and Resistance data reporting modules, and ensure that all HCA hospitals work with local and state public health to implement CDC’s containment strategy.

Henry Ford Health System
Henry Ford Health System commits to improve antibiotic use and reduce the spread of resistance across the continuum of patient care in southeast Michigan and among our global partners. Henry Ford will expand current efforts for global antibiotic stewardship and infection control education and mentoring in Michigan, educate patients about appropriate antibiotic use in urgent care and community settings, and align antibiotic stewardship interventions with priorities and strategies of national and international organizations.

HP, Inc.
HP, Inc. is committed to making its D300e Digital Dispenser, an inkjet technology that can automate and miniaturize dispensing of antibiotics for rapid susceptibility testing, available to CDC’s Antibiotic Resistance Laboratory Network to help fight antibiotic resistance. By continuing work with CDC on their pilot and working with public health labs in the U.S. and worldwide, HP hopes to enable rapid reference method testing of new antibiotics for resistant infections. HP is committed to continuing to refine the HP D300e Digital Dispenser system by seeking feedback from partners to address this growing public health need. HP will also provide system and application support to public health labs working to validate and use the system in their laboratories.

Hy-Plains Feedyard, LLC
Hy-Plains’ Education Research Center, a commercial cattle feeding operation in southwest Kansas, commits to identifying methods to affect and potentially slow the development of antibiotic resistance in the feedyard industry. Hy-Plains has the ability to conduct studies in real-world settings to evaluate new products or practices with the ability to scale it through the industry. Hy-Plains has conducted vaccine, feed additive, antibiotic treatment, immune response, and retrospective data analysis trials and commits to working with partners to bring the results of its research to scale throughout the industry in a more rapid manner

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Government of India – Department of Biotechnology, Ministry of Science and Technology
The Department of Biotechnology (DBT) leads the biotechnology policy, strategy, centers, and programs related to biotechnology in India. As part of its Mission Program on Antimicrobial Resistance, DBT commits to collaborating with DBT’s Biotechnology Research Assistance Council (BIRAC) to launch a Joint Call for Innovative Approaches to address antimicrobial resistance (AMR) in October 2018, with a focus on developing new antibiotics and antibiotic alternatives. DBT also commits to fostering a network of researchers, product developers, and incubators that can work together on AMR, and will explore the possibility of establishing an Indo-US mobility fellowship in AMR that could fund research exchanges under Indo-US collaborative initiatives. In order to catalyze the scientific and technological innovation necessary to address AMR, BIRAC commits to collaborating with the charity, Nesta, to support a Longitude Prize to develop point-of-care diagnostic tests to identify AMR pathogens.

Government of India – Indian Council of Medical Research, Ministry of Health and Family Welfare
The Indian Council on Medical Research, the country’s premier medical research institute and one of the oldest medical research bodies in the world, is committed to: supporting basic and clinical research; working with the Indian Council of Agriculture and Research (ICAR) to create a One Health platform for integrated surveillance; strengthening, standardizing and expanding capacity of the public health and healthcare systems in India to implement appropriate infection control procedures; enhancing stewardship practices and strengthening hospital-based surveillance for HAIs, including working with regulatory bodies to address the excess and access issues; and collaborating with international partners, including the U.S. CDC, the U.S. National Institute for Allergy and Infectious Diseases (NIAID), Research Council Norway, and the German Federal Ministry of Education and Research (BMBF) to develop a better understanding of resistance mechanisms and discover new drug targets and drug molecules.

Infectious Disease Society of America
Infectious diseases physicians are at the forefront of local, national, and international efforts to address antimicrobial resistance (AMR). These providers lead infection prevention and stewardship programs; conduct basic, translational, and clinical research; advance public health interventions; and diagnose and treat patients infected by multidrug resistant pathogens. In 2019, the Infectious Disease Society of America will invest $5 million in educational efforts on AMR, $500,000 in AMR policy and advocacy efforts, and $400,000 in AMR communications.

Intermountain Healthcare
Intermountain Healthcare—which includes 22 hospitals and more than 185 clinics in Utah and Idaho—will launch a patient-centered initiative targeting outpatient antibiotic prescribing. The initiative will include novel antibiotic prescribing metrics with prescriber feedback, electronic health record tools, education for patients and providers, and a public awareness campaign. Intermountain will also launch the Healthy Patient Initiative to build on current infection prevention activities. This includes improving patient hygiene, environmental hygiene, and caregiver infection prevention strategies. The initiative will promote oral care and bathing, hand hygiene, and bundle compliant device maintenance.

International Livestock Research Institute
The International Livestock Research Institute (ILRI) is a non-profit organization that focuses on value chains, health-environment linkages, and knowledge and research on livestock. As part of the AMR Challenge, ILRI commits to: providing guidance on best practices for preventing the release of antibiotics into the environment; advocating for good stewardship of antibiotics in the livestock sector, including the restriction of antibiotics for growth promotion and pre-mixed feed; and promoting a One Health approach to better understand the human-animal-environment relationship of antimicrobial resistance.

IQVIA is committed to identifying and understanding the driving factors behind the rising number of drug-resistant bacteria strains to inform ongoing prevention efforts. To improve antibiotic use, IQVIA is committed to building on an existing framework of antibiotic prescribing reporting and analysis. IQVIA will provide CDC with 50 state-specific reports featuring 2018 data. These data can be shared with individual states and advance CDC’s understanding of the dynamics behind overprescribing at the state and local levels. These reports will also contain urgent care facilities and their affiliated prescribers, to enable detailed analysis of provider prescribing patterns by CDC and the states across the range of acute care settings.

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Government of Japan
Japan commits to contribute to the establishment of an antimicrobial resistance (AMR) surveillance system in Asian countries where the status of AMR has not been systematically investigated by using the data integration system that the AMR Research Center has developed. Japan expects that this surveillance system, as well as provision of essential resources for the laboratory test such as devices and expertise, will greatly contribute to AMR investigations in Southeast Asia.

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Kaiser Permanente
As the largest interdisciplinary healthcare organization in the U.S., Kaiser Permanente commits to remaining a strong antibiotic steward and preventing the spread of resistant infections. Kaiser Permanente pledges to continue using data to avoid unnecessary antimicrobial use in our inpatient, outpatient, and skilled nursing facilities; improve infection prevention and control through the dedication to facilities’ sanitation, and environmental initiatives that include water quality management and thorough housekeeping and cleaning practices; and implement medical product sourcing processes in order to eliminate products with antimicrobial additives.

Kentucky Antibiotic Awareness
Kentucky Antibiotic Awareness (KAA) is a statewide campaign to reduce inappropriate antibiotic use. KAA commits to tracking antibiotic use in children using Medicaid claims data and sharing data analyses with state officials and healthcare providers. We also commit to providing resources and education for providers and patients and promoting collaboration among key stakeholders throughout the state.

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Long Beach Department of Health and Human Services
California’s Long Beach Department of Health and Human Services is committed to improving surveillance of antibiotic resistance by hosting a carbapenem-resistant Enterobacteriaceae (CRE) collaborative with the California Department of Public Health to create dialogue, education, and awareness among skilled nursing facilities and acute care hospitals. By December 2019, the Long Beach Department aims to have antibiotic resistance subject matter experts throughout many healthcare facilities. The Department made CRE reportable locally, and commits to finding new ways to detect outbreaks of resistant organisms more quickly and efficiently; ensure accurate and timely reporting of outbreaks of resistant organisms in local facilities; and monitor for novel multi-drug resistant organisms.

Los Angeles County Department of Public Health
The Los Angeles County Department of Public Health (LACDPH) will continue to prevent, detect, and respond to antibiotic-resistant infections in healthcare settings, using surveillance data to identify threats requiring response. LACDPH will promote the appropriate use of antibiotics among the public and human and veterinary healthcare providers, and will train healthcare staff across the continuum of care in appropriate antibiotic use and stewardship.

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Making a Difference in Infectious Diseases
Making a Difference in Infectious Diseases (MAD-ID), a non-profit organization comprising pharmacists, physicians, nurses, and other health professions focused on continuing professional education in the general area of infectious diseases prevention and treatment and antimicrobial stewardship in particular, commits to optimizing antibiotic use in the practice community and thus reduce the prevalence and spread of resistance. MAD-ID will leverage innovative and practical educational and skills training in antibiotic stewardship and infectious diseases therapeutics. MAD-ID will also continue its support of research documenting effective interventions to provide an evidence base for these practices.

Max Healthcare
Max Healthcare recognizes antimicrobial resistance (AMR) as a major concern threatening the safety and quality of the care it provides throughout the 14 hospitals in its system and the health outcomes of its patients. As one of India’s leading providers of comprehensive healthcare services, Max Healthcare commits to containing and preventing the spread of infections, particularly those that are resistant to antibiotics by: tracking infections via its AMR surveillance system and sharing data nationally as part of the Indian Council of Medical Research surveillance network; developing and implementing comprehensive policies on infection prevention and control that are in line with international standards from Joint Commission, CDC, and World Health Organization, but also incorporate local practice and context; and having five dedicated infection control nurses at the Max Super Specialty Hospital in Saket, a facility of 560 beds.

Mayo Clinic
Mayo Clinic commits to working with care providers and patients to implement interventions that enhance infection prevention and control measures, and to optimize antibiotic use while also increasing public awareness about antibiotic resistance. Improvements or a targeted 5 percent reduction in antibiotic use will be achieved by 2020. Mayo Clinic also commits to developing, sharing, and assessing the value of novel diagnostics in terms of patient outcomes and usage of antimicrobial agents for infectious diseases, which can help identify resistance and improve patient care.

McDonald’s Corporation
McDonald’s Corporation commits to partnering with suppliers and producers on the responsible use of antibiotics in food animals in its supply chain, including a policy for chicken in the U.S. and markets around the world, and a newly launched antibiotic use policy for beef. As one of the world’s largest restaurant companies, McDonald’s aims to use its Scale for Good to help preserve the efficacy of antibiotics for future generations.

Medical University of South Carolina
The Medical University of South Carolina (MUSC) commits to advancing stewardship efforts by developing an evidence-based, institution-specific guidebook and mobile application. The MUSC Antimicrobial Stewardship Program is committed to expanding the hospital’s mission via innovative trainee education and optimization of antimicrobial stewardship protocols. Specifically, MUSC’s Stewardship Team will incorporate evidence-based practice and guidelines into an institutional guidebook for trainees via a mobile app. The team is also pioneering a decision-making tool for the electronic medical record system to promote successful stewardship efforts in conjunction with the Infection Control Team. This platform will streamline data collection and tracking of antibiotic use and infections.

MeMed translates complex immune system signals into simple diagnostic insights to transform management of infectious disease—when and where needed. MeMed commits to providing a test addressing the daily clinical challenge that is a fundamental driver of antibiotic misuse—the difficulty in distinguishing between bacterial and viral infections. MeMed will collaborate with academic, commercial, and government partners towards the goal of making the test available to the broadest global population, as soon as possible. This new tool will provide actionable information to clinicians, promoting prudent antibiotic use and helping to tackle antimicrobial resistance.

New antibiotics are urgently needed to address growing antimicrobial resistance; however, there are relatively few in development. Merck, known as MSD outside the U.S. and Canada, is one of the remaining large pharmaceutical companies conducting research in this area. Merck commits to continuing to make significant investments in both early- and late-stage R&D to discover, develop, and commercialize novel vaccines and medicines to prevent and treat bacterial infections in both humans and animals. Merck focuses its research on pathogens found in CDC’s 2013 Antibiotic Resistance Threats Report and prioritized by the World Organization for Animal Health (OIE).

Milken Institute
The Milken Institute is a nonprofit, nonpartisan think tank determined to increase global prosperity. We will highlight antimicrobial resistance (AMR) at our events around the world to foster greater awareness, connection, and urgency of the challenges of AMR among our network of tens of thousands of global leaders in business, government, science, technology, philanthropy, academia, media, and more. Through raising awareness, we aim to promote best practices and novel solutions, and advance biomedical research.

Montefiore Medical Center
Montefiore Medical Center is committed to improving antibiotic use through reporting and dissemination of antimicrobial utilization (AU) data and educating clinicians about appropriate antibiotic prescribing. Montefiore Medical Center will continue to submit AU data to CDC’s National Healthcare Safety Network and disseminate AU and Standardized Antimicrobial Administration Ratio benchmarking data to prescribers. Montefiore will also continue to educate medical students and residents through monthly seminars on antibiotic prescribing best practices, and a seminar in the spring of 2019 to educate medical students about appropriate antibiotic prescribing and the dangers of antimicrobial resistance.

Mountaire Farms, Inc.
Mountaire Farms, the seventh largest producer of chicken, commits to work together with other animal producers to establish a new One Health Certified (OHC) animal production standard open to any producer and across various commodity groups to be launched in 2019. This standard will be audited to certify compliance by the U.S. Department of Agriculture’s Agriculture Marketing Service with a goal to create a balanced, sustainable, and affordable cross-commodity, retail-labeled, animal-production standard with defined benchmarking requirements. One Health Certified meat products will be promoted directly to meat retailers, wholesalers, and restaurant chains and subsequently promoted by them to their respective customers.

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National Cattlemen’s Beef Association
The National Cattlemen’s Beef Association (NCBA) commits to the promotion of increased education concerning antimicrobial stewardship and the responsible use of antimicrobial drugs to prevent, control, and treat diseases in cattle, as guided by the national Beef Quality Assurance Program (BQA). By promoting increased participation and certification through BQA, NCBA seeks to increase awareness and compliance for responsible antimicrobial drug use in all segments of the beef cattle industry. Responsible use of antimicrobial drugs will aid in preserving the future effectiveness of antimicrobial agents against common pathogens in both human and animal species.

National Institute for Antimicrobial Resistance Research and Education
At the 2015 White House Stewardship Forum, the Association of Public and Land Grant Universities and the American Association of Veterinary Medical Colleges made a joint commitment to develop the National Institute of Antimicrobial Resistance Research and Education (NIAMRRE). NIAMRRE now commits to fostering the collaborative development of interdisciplinary research teams from diverse biologic, physical, and social science backgrounds. NIAMRRE commits to assisting these teams with developing research and educational projects that will address key knowledge gaps and develop practical interventions at the interface of agricultural, environmental, and human health. NIAMRRE consists of over 100 scientists representing all aspects of One Health working together to address critical antimicrobial resistance related issues.

National Milk Producers Federation
The National Milk Producers Federation, which represents producers of the majority of the U.S. milk supply, commits to increase veterinary oversight of antibiotic use through the National Dairy Farmers Assuring Responsible Management (FARM) Program. A cornerstone of the FARM Animal Care program is the establishment of a Veterinarian-Client-Patient-Relationship where the dairy farmer consults with a veterinarian on development of treatment and recordkeeping protocols that address the proper use of antibiotics. Dairy farms will be evaluated on conformance to the standards by a certified independent expert.

National Pork Board
America’s pig farmers are dedicated to raising healthy animals to help ensure a safe and healthy food supply. Pig farmers strive to reduce the need to use antibiotics by implementing production practices for infection control. They recognize the critical importance of using antibiotics responsibly in animals and humans to protect the health and well-being of both. The responsible use of antibiotics as part of an overall herd health plan is important to delivering on this commitment. America’s pig farmers will demonstrate their commitment to preventing antibiotic resistance through their support of scientific discovery and their commitment to continuous learning and improvement.

National Pork Producers Council
The National Pork Producers Council (NPPC), a group of 42 affiliated state associations, will engage with U.S. delegates, as requested, to provide comments and industry information during the process of developing international standards aimed at preventing unsafe residues of veterinary drugs in food, integrating surveillance to inform risk management activities, and minimizing the development and spread of antimicrobial resistance in humans and animals. NPPC will provide industry knowledge and current scientific evidence to inform the development of these standards and utilize communications channels to increase industry knowledge and adoption of standards accepted by World Organisation for Animal Health and Codex Alimentarius.

Government of Nigeria
The Nigeria Centers for Disease Control (NCDC) commits to the development and scaling-up of Nigeria’s new national surveillance system for antimicrobial resistance (AMR) to inform evidence-based policy and practice for containment of AMR. NCDC also commits to the development and distribution of a national toolkit for antimicrobial stewardship in healthcare institutions, advocacy for the creation of hospital multi-disciplinary antimicrobial stewardship committees in at least 85 percent of all federal institutions, and the implementation of a national infection prevention and control program using a participatory quality development approach (PQDA) in at least 85 percent of federal healthcare institutions.

Nile’s Project
Nile’s Project commits to making healthcare safer and reducing antibiotic use in the U.S. and globally to preserve antibiotics for generations to come. As a non-profit, Nile’s Project educates the public with infection prevention awareness and tools, shares research on antibiotic resistance, and empowers the public to be antibiotics aware. Nile’s Project commits to sharing antibiotic stewardship and infection prevention solutions with healthcare professionals and healthcare facilities. Outreach emphasizes the importance of early detection and rapid identification and treatment of patients with sepsis, as well as the importance of adopting CDC’s Core Elements for Antibiotic Stewardship. Nile’s Project will continue to urge industry to deliver an affordable point-of-care rapid diagnostic tool to identify if a respiratory infection is caused by a virus or bacteria, available for healthcare and in-home use.

North American Meat Institute
The North American Meat Institute (NAMI) commits to employing science-based strategies by the meat and poultry industry to slow antibiotic resistance and promote antibiotic stewardship. Specifically, NAMI—which is the oldest and largest trade association representing U.S. packers and processors of beef, pork, lamb, veal and turkey—commits to improving veterinary oversight and eliminating growth uses for medically important drug compounds to protect animal and public health, while maintaining the highest standard of animal welfare practices.

Northwest Antimicrobial Resistance Coalition
The Northwest Antimicrobial Resistance Coalition is a collaboration of the Washington Global Health Alliance, the University of Washington, Washington State University, PATH, Providence St. Joseph Health, Seattle Children’s, Harborview Medical Center, and other organizations based in the Pacific Northwest with a commitment to mitigating the effects of drug-resistant bacteria in the U.S. and around the globe. The Coalition will identify strategies that provide timely, evidence-based global antimicrobial resistance risk data to U.S. health care institutions, and effectively reduce the emergence and spread of drug-resistant germs in high-risk communities around the world. These strategies can inform the policy response to antibiotic resistance on a global scale.

Northwestern Medicine
Northwestern Medicine, an integrated academic health system in the Chicago area with 4,000 physicians and 30,000 employees caring for over 1.1 million patients, is committed to improving antibiotic use to ensure that these important medications remain effective treatment options. The Antimicrobial Stewardship Quality Committee commits to using local and CDC data to reduce unnecessary antibiotic use across their system. They also commit to increased use of penicillin allergy testing to remove misdiagnoses and decrease the use of broader-spectrum antibiotics. Utilizing both of these interventions will be aimed at reducing overly broad spectrum antibiotic use and emphasize their strong commitment to better patient care and combating antibiotic resistance.

Norwegian Institute of Public Health
The Norwegian Institute of Public Health (NIPH) commits to improving the surveillance of the key organisms responsible for driving antimicrobial resistance (AMR) in healthcare institutions, and, therefore, combating the growing risk of outbreaks of multidrug-resistant organisms. NIPH also strives to ensure that Norwegians are fully vaccinated so that illness may be avoided. NIPH commits to continue to work internationally through organizations such as the Transatlantic Taskforce on Antimicrobial Resistance and the European Union’s Joint Action on AMR and healthcare-associated infections to engage healthcare providers to improve stewardship measures as well as find common ground to implement mechanisms that can further stimulate necessary research and innovation.

Candida auris is the cause of a newly evolving fungal infection that can cause serious illness and death. In order to reduce the mortality or disability caused by by C. auris, Los Angeles Biomedical Research Institute at Harbor/UCLA (LABiomed), in collaboration with NovaDigm Therapeutics, Inc., commits to the development of a vaccine for by C. auris in order to prevent the spread of infections and save lives.

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Opal Biosciences Ltd
Opal Biosciences, an Australian preclinical-stage biotechnology company focused on the development of novel treatments for antibiotic-resistant or hard-to-treat infections, commits to continuing to develop urgently needed new anti-infectives for life-threatening and hard-to-treat infections. Opal’s drug, BDM-I, is a small molecule that has shown in vitro activity against many serious human pathogens including six identified by the CDC in the 2013 Antibiotic Resistance Threats Report. Opal Biosciences’ current focus is towards antibiotic-resistant Neisseria gonorrhea, where BDM-I has shown in vitro activity against all of the 2016 World Health Organization Reference strain panel, including against strains highly resistant to currently recommended antibiotics.

Ocean Spray
Ocean Spray’s commitment is to fund and collaborate with universities conducting research on the role of bioactive compounds found in foods, especially those high in phenolic compounds like cranberries, to assess the impact of cranberries on reducing the need for antibiotics for bacterial infections in humans and animals for the next 5 years, including research on antibiotic synergy and alternatives.

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Government of Pakistan
The Pakistan Ministry of National Health Services, Regulation and Coordination and the National Institute of Health commit to the establishment of an integrated national antimicrobial resistance (AMR) surveillance system (human, animal usage, and resistance monitoring); development of national and provincial/regional AMR reference labs in at least two provinces; reduction of the incidence of infection through effective sanitation, hygiene, and infection prevention measure through rolling out National Action Plan for AMR and supporting the provinces for development of respective Provincial Action Plans; and optimization of the use of antimicrobial medicines in human and animal health, as well as in antimicrobial sale and in the utilization audit. Pakistan also commits to complete and share the finding of Tricycle ESBL E. coli Project and the expansion of the Global Antimicrobial Resistance Surveillance System. Pakistan will also launch sentinel surveillance of invasive fungal infections such as Candida auris.

PATH has expertise in infection prevention and control, WASH, and laboratory capacity and surveillance in more than 70 countries around the world. PATH commits to assisting countries in responding to challenges in operationalizing a holistic antimicrobial resistance (AMR) response and supporting ministries of health in developing and operationalizing their AMR plans. Through this commitment, PATH will provide an opportunity for countries to bridge the gap between their national plans and global commitments, and promote an operational network of partners countries may turn to for support in operationalizing national AMR plans.

Pediatric Infectious Disease Society
As the world’s largest organization of professionals dedicated to the treatment of infectious diseases affecting children, the Pediatric Infectious Disease Society (PIDS) commits to decreasing the use of antibiotics in pediatric settings by 20 percent by 2021. PIDS will also increase collection of pediatric-specific data by health systems and support legislative efforts to improve the research and development of new diagnostic and therapeutic environments.

Pet Industry Joint Advisory Council
The Pet Industry Joint Advisory Council (PIJAC) and the broader pet care community commit to the development and adoption of Recommendations for Judicious Use of Antimicrobials in Companion Animal Care. These recommendations will establish best management practices for antibiotic use that will encourage responsible stewardship while protecting human and animal health and well-being. PIJAC and its partners will provide outreach and education to the pet care community and the general public on these best practices to encourage implementation.

Petco will continue a focus on judicious use of antibiotics by not allowing prophylactic use of antibiotics in our supply chain and supporting veterinary oversight for access to antibiotics in its 1,500 locations across the U.S. and online channels.

Pew Charitable Trusts
The Pew Charitable Trusts uses evidence-based, non-partisan analyses to solve today’s challenges. To combat antibiotic resistance, Pew will: strive to reduce inappropriate antibiotic use across healthcare settings by supporting efforts to track prescribing and establish data-driven targets for improving inpatient antibiotic use; coauthor research to support outpatient stewardship; promote judicious antibiotic use across the animal agriculture industry by developing sustainable stewardship standards and publishing research on the impact of different management and disease prevention practices on the need for antibiotics; and spur new antibiotic discovery by providing the publicly-available Shared Platform for Antibiotic Research and Knowledge (SPARK) to enable scientists around the world to collaborate on research targeting the hardest-to-treat bacteria.

Premier, Inc.
Premier, a healthcare improvement company with a network of approximately 4,000 U.S. hospitals and health systems and approximately 165,000 other providers and organizations, is committed to continue to reduce preventable harms caused by hospital-acquired infections and inappropriate antimicrobial use. Premier will work with more than 500 members in its Hospital Improvement Innovation Network (HIIN), funded by Centers for Medicare & Medicaid Services, to provide education, technical assistance, and evidence-based strategies to implement all seven of the CDC’s Core Elements of Hospital Antibiotic Stewardship Programs and reduce the rate of healthcare-associated C. difficile by 20 percent by March 2019. Premier will continue to work alongside healthcare providers to co-develop, scale, and enhance its data-driven solutions, research and educational services, and best practices to improve antimicrobial stewardship across the U.S. In doing so, Premier will conduct follow-up research to measure hospital progress in improving antimicrobial use and publish findings in 2019. Premier also commits to enabling increased reporting of antibiotic use data by Premier members through its data platform; using deep analytics with peer-to-peer benchmarks to understand usage patterns; and applying its collaborative methodology to target, implement and measure improvement efforts.

PointClickCare is committed to helping understand antibiotic prescribing practices in long term care facilities. We analyzed millions of antibiotic orders and admission records in thousands of nursing facilities across the United States. We will continue to mine the data and share insights with CDC to support efforts to improve care.

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Roche Diagnostics
One of the world’s largest diagnostics companies, Roche Diagnostics, commits to implementing antibiotic use education and awareness projects among over 4,000 employees as well as healthcare providers and clinical partners. Roche will also invest in diagnostic solutions and assessment tools that identify or rule out resistant pathogens, and measure the effectiveness of an antibiotic therapy.

Rush University Medical Center
Rush University Medical Center, with over 47,000 annual patient admissions, is committed to reducing hospital-onset C. difficile infections by 25 percent by December 2019. C. difficile infections can cause deadly diarrhea and are associated with antibiotic use, which drives antibiotic resistance. Rush will use a multimodal approach to drive down rates, including infection prevention, antibiotic use programs, environmental services, hospital quality and safety, clinical informatics, and microbiology labs.

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Sackler Institute for Nutrition Science
The Sackler Institute for Nutrition Science commits to support the gathering and sharing of knowledge on the use of antibiotics in animal food production. They will compile and publish scientific advances on antimicrobial resistance (AMR) in animal food industry to clarify the relationship between AMR in animal food production, the various pathways of pathogen transmission to humans, alternatives to antibiotics in animal food industry, and ways of communicating information to consumers.

Invasive fungal infections are often deadly and typically target patients with compromised immune systems. SCYNEXIS is developing a novel IV/oral antifungal medication for the treatment of Invasive Aspergillosis, Invasive Candidiasis, and Vulvovaginal Candidiasis, including patients with resistant pathogens. SCYNEXIS is committing to initiate studies of this antifungal in the treatment of patients with Invasive Aspergillosis and patients with fungal infections that are resistant to current therapies, including patients with Candida auris.

Society for Healthcare Epidemiology of America
The Society for Healthcare Epidemiology of America (SHEA) commits to improving antibiotic use through expanded educational efforts. SHEA will increase content for healthcare professionals by 25 percent, increase scholarship funds for antibiotic stewarship training by 100 percent, develop antibiotic use guidance for long-term care settings, publish a white paper on antibiotic stewardship research priorities, and launch an education campaign for new Congressional members.

Society of Infectious Disease Pharmacists
The Society of Infectious Disease Pharmacists (SIDP) will promote the appropriate use of antibiotics among its more than 1500 members by expanding global stewardship provider education in acute and long-term care, providing antibiotic stewardship certificate programs, securing commitments from U.S. acute care hospitals to adopt the stewardship practices outlined in pharmacy action posters, a collaboration between CDC, SIDP, and the American Society of Health-System Pharmacists, and sponsoring an Antibiotic Take Back Day campaign in partnership with community pharmacists.

Summit Therapeutics
Summit Therapeutics is committed to discovering and developing new antibiotics for serious infectious diseases. Once easy to cure infections are becoming deadly due to increasing antibiotic resistance and a lack of truly new antibiotics coming to market. Summit believes by developing new antibiotics for specific infections, misuse of antibiotics could be reduced and resistance kept at bay. The Company is currently developing antibiotics for C. difficile, gonorrhea and ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species).

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The Joint Commission
As an independent organization that accredits and certifies nearly 21,000 health care organizations and programs in the U.S., the Joint Commission will work to improve antibiotic use among its accredited organizations. The Joint Commission will implement antibiotic stewardship requirements in accredited hospitals, identify and share leading practices for antibiotic stewardship with organizations being surveyed, and develop new antibiotic use standards for ambulatory care providers by 2020.

The Perelman School of Medicine of the University of Pennsylvania and the Children’s Hospital of Philadelphia
The Perelman School of Medicine of the University of Pennsylvania (PENN) and the Children’s Hospital of Philadelphia (CHOP) commit to evaluate data-driven strategies that will protect their patients and serve to inform actions to combat antimicrobial resistance (AMR) in healthcare facilities nationwide. To help its providers improve antibiotic use, PENN will investigate strategies to identify excess antibiotic duration. To improve cleanliness of the hospital environment, PENN and CHOP will establish a cleaning quality assessment system, including daily inspections and unit-based performance dashboards, and conduct two studies that investigate strategies and barriers to effective cleaning. To protect patients with recurrent C. difficile infections, PENN will develop a fecal microbial transplantation program, which can help restore the gut microbiome when antibiotics are used and infections take over.

Tiny Earth
Tiny Earth, a network of instructors and students from more than 250 high schools and colleges across 45 U.S. states and in 15 countries focused on crowdsourcing antibiotic discovery from soil, commits to creating public service announcements to raise awareness about antimicrobial resistance and stewardship, illuminating simple actions people can take to help turn the tide. Tiny Earth will also leverage the discovery potential of its global network of student-scientists to continue the hunt for novel antibiotics.

Trinity Health
Trinity Health, a network that includes 94 hospitals and 120 continuing care locations across 22 states, commits to reducing incidences of healthcare-associated infections (HAIs) by implementing best-in-class infection prevention-and-control protocols; ensuring the appropriate use of antibiotics through stewardship at the local level guided by oversight and support from system-level leaders; implementing an improved standard environmental services program model proven to help avoid HAIs; and by developing clinical decision support processes and tools to optimize the use and stewardship of laboratory diagnostics, therapeutics, and vaccines.

Typhoid Vaccine Acceleration Consortium
The Typhoid Vaccine Acceleration Consortium (TyVAC) commits to furthering the data available regarding typhoid conjugate vaccines (TCV), elevating typhoid and TCVs as urgent public health priorities, and supporting countries that want to introduce TCV, particularly as a means to help prevent and control outbreaks of drug-resistant typhoid. TyVAC is working in Bangladesh, Burkina Faso, Nepal, Malawi, Pakistan, and Zimbabwe, with the possibility of adding new countries during the project.

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U.S. Agency for Healthcare Research and Quality
The U.S. Agency for Healthcare Research and Quality (AHRQ) supports research and implementation projects to develop improved methods for combating antibiotic resistance (AR) and accelerate adoption of evidence-based practices in three core domains of the fight against AR: promoting antibiotic stewardship, preventing transmission of resistant bacteria, and preventing healthcare-associated infections (HAIs) in the first place. The AHRQ Safety Program for Improving Antibiotic Use has made significant progress in adapting AHRQ’s Comprehensive Unit-based Safety Program (CUSP), which has been highly effective in preventing HAIs, to improve antibiotic use and promote antibiotic stewardship in multiple health care settings: acute care hospitals, long-term care facilities, and ambulatory care settings.

U.S. Biomedical Advanced Research and Development Authority
In a global partnership with the National Institutes of Health, the Gates Foundation, the Wellcome Trust, and the United Kingdom Government, the U.S. Biomedical Advanced Research and Development Authority (BARDA) continues to support the Combatting Antibiotic Resistant Bacterial Accelerator (CARB-X) through a cooperative agreement with Boston University to accelerate global antibacterial innovation. Including CARB-X, BARDA supports the end-to-end research, development and regulatory approval of 45 promising antibacterial products from lead optimization through product approval. To date, CARB-X has provided $87 million to support 34 innovative early stage projects, including 10 new classes of antibiotics, 10 non-traditional therapies, and six rapid diagnostics, while BARDA has provided over $1 billion to support the clinical development of 12 advanced stage antibacterial products, two of which, Vabomere and Zemdri, were approved for use by the FDA.

U.S. Centers for Disease Control and Prevention
The U.S. Centers for Disease Control and Prevention (CDC) is a global leader in the fight against antibiotic resistance. CDC is leading The AMR Challenge with the U.S. Department of Health and Human Services (HHS) to build on its domestic and global commitments to combat antibiotic resistance, and to engage stakeholders from around the world to participate in the fight. Only through our collective efforts will we be able to make a difference against this growing problem that has the potential to impact all of us. In order to protect patients and communities from resistance, CDC will continue to leverage its unique expertise to: collaborate with other countries to prevent and contain the global spread of resistance threats; partner with states and countries to improve antibiotic use; enhance detection and tracking in the U.S., including scaling up cuttingedge laboratory technology through CDC’s Antibiotic Resistance Laboratory Network; pilot new and innovative approaches to combat resistance domestically and globally; and share isolates via the CDC and FDA Antibiotic Resistance Isolate Bank to inform the development of new drugs and diagnostics.

U.S. Centers for Medicare and Medicaid Services
The U.S. Centers for Medicare and Medicaid Services (CMS) Hospital Improvement Innovation Networks (HIIN) and Quality Innovation Network/Quality Improvement Organizations (QIN/QIOs) works with recruited hospitals to prevent device and procedure-associated infections and C. difficile in hospitals. Quality Innovation Networks-Quality Improvement Organization (QIN-QIOs) work with recruited nursing homes to improve upon several areas of patient safety including tracking, reporting, and preventing C. difficile infections in this setting. Additionally, the CMS Merit-Based Incentive Payment System (MIPS) supports CDC’s development of an antibiotic stewardship training course for healthcare professionals. Further, CMS completed and released new Interpretive Guidance in 2017 which includes how to survey for antibiotic stewardship in nursing homes.

U.S. Department of Agriculture
U.S. Department of Agriculture Animal and Plant Health Inspection Service (APHIS) launched an ongoing antibiotic resistance (AR) pilot project in 2018 with the goals of monitoring AR profiles in animal pathogens from veterinary diagnostic laboratories across the U.S. using standard test methods, and developing standardized antimicrobial susceptibility data transmission and sharing processes. USDA APHIS also created two modules—Antibiotics in Animals and Veterinary Feed Directive—through the National Veterinary Accreditation Program (NVAP) that play key roles in USDA’s AR global education and outreach efforts. For over two decades, USDA APHIS’ National Animal Health Monitoring System (NAHMS) has collected data on antimicrobial use and resistance in periodic national studies of multiple food animal species. In 2017, NAHMS conducted two targeted studies of antimicrobial use and stewardship practices on swine operations and cattle feedlots. USDA’s Food Safety and Inspection Service (FSIS) continued to expand the animal species and commodities to test for regulated pathogens. All the pathogens including Salmonella, Campylobacter, and Shiga toxin-producing E. coli (STEC) that originate from regulatory samples are subject to whole genome sequencing (WGS) and further characterization including AR. FSIS continues to administer the National Antimicrobial Monitoring System (NARMS) cecal sampling program and subjects all Salmonella and Campylobacter and a subset of E. coli and Enterococcus isolates to WGS. In addition, all the FSIS isolates continue to be phenotypically tested for antimicrobial susceptibility. In addition, all the FSIS isolates continue to be phenotypically tested for antimicrobial susceptibility.

U.S. Department of Defense
The Multidrug-resistant organism Repository and Surveillance Network (MRSN) is the U.S. Department of Defense’s (DoD) reference laboratory for multidrug-resistant pathogen characterization throughout the military healthcare system. In addition, it works collaboratively with the DoD Infectious Disease Research Program (IDCRP) on wound-specific characterization and the Veterans Health Administration (VA) on pathogen information data sharing as well as with the Drug Development arm of Experimental Therapeutics and Bacterial Disease Branches at the Walter Reed Army Institute of Research (WRAIR) for therapeutics development. As part of the Antibiotic Resistance Monitoring and Research (ARMoR) program, inclusive of the MRSN, Navy Marine Corps Public Health Center-Epi Data Center (NMCPHC-EDC), and Army Pharmacovigilance Center (PVC), the program compiles and analyzes both pathogen-specific trends, transmission patterns, and the associated use of antibiotics as part of the DoD-wide antimicrobial stewardship program. It is through this program that DoD was able to implement centralized pathogen and antibiotic use centralized reporting to NHSN AR and AU modules. Furthermore, the DoD works with CDC as an AR Lab Network regional hub.

U.S. Department of Health and Human Services Office of Global Affairs
The U.S. Department of Health and Human Services (HHS) Office of Global Affairs (OGA) facilitated bilateral meetings where antimicrobial resistance (AMR) was a priority topic of discussion between HHS and the Ministries of Health from the European Union, Netherlands, Japan, Canada, and Argentina. Additionally, in July 2017 OGA hosted leaders from the World Health Organization (WHO) for a discussion on policy and efforts with the Combating Antibiotic Resistant Bacteria (CARB) Task Force members. A second visit with WHO principles was hosted in March 2018 to introduce new WHO leadership on AMR to HHS and U.S. Department of Agriculture principles.

U.S. Department of State
The Department of State has successfully advanced a multi-year comprehensive, strategic, and innovative approach to enable immediate and lasting action globally to combat antimicrobial resistance (AMR). In addition to multilateral efforts culminating in high-level political support globally for multi-sectoral action on AMR, the Department of State has pursued pioneering efforts to enhance individual, community, and country action. The Department of State co-hosted the first forum for faith-based organizations to self-identify their roles and responsibilities in addressing the AMR challenge, titled “Combating the Emergence and Spread of Antimicrobial Resistance: A Workshop to Strengthen Faith-Based Engagement.” In addition, the Department of State also promoted policy support (including at United Nations Environment Assembly 3) and technical collaborations to advance a scientific agenda that will enable all communities—including in low-resource settings—to understand and implement evidence-based interventions related to the environmental component of AMR. As a 2018-2019 Science Envoy, Dr. Michael Osterholm, Ph.D., MPH will work to support key priorities including addressing the emergence and spread of drug-resistant disease globally.

U.S. Department of Veterans Affairs
The U.S. Department of Veterans Affairs (VA) has collaborated with CDC to fund the CDC/VA Infection Control Research Network to evaluate high priority healthcare-associated infections/antibiotic resistance prevention focus areas in 15 VA medical centers and their affiliated skilled nursing facilities. The VA was funded by CDC to design and pilot test a registry that would allow for identification of patients with previous multidrug-resistant organisms (MDRO) to be identified at admission to any VA facility allowing for a more complete and timely institution of MDRO infection control precautions at hospital admission. The VA is also working with CDC to scale-up stewardship interventions in VA outpatient and acute care settings, and to refine methods for measuring hospital antibiotic use in the National Healthcare Safety Network. And lastly, the VA, in collaboration with CDC and the University of Utah, supported a hospital-level analysis on acute-care methicillin-resistant Staphylococcus aureus (MRSA) admission prevalence, and found that decreased MRSA acquisition rates lead to decreased importation and further abates acquisition.

U.S. Food and Drug Administration
The U.S. Food and Drug Administration (FDA) has issued several guidance documents on recommended clinical trial designs for evaluating antibacterial drugs. FDA has been working to implement the Limited Population Pathway for Antibacterial and Antifungal Drugs (LPAD) pathway created under the 21st Century Cures Act and recently published a draft guidance, “Limited Population Pathway for Antibacterial and Antifungal Drugs Guidance for Industry,” which, when finalized, will describe an approval pathway for certain antibacterial drugs to treat serious or life-threatening infections in limited populations of patients with unmet needs. FDA continues collaboration with CDC on the Antibiotic Resistance Isolate Bank. FDA also launched the susceptibility test interpretive criteria (“breakpoints”) webpages required by the Cures Act, which provided FDA with the tools to modernize and streamline updating of breakpoints information for antimicrobial drugs. FDA is also implementing the Generating Antimicrobial Incentives Now (GAIN) Act provisions of the Food and Drug Administration Safety and Innovation Act (FDASIA) to help facilitate antibacterial drug development. In this connection, it has granted 163 Qualified Infectious Disease Product (QIDP) designations, including approximately 80 designations for novel drugs, and has approved 14 drug products with QIDP designation. Lastly, FDA supports efforts to monitor antimicrobial drug use in food-producing animals through collection of nationally representative on-farm data on antimicrobial use practices and resistance. To build on the progress already made, FDA recently published a blueprint on the additional steps it will take to address antimicrobial resistance in veterinary settings. Serving as FDA’s new five-year plan, this blueprint iincludes Center for Veterinary Medicine’s key goals, objectives and actions for fiscal years 2019 – 2023.

U.S. National Institutes of Health
In 2014, the U.S. National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID) issued its report “NIAID’s Antibacterial Resistance Program: Current Status and Future Directions” to describe the Institute’s research portfolio and outline a combination of innovative approaches based on the latest scientific advances. NIH/NIAID is actively pursuing research in these innovative areas, including bacteriophage therapy, microbiome-based therapeutics, and immune-based strategies to be pursued. In 2016, NIH/NIAID published a paper in the Journal of the American Medical Association reinforcing the need for novel approaches to combat antibiotic resistance. The NIH/NIAID-supported Antibacterial Resistance Leadership Group (ARLG) is pioneering a robust clinical research agenda on antibacterial resistance, including novel drugs, treatment regimens, and diagnostics. With NIH/NIAID support, scientists are developing and testing new tools to rapidly detect bacteria, and determine their sensitivity and/or resistance to antibiotics, and distinguish bacterial and viral infections at the patient point-of-care.

United Nations Foundation
The United Nations Foundation commits to leveraging its convening power, advocacy and communications expertise, access to UN agencies, relationships with the private sector, civil society organizations, and other key stakeholder groups, to secure political will and financial support to combat antimicrobial resistance (AMR). UN Foundation will continue to convene AMR community calls to coordinate advocacy and policy efforts on a monthly basis to provide a platform for all stakeholders to share lessons learned and rally around priority initiatives, and work with partners to organize and host events to elevate the AMR agenda amongst relevant stakeholders, including the November 2018 Call to Action on AMR in Ghana. They will further the work with the private sector and policy community to mobilize resources to build a sustained, neutral and broad based multi-stakeholder platform for engagement that cuts across environment, animal, and human health, and across private, public and civil society sectors.

United States Pharmacopeial Convention (USP)
United States Pharmacopeial Convention (USP) commits to develop and revise science-based quality standards for antibiotics. USP will support inclusion of medicine quality assurance in AMR national action plans and build coalitions for action, through the Medicines We Can Trust campaign. USP will work within the USP-APEC Center of Excellence to train regulators and industry on quality assurance practices that help combat AMR. USP will generate evidence on the link between poor quality medicines (which do not meet regulatory requirements for quality) and antibiotic resistance. Through the USAID-funded, USP-implemented Promoting the Quality of Medicines program, USP will continue working with regulators and drug manufacturers to expand access to quality-assured essential antibiotics; strengthen quality systems to prevent, detect, and respond to poor quality antibiotics; and contribute to surveillance efforts tracking antibiotic quality.

University of Illinois at Chicago and University of Illinois Hospital and Health Sciences System
As a CDC Prevention Epicenter, the University of Illinois at Chicago and University of Illinois Hospital and Health Sciences System (UIH) is committed to prevention of infections and decreasing inappropriate antimicrobial use. UIH will continue to improve antibiotic use for specific illnesses, like upper respiratory infections, among its over 600 providers; reduce sepsis-related deaths; and participate in clinical trials of new antibiotics.

University of Illinois at Chicago, University of Iowa, University of Maryland, Emory University, University of Utah
CDC’s Prevention Epicenters at the University of Illinois at Chicago, University of Iowa, University of Maryland, Emory University, and the University of Utah will evaluate the use of a negative pressure dressing to decrease surgical site infections and therefore reduce antimicrobial use. They also will evaluate a machine learning model that can provide surgeons real-time decision support to prevent infections. The model could help surgeons determine if their patient is at risk for a surgical site infection and if the patient could benefit from negative pressure wound therapy, a prevention technique. Surgical site infections are common healthcare-associated infections that are treated with antibiotic use, which drives antibiotic resistance. Reducing these infections can improve patient outcomes and slow antibiotic resistance.

University of Illinois, College of Medicine, Chicago
The University of Illinois, Chicago commits to researching the factors, including antibiotic use and infection control practices, that may contribute to the development and spread of resistance in the Dominican Republic. Researchers will perform a multi-site cross-sectional point-prevalence study to assess antibiotic use and resistance in acute care teaching hospitals, pharmaceutical dispensaries, and outpatient laboratories, as well as survey providers and consumers about their attitudes and perceptions of antibiotic use.

Urgent Care Association of America
As the largest urgent care professional association, with more than 3,300 member centers, the Urgent Care Association (UCA) will improve antibiotic use by co-hosting an Antibiotic Stewardship Summit in 2018 with the Antibiotic Resistance Action Center (ARAC); incorporating antibiotic stewardship as an essential component of any UCA-accredited organization’s quality plan (effective Jan. 1, 2019); and developing a Quality Commendation recognition in 2019 for urgent care organizations that demonstrate an exemplary commitment to appropriate antibiotic prescribing based on CDC’s Core Elements of Outpatient Antibiotic Stewardship framework.

U.S.-India Strategic Partnership Forum
The U.S.–India Strategic Partnership Forum (USISPF) is a non-profit organization that seeks to strengthen the bilateral relationship between India and the U.S. Recognizing that antimicrobial resistance (AMR) is a critical issue for both countries, USISPF commits to: working with members and other relevant stakeholders to identify new business or public-private partnership models that can improve access to antibiotics and other antimicrobial products; helping to develop corporate social responsibility (CSR) initiatives on AMR to leverage India’s two percent CSR mandate for greater impact; providing guidance on best practices for preventing the release of antibiotics into the environment, and encouraging members to review their manufacturing and supply chains based on these standards; advocating for good stewardship of antibiotics in healthcare and agriculture; and working with the Department of Biotechnology and other partners to provide institutional support to biotechnology startups working on AMR.

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Vermont Oxford Network
The Vermont Oxford Network (VON), comprised of more than 1,200 hospital members worldwide, commits to reducing antibiotic use for newborns in neonatal intensive care units by 45 percent by December 2022. This commitment to the AMR Challenge builds on VON’s successful commitment in 2015 to reduce antibiotic prescribing rates by 25 percent in newborns and NICUs; VON exceeded their target with an actual reduction of 34 percent across 187 centers from 38 states and 7 countries by 2017. With CDC and partnerships with hospitals, state health departments, health systems, and international participants, VON will employ a coordinated program of education, disciplined quality improvement, and focused audits. In partnership with the CDC, VON will collaborate to make key programs and materials publicly available including the Choosing Antibiotics in Newborns Wisely Toolkit, a universal training program and more than 200 data-driven quality improvement abstracts with tangible examples of measurable results.

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Walmart US commits to improving responsible antibiotic use in supply chains in line with its position on antibiotic use in farm animals. With more than 5,000 stores and clubs nationwide, Walmart US will ask animal protein suppliers to report antibiotic use throughout their supply chain and will conduct blockchain projects, which will provide greater transparency about antibiotic use on the farm and throughout the supply chain, starting with pork in 2018.

Wellcome Trust
Wellcome Trust committed to a five-year, $225 million program of work to combat antimicrobial resistance, which combines investing in scientific research to support the development of new therapeutics and diagnostics, with efforts to support an effective response by national and global policy-makers. As a politically and financially independent global charitable foundation, we are committed to working with civil society, governments, and the private sector to find powerful solutions to the challenge of rising drug-resistant infections. The Call to Action conference is a key mechanism to bring these different groups together to share and celebrate best practice, and commit to tangible actions and continued progress.

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