Containment Strategy Responding to Emerging AR Threats

When launched at the first sign of a problem, CDC’s Containment Strategy keeps new or rare forms of antibiotic resistance from spreading.  Containment complements foundational CDC strategies, including improving antibiotic use and preventing infections, and builds on existing detection and response structure. The entire package is needed to address urgent threats such as Candida auris and carbapenem-resistant Enterobacteriaceae (CRE), before they gain a foothold.  Working together, public health teams can defend the nation from new threats and help protect patients.

Overview

Be On Alert for Unusual Resistance Such As:

  • Candida auris
  • Carbapenemase-producing Enterobacteriaceae and Pseudomonas aeruginosa
  • Enterobacteriaceae with the colistin resistance gene mcr-1
  • Vancomycin-resistant Staphylococcus aureus
  • Isolates resistant to all antibiotics tested

This list may change over time. Health departments should contact CDC for current alert guidance.

The Containment Strategy includes:

  • Rapid identification
  • Infection control assessments
  • Colonization screenings when needed
  • Coordinated response between facilities
  • Continue assessments and colonization screenings until spread is controlled

Response Tiers

These three response tiers help health departments launch effective and tailored responses once a threat is confirmed by the laboratory:

  • Tier 1 Containment Response: Genes and germs never seen in the U.S and/or pan-resistant germs
  • Tier 2 Containment Response: Genes and germs never or rarely seen in a geographic area
  • Tier 3 Containment Response: Genes and germs that are known threats in a geographic area but not endemic

CDC’s April 2018 Vital Signs asks health departments to lead aggressive detection and response activities when new or rare genes and germs are identified. This includes threats like germs resistant to all antibiotics, Vancomycin-resistant Staphylococcus aureus (VRSA), Candida auris, and certain types of “nightmare bacteria” like carbapenem-resistant Enterobacteriaceae (CRE) and Pseudomonas aeruginosa (CRPA).

Antibiotic resistance threats vary by state.  Health departments should make sure all health care facilities know what isolates (pure samples of a germ) to send for testing, and what state and local laboratory support is available.

Examples of unusual antibiotic resistance germs include those that:

  • Are resistant to all or most antibiotics tested, making them hard to treat, and
  • Are uncommon in a geographic area or the US, or
  • Have special genes that allow them to spread their resistance to other germs.

For more information about what germs are considered unusual for your area, consult the AR Lab Network alert guidance or email ARLN@cdc.gov.