Kersh Ellen N, Pham Cau D, Papp John R, Myers Robert, Steece Richard, Kubin Grace, Gautom Romesh, Nash Evelyn E, Sharpe Samera, Gernert Kim M, Schmerer Matthew, Raphael Brian H, Henning Tara, Gaynor Anne M, Soge Olusegun, Schlanger Karen, Kirkcaldy Robert D, St Cyr Sancta B, Torrone Elizabeth A, Bernstein Kyle, Weinstock Hillard
Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
J Clin Microbiol. 2020 Mar 25;58(4). doi: 10.1128/JCM.01461-19.
U.S. gonorrhea rates are rising, and antibiotic-resistant (AR-Ng) is an urgent public health threat. Since implementation of nucleic acid amplification tests for identification, the capacity for culturing in the United States has declined, along with the ability to perform culture-based antimicrobial susceptibility testing (AST). Yet AST is critical for detecting and monitoring AR-Ng. In 2016, the CDC established the Antibiotic Resistance Laboratory Network (AR Lab Network) to shore up the national capacity for detecting several resistance threats including AR-Ng testing, a subactivity of the CDC's AR Lab Network, is performed in a tiered network of approximately 35 local laboratories, four regional laboratories (state public health laboratories in Maryland, Tennessee, Texas, and Washington), and the CDC's national reference laboratory. Local laboratories receive specimens from approximately 60 clinics associated with the Gonococcal Isolate Surveillance Project (GISP), enhanced GISP (eGISP), and the program Strengthening the U.S. Response to Resistant Gonorrhea (SURRG). They isolate and ship up to 20,000 isolates to regional laboratories for culture-based agar dilution AST with seven antibiotics and for whole-genome sequencing of up to 5,000 isolates. The CDC further examines concerning isolates and monitors genetic AR markers. During 2017 and 2018, the network tested 8,214 and 8,628 isolates, respectively, and the CDC received 531 and 646 concerning isolates and 605 and 3,159 sequences, respectively. In summary, the AR Lab Network supported the laboratory capacity for AST and associated genetic marker detection, expanding preexisting notification and analysis systems for resistance detection. Continued, robust AST and genomic capacity can help inform national public health monitoring and intervention.
美国淋病发病率呈上升趋势，耐抗生素淋病奈瑟菌（AR-Ng）构成紧迫的公共卫生威胁。自采用核酸扩增检测进行鉴定以来，美国的培养能力有所下降，基于培养的抗菌药物敏感性试验（AST）能力也随之降低。然而，AST对于检测和监测AR-Ng至关重要。2016年，美国疾病控制与预防中心（CDC）建立了抗生素耐药性实验室网络（AR实验室网络），以增强国家检测多种耐药性威胁的能力，包括AR-Ng检测。AR-Ng检测作为CDC的AR实验室网络的一项子活动，在一个由约35个地方实验室、四个区域实验室（马里兰州、田纳西州、得克萨斯州和华盛顿州的州公共卫生实验室）以及CDC的国家参考实验室组成的分层网络中开展。地方实验室接收来自约60家诊所的标本，这些诊所与淋球菌分离株监测项目（GISP）、强化GISP（eGISP）以及加强美国应对耐药淋病项目（SURRG）相关。它们分离并向区域实验室运送多达20,000株分离株，用于进行基于培养的琼脂稀释AST，检测七种抗生素，并对多达5,000株分离株进行全基因组测序。CDC进一步检查可疑分离株并监测耐药性基因标记。在2017年和2018年期间，该网络分别检测了8,214株和8,628株分离株，CDC分别收到531株和646株可疑分离株以及605个和3,159个序列。总之，AR实验室网络支持了AST及相关基因标记检测的实验室能力，扩展了现有的耐药性检测通报和分析系统。持续、强大的AST和基因组检测能力有助于为国家公共卫生监测和干预提供信息。
