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Antimicrobial Resistance Laboratory Network (ARLN)

Antimicrobial Resistance Laboratory Network (ARLN)

What is ARLN?

The Centers for Disease Control and Prevention (CDC) Antibiotic Resistance Laboratory Network (ARLN) is a national initiative that enables state public health labs and state health departments to collaborate with local healthcare facilities and clinical labs to detect, respond to, and contain emerging threats of multidrug resistant organisms (MDROs). CDCs ARLN includes labs in all 50 states, 5 cities (including Washington, DC), and Puerto Rico. This nationwide ARLN network is further divided into 7 regions. The Mid-Atlantic Regional ARLN lab is located in Baltimore, MD and supports the public health laboratories in the District of Columbia (DC) Maryland, Pennsylvania, Delaware, Virginia, West Virginia, North Carolina and South Carolina.

The District of Columbia (DC) received funding to begin building its ARLN program in 2016 and officially kicked-off its implementation in the spring of 2018. DC ARLN has commitment from clinical labs that serve all acute care and some outpatient facilities in DC. Epidemiologists who staff the DC Department of Health (DC Health) Healthcare-Associated Infections (HAI) Program work closely with microbiologists at the DC Department of Forensic Science (DFS) Public Health Lab (PHL) to respond to alerts of new and unusual MDROs that are detected from isolates submitted by clinical labs serving District healthcare facilities. The DC HAI Program then works with infection prevention staff at corresponding healthcare facilities to ensure that appropriate actions are taken to control the spread of these MDROs.

For more information, please send an email to [email protected].

Containment of MDROs in District Healthcare Facilities

The DC Health HAI Program works closely with local healthcare facilities to ensure that appropriate actions are taken to stop the spread of high priority multidrug resistant organisms (MDROs). High priority MDROs are those that fall into one of the three following categories:

Tier 1

  • Organisms in this group include those with resistance mechanisms novel to the United States (i.e., never previously or only very rarely identified in the United States) or organisms for which no current treatment options exist (pan-resistant) and that have the potential to spread more widely within a region. This category also includes organisms and resistance mechanisms for which reports and therefore experience in the United States is extremely limited and a more extensive evaluation might better define the risk for transmission. Examples of organisms in this category include Candida auris and vancomycin-resistant Staphylococcus aureus (VRSA).

Tier 2

  • Organisms in this group include MDROs primarily found in healthcare settings but not believed to be found regularly in the region; these organisms might have been found more commonly in other areas in the United States. For these organisms information is available about how transmission occurs and the groups primarily at risk. Examples include carbapenem-resistant Enterobacteriaceae with novel mechanisms (e.g., New Delhi Metallo-β-lactamase), carbapenemase-producing Pseudomonas spp.

Tier 3

  • Organisms in this group include MDROs targeted by the facility/region that are already established in the United States and have been identified before in the region but are not thought to be endemic; information is available about transmission. Examples include carbapenem-resistant Enterobacteriaceae producing Klebsiella pneumoniaecarbapenemase in regions where these organisms are more regularly identified; if only rarely identified in the region, these should be considered Tier 2 organisms.

As part of ARLN, DC Health can provide assistance to healthcare facilities with responding to high priority MDROs by

  • making pathogen-specific containment recommendations,
  • providing resources to conduct point prevalence studies and implement admission screening,
  • ensuring that proper infection control measures are being taken, and
  • facilitating communications with subject matter experts at CDC

For more information, please send an email to [email protected].

Additional Information

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