Lab Matters Summer 2019 - Page 12

INFECTIOUS DISEASES Antimicrobial Resistance Fellows Contribute to CRE Identification in Maryland and Minnesota Jessica Plemmons Maryland Public Health Laboratory I have gained experience in both hospital and molecular epidemiology from working as a laboratory scientist and Master’s level training in a hospital setting. Knowing several facets of public health is an asset in working with epidemiologists and microbiologists. I wanted to incorporate both areas into my research project at the Maryland Department of Health (MDH) Public Health Laboratory as an APHL-CDC Antimicrobial Resistance Fellow in the Antibiotic Resistance Laboratory Network (AR Lab Network). The flexibility of the program encouraged several divisions to collaborate and answer important public health questions that we face in antibiotic resistance every day. I developed a culture-based method to recover carbapenemase-resistant Enterobacteriaceae (CRE) from rectal swabs at the MDH Public Health Laboratory. I also collected clinical specimens with the MDH epidemiologists during CRE colonization screenings at healthcare facilities within the Mid-Atlantic region to understand the full process of CRE colonization screenings from specimen collection to data reporting. CRE is a major public health concern because it is highly resistant to conventional treatment and consequently there is an elevated mortality rate for those who become infected. We receive rectal swabs from CRE colonization screenings and run a molecular test to screen swabs for CRE markers. If a CRE marker is detected in a swab, I recover the CRE organism using the culture-based method. Before the development of the culture- based method, we only knew if a CRE marker was present in the swab specimen. Now, after recovering CRE organisms from rectal swabs, we are able to investigate transmission events between patients in a facility using whole genome sequencing. This is crucial 10 LAB MATTERS Summer 2019 Carbapenemase-resistant Enterobacteriaceae (CRE) when there are many patients with CRE organisms in a facility. We can determine if their presence is a result of a facility- acquired transmission event or from an unrelated source. This culture-based method will improve CRE surveillance within healthcare facilities and help in the fight against antibiotic resistance transmission. Bradley Craft Minnesota Public Health Laboratory I never thought that my Master’s in Public Health Microbiology and Emerging Infectious Disease at the George Washington University would lead me to the work I’ve been able to do through the APHL-CDC Antimicrobial Resistance Fellowship. Many of the things I learned about disease—its impacts on quality of life as well as the transmission and risk factors—were put into perspective as I worked hands-on with testing and public health outreach. It has been rewarding to be able to make a difference and to be on the front line of cutting-edge research regarding screening and detection of disease. As a fellow, I conducted routine testing of CRE using traditional mCIM and real-time PCR testing. My main project focus for the duration of my fellowship was expanding this testing through the utilization of a new HP D300e Digital Dispenser Bioprinter, and having this printer become another application of technology for direct patient testing of hard-to-treat infections. As both a state public health laboratory and a member of the AR Lab Network, the Minnesota Public Health laboratory tests a variety of isolates for antibiotic resistance. The use of these bioprinters helps to cut down testing time and increase precise data results for a more rapid response. Major learnings from this fellowship include how to perform numerous innovative assays, and the incredible amount of time and effort put in by those in and out of the laboratory to maintain and advance public health. A valuable insight I gained from participating in implementation of the bioprinter was that we can improve and expand testing by taking familiar technology and applying it in new ways. While new technologies are often needed, we can examine what we already have and see if we can use it in alternative ways to improve lives. n PublicHealthLabs @APHL APHL.org