Antibiotic / Antimicrobial Resistance and How Lab is Stepping in to Help

The Center for Disease Control

September 2018

Healthcare Facility Labs and Public Health Department Labs

When healthcare facility labs suspect CRE or carbapenem-resistant Pseudomonas aeruginosa (CRPA), they send the isolates (pure samples of a germ) to the public health department labs, also known as jurisdictional labs. The public health labs confirm the species identity of the bacteria, and do additional susceptibility and molecular testing to characterize (describe) the CRE and CRPA isolates. In addition to CRE and CRPA, every state health department can test for enteric (gut) bacteria like Salmonella. When public health labs identify unusual resistance, they notify CDC and can send the isolates to their regional labs for additional testing if needed.

Regional Labs and National TB Center

The regional labs help track changes in resistance and identify outbreaks. Since outbreak response varies by state, the support might also vary by state or threat discovered. In general, the regional labs provide support by:

  • Doing additional tests to further characterize the threat

  • Providing support to respond to the threat by performing colonization screening tests for CRE or CRPA, or an emerging fungal threat like Candida auris

  • Tracking and monitoring discoveries that are found

The regional labs coordinate local efforts and are located in the following state health departments:

  • Maryland

  • Minnesota

  • New York

  • Tennessee

  • Texas

  • Washington

  • Wisconsin

The public health department labs will send some pathogen isolates, like CRE and CRPA, to the regional labs when support is needed, but the AR Lab Network receives other pathogens in different ways. For example, the regional labs are processing N. gonorrhoeae isolates through CDC activities, including two projects: Gonococcal Isolate Surveillance Project (GISP) and Strengthening the United States Response to Resistant Gonorrhea (SURRG).

This work is a key part of monitoring antibiotic-resistant gonorrhea trends to help ensure that the recommended drug treatment for gonorrhea works. The National TB Center is coordinated from the Michigan Department of Health and Human Services, and is equipped to perform WGS for isolates of M. tuberculosis in the U.S. The National TB Center receives all available isolates from the state health departments.


CDC coordinates the AR Lab Network and provides technical expertise. When antibiotic resistance threats are reported, CDC works across the different labs to support outbreak response and create tailored solutions. CDC also adds new isolates to the Antibiotic Resistance Isolate Bank for drug and diagnostic test development.