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About the Maryland ARLN Laboratory

MD ARLN Contacts 

Niketa Jani, Ph.D.
Principal Developmental Scientist
Division of Molecular Biology
Maryland Department of Health (MDH)

Laboratories Administration

1770 Ashland Avenue

Baltimore, MD 21205

Phone (O) # 443-681-3922

Main Phone # 443-681-3800

Main Fax# 443-681-4501

Email: Niketa.Jani@Maryland.gov  

Mid-Atlantic State Public Health Lab Contacts

CARBAPENEM-RESISTANT ENTEROBACTERIACEAE (CRE) COLONIZATION TESTING

Goal: Detect the presence of carbapenemase-producing organisms in order to intervene and stop the spread.

Organisms of interest: Non-endemic carbapenemase-producing gram negatives

What is sent to MD PHL:

• Index patient's clinical isolate if the resistance mechanism has not yet been identified. The gene responsible for carbapenem-resistance must be determined prior to screening other patients for colonization.
• Rectal swabs for patients with possible exposure to the index patient (your state's HAI program epidemiologists should assist in determining the population at risk).

 

Body sites: Any for initial detection, Rectal/fecal swabs for colonization screening.

Initial case detection location: Clinical labs able to detect carbapenemase production, state public health laboratories

Testing to be performed at MD PHL: Xpert Carba–R Assay (Cepheid)

Reporting: Results will be returned to the submitting state's PHL, HAI program coordinator and submitting facility and to the CDC within 24-48hours after completion of testing.

• CRE Colonization Specimen Submission

Procedures for CRE Colonization Screening Through the Maryland ARLN Laboratory

Flowchart for Requesting CP-CRE Colonization

CRE Colonization Screening Requisition Form

Instructions for Specimen Submission for CRE Colonization Testing 

Cepheid Swab Shipping Guidance

• Other Useful Documents

XPERT CARBA-R Assay- 301-2438 Rev B (Package Insert)

XPERT CARBA-R Datasheet

Cepheid Limitations

TARGETED SURVEILLANCE TESTING

Goal: Detect carbapenemase-producing Acinetobacter and mcr-1/2.

What is sent to MD PHL: Clinical isolates (no more than 25 per site/lab each month) and limited metadata.

Organisms of interest: Carbapenem-resistant Acinetobacter spp. and third-generation cephalosporin-resistant E. coli and Klebsiella spp. from any body site

Initial case detection location: Sentinel labs (1 per state)

Testing to be performed at MD PHL:

• Species identification by MALDI-TOF and ViteK 2
• Antimicrobial susceptibility testing (AST) for phenotypic confirmation of carbapenem-resistant Acinetobacter and third-generation cephalosporin-resistant extended-spectrum β-lactamase (ESBL)-producing E. coli and Klebsiella spp.
• CarbaNP assay to detect carbapenemases production in carbapenem-resistant Acinetobacter.
• Disk dilution and Broth microdilution to detect Extended-spectrum beta-lactamase (ESBL)-producing E. coli and Klebsiella spp.
• PCR (X-pert Carba-R) for Carbapenem-resistant Acinetobacter molecular targets (KPC, NDM, OXA-48-like, VIM and IMP) and for ESBL-producing E. coli and Klebsiella spp (MCR-1 /2)

 

Reporting:  The MD PHL will report mcr-1 and mcr-2 (and any other mcr gene tested), colistin resistance gene-positive isolates and carbapenemase-producing Acinetobacter to the submitting healthcare facility/lab, the jurisdictional HAI coordinator (submitting State PHL), and CDC within 24 hours of detection. Monthly summary reports will be submitted to CDC, jurisdictional state public health laboratories and HAI program coordinators via APHL portal and/or via secure communications.

 

• Targeted Surveillance Specimen Submission
  • [Re-uploading links in progress]
• Other Useful Documents

NON-BIG 3 (CP-CRE OTHER THAN KLEBSIELLA SPP., E. COLI AND ENTEROBACTER)

Goal: Determine the prevalence of CP in non-big -3 Carbapenem-resistant Enterobacteriaceae (CRE).

Organisms of interest: Carbapenem-resistant Enterobacteriaceae other than Klebsiella spp., E.coli and Enterobacter, (such as Proteus, Citrobacter, Providencia etc.)

Body sites: Any

What is sent to MDH: Clinical isolates

Case detection location: Sentinel labs

Testing to be performed at MDH:  

• Species identification by MALDI-TOF and ViteK 2.
• Antimicrobial susceptibility testing (AST) for phenotypic confirmation of carbapenem-resistant.
• CarbaNP assay to detect carbapenem-resistant Acinetobacter.
• PCR for Carbapenemases and MCR-1 /2.

 

Reporting:  MCR and CRAB results will be submitted to the submitting lab, jurisdiction HAI program, and CDC within 24 after detection. Monthly summary reports will be submitted to CDC, jurisdictional PHL and HAI program via ARLN portal

 

• NON-BIG 3 Specimen Submission
• Other Useful Documents

ENHANCED DETECTION OF DRUG-RESISTANT NEISSERIA GONORRHEA

Goal: Bacterial identification and antimicrobial susceptibility determination of confirmed gonorrhea isolates 

What is sent to MDH: Neisseria gonorrhea isolated from men with urethral discharge.

Organisms of interest: Neisseria gonorrhea initially identified at the sentinel site.

Body sites: Male urethra. (Isolates from other anatomical sites may be submitted under direction from CDC).  

Case detection location: Sentinel labs (selected STD clinics).

Testing to be performed at MDH: 

• MALDI-TOF for bacterial identification
• Antimicrobial susceptibility testing (AST) by Agar dilution 

 

Reporting:  AST results will be submitted to CDC on a monthly basis. Alert MICs will be reported to CDC DTSDP, submitting sentinel site, and the pertinent local and state STD program(s) within one working day. The same will apply for retested isolates.

 

• Gonorrhea Specimen Submission

N. Gonorrhea Testing Requisition Form

• Other Useful Documents

GC AR Lab Guidance

ARLN AMR REFERENCE TESTING

Goal: Act as a reference lab during outbreaks.  

When to send isolates to MDH for reference testing:

• Unique gene found in PCR (NDM, OXA, IMP, VIM)
• Phenotypic and Genotypic result discrepancy
• Outbreak of CRE/CRPA and further characterization warranted. 

What is sent to MD PHL Clinical isolates

Body sites: Any

Case detection location: State PH labs

Testing to be performed at MD PHL:

• PCR and AST results will be confirmed.
• Additional testing such as Whole Genome Sequencing (WGS) may also be performed.

 

Reporting:

 

• Specimen Submission for Reference Testing

Instructions for Isolate Submission - AMR Reference Testing

Reference Test Request Form

• Other Useful Documents

SHIPPING INFORMATION

Guidance on Using ARLN FedEx Account