AMR surveillance projects address the epidemiology and mechanisms of resistance transmission for wound and healthcare-associated infections (HAI) and Neisseria gonorrhoeae (GC) through:

• Surveillance in the U.S. military, including recruit, shipboard, and deployed populations, and in foreign military and civilian populations
• Description of the disease burden and risk factors for militarily-relevant AMR pathogens
• Harmonization and standardization of Department of Defense AMR efforts with the Multidrug-resistant organism Repository and Surveillance Network (MRSN) and the GC Resistance Repository
• Advanced characterization of bacteria to analyze resistance and potential emerging resistance mechanisms

Importance of AMR Surveillance within the U.S. Military

AMR in bacteria has been accelerated by inappropriate antibiotic use and infection control practices, ineffective or absent surveillance systems and underdeveloped or non-existent mechanisms to ensure drug quality. In response to this growing public health concern, the White House issued an executive order followed by its National Action Plan (2020-2025) for Combating Antibiotic Resistant Bacteria (CARB). These documents mandate that U.S. government agencies work domestically and internationally, to mitigate this critical health and security threat.

As a globally positioned force, the U.S. military is at increased risk of exposure to AMR bacteria. Multidrug-resistant organisms have been identified as contaminants of wounds of injured U.S. personnel in military treatment facilities and in the field, demonstrating that robust surveillance efforts are necessary to better understand and prevent these exposures.

AMR Focus Area Strategy

• Provide timely, accurate, and actionable AMR surveillance data for decision makers within the Department of Defense and global public health community
• Fill a surveillance gap by focusing on surveillance of resistant wound infections and HAIs
• Support surveillance of AMR in both U.S. and overseas laboratories, which includes specialized laboratories, medical treatment facilities within the Military Health System, and collaboration with partner nations
• Incorporate the One Health initiative into surveillance to understand the risk factors for transmission of and exposure to AMR bacteria
  • One Health seeks to improve the lives of all species through the integration of human medicine, veterinary medicine, and environmental science. The GEIS One Health focus is to estimate and predict the risk of human disease by conducting surveillance in animal populations or the environment.
• Provide support for outbreaks of AMR bacteria, as requested by U.S. government or partners

Pathogens of interest include:

Multidrug-resistant organisms (as defined by resistance to representative agents within three antimicrobial classes), ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Carbapenem-resistant Enterobacteriaceae (CRE) and other gram-negative pathogens, Methicillin and vancomycin non-susceptible Staphylococcus aureus (MRSA, VISA, VRSA), Clostridium difficile infections, resistant Neisseria gonorrhoeae, and Mycoplasma species.

AMR Focus Area Activities

• AMR surveillance in U.S. military members in all Geographic Combatant Commands, including recruits, shipboard, and deployed populations, and those based in hospital and outpatient settings
• Surveillance of HAI and wound infections in nearly 20 countries throughout Africa, Asia, South America, North America and Europe
• Studies designed to analyze resistance and/ or virulence genes and markers persisting or emerging in AMR pathogens by using advanced molecular methods such as next-generation sequencing

What's New in the AMR Focus Area for FY20

The AMR focus area provides approximately $9.9 million of funding to support partner projects, which includes funding from GEIS and the CARB initiative.

New projects include:

• Surveillance of high-risk populations (i.e., commercial sex workers and men who have sex with men) for STI studies in multiple locations within the GEIS network
• Enhanced surveillance of wound infections associated with blast injuries
• Enhanced surveillance of AMR patterns in Mycoplasma genitalium
• Surveillance by Georgetown University to address a data gap of carbapenem and colistin resistance in FHP-strategic countries within Southeast Asia and sub-Saharan Africa

Where We're Going

• Enhancing the focus on secondary verification of presumptive resistant organisms
• Expanding global comparison of resistance patterns
• Improving the evaluation of the spread, scope, and severity of AMR to inform the effect on diminishing choices for effective therapy

See what GEIS is doing to combat enteric infections, febrile and vector-borne infections, and respiratory infections.

If you are involved with the Department of Defense medical community and are interested in partnering with GEIS, or if you would like more information, please contact us.