Texas Antimicrobial Resistance (AR) Laboratory Network
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Texas Antimicrobial Resistance (AR) Laboratory Network
Antimicrobial resistance (AR) is one of the greatest global health challenges of our time. The Antimicrobial Resistance Laboratory Network (ARLN) leads the fight by providing advanced testing and surveillance to emerging threats. This network of laboratories, public health agencies, and healthcare providers prevents the spread of AR organisms by gathering critical data that shapes local and national strategies, protecting lives and slowing the rise of antimicrobial resistance.
- Questions? Reach out to TexasARLN@dshs.texas.gov for more information.
AR Isolate Testing and Submission Criteria
We are recruiting isolates of Carbapenem Resistant Enterobacterales (CRE), Carbapenem Resistant Pseudomonas aeruginosa (CRPA), Carbapenem Resistant Acinetobacter baumannii (CRAB), and suspected resistant or difficult to treat Neisseria gonorrhoeae (GC). Submission of these targeted organisms significantly enhances our network’s ability to gather essential data for combating antimicrobial resistance.
- It is mandatory to report positive results of Candida auris and CRE E. coli and Klebsiella species to a disease reporting contact (epidemiologist). Additionally, for positive Candida auris results, it is mandatory to submit an isolate to DSHS Laboratory. Learn more about all notifiable conditions and mandatory isolate submissions.
- Always include any prior Antimicrobial Susceptibility Test (AST) reports or other relevant laboratory results with isolate submissions.
- Please review our FAQ section about duplicate isolate submission criteria.
Please forward CRE isolates that meet the following criteria:
| Organism | Antimicrobial Resistance | CLSI Break Points |
|---|---|---|
| All Enterobacterales e.g., Escherichia coli, Klebsiella oxytoca, K. pneumoniae, Citrobacter, Enterobacter spp, and Serratia spp etc. | Resistant to any Imipenem, Meropenem, or Ertapenem |
|
| Providencia spp, Proteus spp, and Morganella spp | Resistant to any Meropenem, or Ertapenem |
|
*CLSI M100-ED34:2024
Tests offered:
- MALDI-TOF mass spectrometry ID Confirmation
- Antimicrobial susceptibility testing (AST)
- Modified Carbapenem Inactivation Method (mCIM)
- Real-time polymerase chain reaction (PCR)
- Next Generation Sequencing (NGS)
Transport Media for Isolates:
- Any non-inhibitory, non-selective agar plate, slant (e.g., Sheep Blood Agar, Tryptic Soy Agar, etc.), or broth.
- Slant tubes are preferred (if available) because they are more stable during shipping and less likely to break.
Transport Temperature:
- 2-8⁰C or ambient.
Submit CRE isolates using submission form G-2E. Updated submission forms can be requested from LabInfo@dshs.texas.gov.
- Section 1. Submitter
- Prefilled for your facility to match our records. To establish or update submitter information, please complete a Submitter ID Request Form and email to LabInfo@dshs.texas.gov or fax to (512) 776-7533.
- Section 2. Patient
- Name on form must match specimen EXACTLY or the specimen may be rejected. Three unique identifiers (e.g., Name, DOB, Unique ID) are recommended. These identifiers must match exactly on both the form and specimen.
- Section 3. Specimen
- Date and time of collection is required, or the specimen may be rejected.
- Section 4. TEST REQUEST
- Select: Box 1 Isolate Testing.
- Print/write the name of the organism.
- Select isolate test: CRE: Carbapenem Resistant Enterobacterales.
- If a test is not selected or the organism is not written, the specimen may be rejected.
- Section 7. Collection Site
- This section is used by the AR Laboratory to contact the facility and/or local health provider directly for troubleshooting issues and providing notifications. Sometimes, the location where the specimen was collected is different from the submitter detailed in Section 1. Section 7 allows this distinction to be made so that we can quickly contact the most relevant individual.
- For example, a reference laboratory is submitting an isolate to the state laboratory that was originally collected at a skilled nursing facility. The reference lab’s info will be in Section 1 and the nursing facility’s info should be added in Section 7. See our FAQ section for more examples.
Please forward CRPA isolates that meet the following criteria:
| Organism | Resistant to at least one | AND non-susceptible (intermediate or resistant) to | CLSI Break Points |
|---|---|---|---|
| P. aeruginosa | Imipenem, Meropenem, | Cefepime, Ceftazidime, Ceftolozane/Tazobactam |
|
* CLSI M100-ED34:2024
Tests offered:
- MALDI-TOF mass spectrometry ID Confirmation
- Antimicrobial susceptibility testing (AST)
- Modified Carbapenem Inactivation Method (mCIM)
- Real-time polymerase chain reaction (PCR)
- Next Generation Sequencing (NGS)
Transport Media for Isolates:
- Any non-inhibitory, non-selective agar plate, slant (e.g., Sheep Blood Agar, Tryptic Soy Agar), or broth
- Slant tubes are preferred (if available) because they are more stable during shipping and less likely to break.
Transport Temperature:
- 2-8⁰C or ambient.
Submit CRPA isolates using submission form G-2E. Updated submission forms can be requested from LabInfo@dshs.texas.gov.
- Section 1. Submitter
- Prefilled for your facility to match our records. To establish or update submitter information, please complete a Submitter ID Request Form and email to LabInfo@dshs.texas.gov or fax to (512) 776-7533.
- Section 2. Patient
- Name on form must match specimen EXACTLY or the specimen may be rejected. Three unique identifiers (e.g., Name, DOB, Unique ID) are recommended. These identifiers must match exactly on both the form and specimen.
- Section 3. Specimen
- Date and time of collection is required, or the specimen may be rejected.
- Section 4. TEST REQUEST
- Select: Box 1 Isolate Testing.
- Print/write the name of the organism.
- Select isolate test: CRPA: Carbapenem Resistant Pseudomonas aeruginosa.
- If a test is not selected or the organism is not written, the specimen may be rejected.
- Section 7. Collection Site
- This section is used by the AR Laboratory to contact the facility and/or local health provider directly for troubleshooting issues and providing notifications. Sometimes, the location where the specimen was collected is different from the submitter detailed in Section 1. Section 7 allows this distinction to be made so that we can quickly contact the most relevant individual.
- For example, a reference laboratory is submitting an isolate to the state laboratory that was originally collected at a skilled nursing facility. The reference lab’s info will be in Section 1 and the nursing facility’s info should be added in Section 7. See our FAQ section for more examples.
Please forward CRAB isolates that meet the following criteria:
| Organism | Antimicrobial Resistance | CLSI Break Points* |
|---|---|---|
| Acinetobacter baumannii complex | resistant to Imipenem, or Meropenem. |
|
*CLSI M100-ED34:2024
Tests offered:
- MALDI-TOF mass spectrometry ID Confirmation
- Antimicrobial susceptibility testing (AST)
- Real-time polymerase chain reaction (PCR)
- Next Generation Sequencing (NGS)
Transport Media for Isolates:
- Any non-inhibitory, non-selective agar plate, slant (e.g., Sheep Blood Agar, Tryptic Soy Agar), or broth
- Slant tubes are preferred (if available) because they are more stable during shipping and less likely to break.
Transport Temperature:
- 2-8⁰C or ambient.
Submit CRAB isolates using submission form G-2E. Updated submission forms can be requested from LabInfo@dshs.texas.gov.
- Section 1. Submitter
- Prefilled for your facility to match our records. To establish or update submitter information, please complete a Submitter ID Request Form and email to LabInfo@dshs.texas.gov or fax to (512) 776-7533.
- Section 2. Patient
- Name on form must match specimen EXACTLY or the specimen may be rejected. Three unique identifiers (e.g., Name, DOB, Unique ID) are recommended. These identifiers must match exactly on both the form and specimen.
- Section 3. Specimen
- Date and time of collection is required, or the specimen may be rejected.
- Section 4. TEST REQUEST
- Select: Box 1 Isolate Testing.
- Print/write the name of the organism.
- Select isolate test: CRAB: Carbapenem Resistant Acinetobacter.
- If a test is not selected or the organism is not written, the specimen may be rejected.
- Section 7. Collection Site
- This section is used by the AR Laboratory to contact the facility and/or local health provider directly for troubleshooting issues and providing notifications. Sometimes, the location where the specimen was collected is different from the submitter detailed in Section 1. Section 7 allows this distinction to be made so that we can quickly contact the most relevant individual.
- For example, a reference laboratory is submitting an isolate to the state laboratory that was originally collected at a skilled nursing facility. The reference lab’s info will be in Section 1 and the nursing facility’s info should be added in Section 7. See our FAQ section for more examples.
| Organism | Antibiotic Resistance | CLSI Break Points* |
|---|---|---|
| Neisseria gonorrhoeae |
|
|
*CLSI M100-ED34:2024
Tests Offered:
- Ceftriaxone susceptibility (ETest)
- Ciprofloxacin susceptibility
- MALDI-TOF mass spectrometry
- Beta lactamase detection.
- Azithromycin and Cefixime susceptibility (for research use only)
Transport Media for Isolates:
- Chocolate agar slants
Clinical Specimen Types
- Rectal swab
- Vaginal swab
- Endocervical swab
- Urethral swab
- Oral swab
- Rectal swab
- Nasopharyngeal swab
- Penile Meatal swab
- Conjunctival swab (neonates)
Transport Temperature:
- Ambient
- Note: This organism has a very limited testing window of 24 hrs after collection. We recommend collecting in the afternoon and shipping that same afternoon.
Submit GC AST specimens using submission form G-2B. Updated submission forms can be requested from LabInfo@dshs.texas.gov.
- Section 1. Submitter
- Prefilled for your facility to match our records. To establish or update submitter information, please complete a Submitter ID Request Form and email to LabInfo@dshs.texas.gov or fax to (512) 776-7533.
- Section 2. Patient
- Name on form must match specimen EXACTLY or the specimen may be rejected. Three unique identifiers (Name, DOB, Unique ID) are recommended. These identifiers must match exactly on the form and specimen.
- Section 3. Specimen
- Date and time of collection is required, or the specimen may be rejected.
- Note: this specimen must be tested within 24 hrs of collection.
- Section 4. TEST REQUEST
- Section 4.1: Select Neisseria gonorrhoeae (GC) AST.
- If the test request is not selected, the specimen may be rejected.
- Section 4.1: Select Neisseria gonorrhoeae (GC) AST.
- Section 6. Payor Source
- Select box “Other” and write “CDC Special Project (14)” on the blank line.
Recommended Isolates:
- At least one viable colony of C. auris.
- MALDI-TOF mass spectrometry
- Whole Genome Sequencing (WGS)
Transport Media for Isolates
- Sabouraud’s Dextrose Agar slant or other appropriate media. CHROMagarTM Candida plates, if available, are best for isolation.
Recommended Clinical Specimen Types
- Rectal swab
- Axilla/Groin swab
- Axilla and groin should be swabbed together using one swab
- Nares swab
- Oropharynx swab
- External ear swab
- Vaginal swab
Submit Candida isolates using submission form G-2E. Updated submission forms can be requested from LabInfo@dshs.texas.gov.
- Section 1. Submitter
- Prefilled for your facility to match our records. To establish or update submitter information, please complete a Submitter ID Request Form and email to LabInfo@dshs.texas.gov or fax to (512) 776-7533.
- Section 2. Patient
- Name on form must match specimen EXACTLY or the specimen may be rejected. Three unique identifiers (Name, DOB, Unique ID) are recommended. These identifiers must match exactly on both the form and specimen.
- Patient’s sex is required for reporting purposes.
- Section 3. Specimen
- Date and time of collection is required, or the specimen may be rejected.
- Section 4. TEST REQUEST
- Select: Box 1 Isolate Testing.
- Print/write the name of the organism.
- Select isolate test: Candida identification by MALDI.
- If a test is not selected or the organism is not written, the specimen may be rejected.
- Section 7. Collection Site
- This section is used by the AR Laboratory to contact the facility and/or local health provider directly for troubleshooting issues and providing notifications. Sometimes, the location where the specimen was collected is different from the submitter detailed in section 1. Section 7 allows this distinction to be made so that we can quickly contact the most relevant individual.
- For example, a reference laboratory is submitting an isolate to the state laboratory that was originally collected at a skilled nursing facility. The reference lab’s info will be in section 1 and the nursing facility’s info should be added in section 7. See our FAQ section for more examples.