AR Lab Network | Wisconsin State Laboratory of Hygiene

The Wisconsin State Laboratory of Hygiene (WSLH) is proud to be 1 of 7 Regional Laboratories for the Antibiotic Resistance (AR) Laboratory Network.

The AR Lab Network was established in 2016 to help identify, respond to, and prevent antibiotic resistance in the United States. As a Regional Lab, the WSLH performs comprehensive testing on antimicrobial resistant organisms for the state of Wisconsin, as well as select testing for other states in the Midwest Region of the AR Lab Network: Kentucky, Illinois, Indiana, Michigan, and Ohio.

CDC’s AR Lab Network

Wisconsin Division of Public Health – Reportable MDROs

AR Lab Network Midwest Report 2023

APHL Modules on Colonization Screening for Multidrug-Resistant Organisms (MDROs) in Healthcare Facilities

Carbapenem-Resistant Enterobacterales

Specimen collection and submission instructions	Isolates submitted on agar slants Include copy of susceptibility results performed in your laboratory
Pre-approval required?	No
Isolates accepted	Any Enterobacterales species that tested resistant to one or more carbapenems (ertapenem, doripenem, meropenem or imipenem)
WSLH Testing Methodology	Species identification using MALDI-TOF mass spectrometry Antibiotic susceptibility testing via broth microdilution Modified Carbapenemase Inactivation Method (mCIM) to detect presence of carbapenemases Identification of select resistance mechanisms when carbapenemases are detected by mCIM
Turnaround Time	1 week
Contact	Ann Valley, 608-224-4246
Notifiable Conditions Information	Carbapenemase producing Enterobacterales is a reportable condition in Wisconsin. Please report any confirmed cases to the Local Health Department and the Wisconsin HAI Program at 608-267-7711 or DHSWIHAIPreventionProgram@dhs.wisconsin.gov

Carbapenemase-producing carbapenem-resistant Enterobacterales colonization screening

Specimen collection and submission instructions	Collection Kits will be provided by WSLH when testing is approved Rectal swabs must be tested within 5 days of collection Axilla/groin swabs should be shipped on ice and tested within 4 days for axilla/groin swabs Tracheostomy swabs from ventilated patients. Specimens should be shipped on ice and tested within 4 days of collection
Pre-approval required?	Yes, prior approval needed from state HAI program
Specimens accepted	Rectal swabs from provided collection kits Axilla/groin swabs from provided collection kits
WSLH Testing Methodology	CARBA-R PCR and/or culture test for presence of select carbapenemases (KPC, NDM, VIM, OXA, IMP)
Turnaround Time	2 days for CARBA-R, 5 days for culture
Contact	If you would like to conduct a screening for CP-CRE, please contact the Wisconsin HAI Program at 608-267-7711 or DHSWIHAIPreventionProgram@dhs.wisconsin.gov

Carbapenem-Resistant Acinetobacter baumannii Colonization Screening (CRAB)

Specimen collection and submission instructions	Collection Kits will be provided by WSLH when testing is approved Rectal swabs must be tested within 5 days of collection Axilla/groin swabs should be shipped on ice and tested within 4 days of collection Tracheostomy swabs from ventilated patients. Specimens should be shipped on ice and tested within 4 days of collection
Pre-approval required?	Yes, prior approval needed from state HAI program
WSLH Testing Methodology	Culture with PCR to determine the presence of select resistance mechanisms
Turnaround Time	Up to 7 days
Contact	If you would like to conduct a screening for CRAB, contact the Wisconsin HAI program at DHSWIHAIPreventionProgram@dhs.wisconsin.gov or 608-267-7711

Carbapenem-Resistant Pseudomonas aeruginosa

Specimen collection and submission instructions	Isolates submitted on agar slants Include copy of susceptibility results performed in your laboratory
Pre-approval required?	No
Isolates accepted	Pseudomonas aeruginosa isolates that are resistant to a carbapenem (doripenem, imipenem, meropenem) and non-susceptible to cefepime and/or ceftazadime NOTE: Other species may be accepted on a case by case basis
WSLH Testing Methodology	Species identification using MALDI-TOF mass spectrometry Antibiotic susceptibility testing via broth microdilution Modified Carbapenemase Inactivation Method (mCIM) to detect presence of carbapenemases PCR tests for presence of select resistance mechanisms when carbapenemases are detected by mCIM
Turnaround Time	1 week
Contact	Ann Valley, 608-224-4246

Candida species confirmation/speciation and antifungal susceptibility testing

Specimen collection and submission instructions	Isolates submitted on agar slants Isolates may be stored for 2-3 weeks for batch submission
Pre-approval required?	Not required
Isolates accepted	Any confirmed or suspected Candida auris isolates (See what species auris is commonly misidentified as) Candida glabrata from normally sterile sites (including serial glabrata isolates from patients receiving antifungal treatment Multi-drug resistant Candida isolates Unusual Candida species (any species other than albicans, C. parapsilosis, C. dubliniensis, C. lusitaniae, C. tropicalis, C. krusei) Any Candida species that was unable to be identified after a validated method was attempted
WSLH Testing Methodology	Species identification using MALDI-TOF mass spectrometry Antifungal susceptibility testing via broth microdilution (azoles and echinocandins) Amphotericin B susceptibility testing using Etest strips Testing performed for surveillance. MIC results provided upon request.
Turnaround Time	1 week for species identification
Contact	Ann Valley, 608-224-4246
Notifiable Conditions Information	Candida auris is a reportable condition in Wisconsin. Please report any confirmed cases to the Local Health Department and the Wisconsin HAI Program at 608-266-0915 or 608-267-7711
Other Information	AR Lab Network Candida fact sheet

Candida auris screening/colonization

Specimen collection and submission instructions	Collection kits provided by WSLH when testing is approved Axilla/groin swabs must be tested within 7 days of collection
Pre-approval required?	Yes, prior approval needed with state HAI program.
Specimen type	Collect from patient’s axilla and/or groin
WSLH Testing Methodology	PCR Selective enrichment broth to isolate Candida auris Species identification using MALDI-TOF mass spectrometry
Turnaround Time	2 days for PCR, Up to 10 days for culture
Contact	If you would like to conduct a screening for Candida auris, please contact Wisconsin HAI Program at 608-267-7711 or DHSWIHAIPreventionProgram@dhs.wisconsin.gov

Carbapenem-Resistant Acinetobacter baumannii – Targeted Surveillance

Specimen collection and submission instructions	Isolates submitted on agar slants Include copy of susceptibility results performed in your laboratory
Pre-approval required?	Not required
Isolates Accepted	Acinetobacter baumannii isolates resistant to any carbapenem (doripenem, imipenem, meropenem)
WSLH Testing Methodology	Species identification using MALDI-TOF mass spectrometry Antibiotic susceptibility testing via broth microdilution PCR tests for presence of carbapenemases
Turnaround Time	1 week
Contact	Ann Valley, 608-224-4246
Notifiable Conditions Information	Carbapenemase producing Acinetobacter baumannii is a reportable condition in Wisconsin. Please report any confirmed cases to the Local Health Department and the Wisconsin HAI Program at 608-267-7711 or DHSWIHAIPreventionProgram@dhs.wisconsin.gov

Expanded Drug Testing for Hard-to-Treat Infections

Specimen collection and submission instructions	Isolates submitted on agar slants Include copy of susceptibility results performed in your laboratory
Test Code	MP00696
Pre-approval required?	Yes Submit completed AR Expanded AST Request Form (Excel file) for approval to: Email: wiarln@slh.wisc.edu Fax: 1-844-390-6233
Isolates accepted	Enterobacteriaceae isolates that: Test non-susceptible to all beta-lactams, including either ceftazidime-avibactam or meropenem-vaborbactam. -OR- Enterobacteriaceae possessing NDM, VIM, or IMP genes confirmed by a molecular test and are highly resistant to all or the majority of antimicrobial agents already tested.
WSLH Testing Methodology	Antibiotic susceptibility testing via broth microdilution
Turnaround Time	3 days
Contact	wiarln@slh.wisc.edu 1-800-862-1013
Other Information	CDC Fact Sheet: Expanded Antimicrobial Susceptibility Testing for Hard-to-Treat Infections Updated 5/29/19