A key factor in any state’s ability to detect, monitor and control antimicrobial resistance is laboratory capacity. In Michigan, the state public health laboratory routinely monitors antimicrobial resistance only in targeted organisms (Mycobacterium tuberculosis, Neisseria gonorrhoeae, and Salmonella species). Currently, the detection and control of most infections caused by resistant organisms is largely dependent on activities that occur in private sector patient care facilities, with passive reporting of outbreaks or unusual occurrences to public health authorities. The increasing dependence on automated instrumentation in clinical laboratories is a concern; these instruments may not detect a new pattern or mechanism of resistance, and fewer hospital microbiologists maintain manual skills to recognize them. The Michigan public health laboratory has provided support to assure the quality of and strengthen the capacity for testing in private sector laboratories by offering antibiotic resistance education programs and limited surveillance in the past. Although funding for these activities has been inconsistent, the state in 2009 hired a full-time antimicrobial resistance microbiologist to continue and expand best practices.
Michigan’s public health laboratory has technical capability for testing antimicrobial resistance in other organisms. Targeted funding for reagents and equipment to detect and characterize emerging resistance patterns, including implementation of molecular testing methods, is needed to expand the detection, monitoring and surveillance of antimicrobial resistance.
1Dr. Fred Tenover, quoted in “The Bacteria Fight Back” Science, July 18, 2008. 2R. Monina Kleevens et al. “Invasive Methicillin-resistant Staphylococcus aureus Infections in the United States,” JAMA, October 17, 2007: 1763-1771.3Elixhauser, A. and Steiner, C. Infections with Methicillin-Resistant Staphylococcus Aureus (MRSA) in U.S. Hospitals, 1993–2005. HCUP Statistical Brief #35. July 2007. Agency for Healthcare Research and Quality.4Finks J, Wells E, Dyke TL, Husain N, Plizga L, Heddurshetti R, et al. Vancomycin-resistant Staphylococcus aureus, Michigan, USA, 2007. Emerg Infect Dis. 2009 June 5Dr. Fred C. Tenover, “Vancomycin-Resistant Staphylococcus aureus: A Perfect but Geographically Limited Storm?,” Clinical Infectious Diseases, March 1, 2008; 46:675-76CDC MMWR “Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities” March 20, 2009 / Vol. 58 / No. 107K. F. Anderson, et al.; Evaluation of Methods To Identify the Klebsiella pneumoniae Carbapenemase in Enterobacteriaceae; Journal of Clinical Microbiology, August 2007, p. 2723-2725, Vol. 45, No. 88CDC Wonder Death Certificate Data, cited in a July 28, 2008 communication to Senator Sherrod Brown9Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), Agency for Healthcare Research and Quality, http://www.hcupnet.ahrq.gov/, cited in a July 28, 2008 communication from CDC to Senator Sherrod Brown
STATE CONTACT:State EpidemiologistCorrine Miller, PhDMillerCori@michigan.gov
Michigan AR Fact Sheet
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