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Multi-Drug Resistance Organism (MDRO) Testing

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The Microbiology section provides routine antimicrobial susceptibility testing (AST) for most organisms, including confirming drug resistance to MDRO (i.e. methicillin resistant Staphylococcus aureus, otherwise known as MRSA, or Vancomycin resistant Enterococcus, known as VRE). Any concerns regarding atypical drug resistance, please contact The Delaware Public Health Laboratory (DPHL) for additional support. The section receives federal funding to partner with acute and long-term care facilities against antimicrobial resistance (AMR). The Centers for Disease Control and Prevention (CDC) published a comprehensive analysis outlining the top 18 antibiotic-resistant threats in the U.S., titled Antibiotic Resistance Threats in the United States, 2013.

The funding that DPHL receives is currently used to test carbapenem resistant Enterobacteriaceae (CRE) and carbapenem resistant Pseudomonas aeruginosa (CRPA), organisms classified as urgent threats in the 2013 CDC report. The testing is to identify mutations within the bacteria that allow AMR genes to share between different bacteria.

DPHL screens for resistance mechanisms using the modified Carbapenemase Inactivation Method (mCIM). A positive mCIM reflexes to a PCR test for the following plasmid mediated resistance mechanisms:

  • Respiratory (sputum, bronchoalveolar lavage, bronchiolar washing, induced sputum, etc.)
  • Klebsiella pneumoniae carbapenemase (KPC)
  • New Delhi metallo-beta-lactamase (NDM)
  • Verona integron-encoded metallo-beta-lactamase (VIM)
  • Oxacillinase (OXA)-48 like

Additional antibiotic resistance testing of these organisms, collectively known by the media as "nightmare bacteria", is performed using varying classes of antibiotics, including Colistin, a drug of last choice. These organisms are submitted from acute and long-term healthcare facility laboratories. Any healthcare settings that identify MDRO, please contact OIDE or DPHL for additional action. The Microbiology Section remains compliant with the Department of Transportation (DOT) to package and ship infectious MDRO for additional testing to regional and federal partners. Part of our MDRO funding is used to foster collaboration with our state, regional, and federal partners. This includes working with the Office of Infectious Disease Epidemiology (OIDE) and infection control partners to prevent spread of these nightmare bacteria within the Delaware community. We also coordinate with (CDC) and public health laboratories through the Antimicrobial Resistance Laboratory Network (ARLN) to share real-time information of newly discovered nightmare bacteria in an effort to reduce the spread of AMR. The Delaware State Public Health Laboratory is part of the Mid-Atlantic region of the ARLN. Coordination with our regional partners, Maryland Department of Health Laboratories Administration, provides additional services routinely not requested by submitters, including:

  • Neisseria gonorrhoeae antibiotic susceptibility testing
  • Identification of Candida auris, and emerging resistant pathogen
  • Colonization testing for targeted MDRO found in the region.

Maryland Laboratories Administration and DPHL partner with local submitters to provide targeted surveillance for Acinetobacter baumanii complex that are non-susceptible to carbapenems and Carbapenem susceptible E. coli and K. pneumoniae that are extended spectrum beta lactamase (ESBL) or third generation cephalosporins for resistance markers to Colistin.

Additional information about ARLN can be found here.


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