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-  About the MHS        -  Accessibility     
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                                            Recent News Articles                                        -                      Apr 25, 2024                                    Full Military Pharmacy Operations Restored After Change Healthcare Cyberattack                 
-                      Apr 25, 2024                                    National Guard and Reserve Members: Explore Plan Options With This TRICARE Handbook                 
-                      Apr 24, 2024                                    Program Manager Continues Serving Military Members, Families, After Almost 40 Years                 
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                                            Upcoming Events                                        -  
May

4
  Immunization Lifelong Learners Short Course: Williamsburg/Yorktown, VA     
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May

14
  Immunization Lifelong Learners Course: Fort Moore, GA     
                                        Most Recent Updates                                    Articles
Full Military Pharmacy Operations Restored After Change Healthcare Cyberattack

 FALLS CHURCH, Virginia —The Defense Health Agency announced military pharmacies have returned to normal operations after a cyberattack on the nation’s largest commercial prescription processor, Change Healthcare.
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                                    Most Popular References                                -  Combat and Operational Stress 101 Part I - Understanding Stress and Taking Care of Yourself     
-  Military Acute Concussion Evaluation 2 (MACE 2)     
-  ABA Maximum Allowed Rates Effective May 1, 2024     
-  ABA Maximum Allowed Rates Effective May 1, 2023     
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#     Antimicrobial Resistant Infections Focus Area  

## Antimicrobial Resistant Infections Surveillance Activities

The Antimicrobial Resistant Infections Focus Area supports routine surveillance for high-threat pathogens and multidrug-resistant organisms associated with healthcare-associated and wound infections, sexually transmitted infections, and enteric infections.

The AMRI Focus Area's pathogens of interested are divided into three pathogen domains:

*ESKAPE+ Pathogens*
                - Enterococcus faecium
                - Staphylococcus aureus
                - Klebsiella pneumoniae
                - Acinetobacter baumannii
                - Pseudomonas aeruginosa
                - Enterobacter spp.
                - Escherichia coli
                - Candida auris

*Sexually Transmitted Infections*
                - Neisseria gonorrhoeae
                - Mycoplasma genitalium

*Enteric Infections*
                - Bacteria                       - Pathogenic Escherichia coli (ETEC, EAEC, EHEC, EPEC, EIEC)
                  - Shigella spp.
                  - Campylobacter spp.
                  - Nontyphoidal Salmonella  serotypes
                  - Salmonella typhi 
                - Viruses:                       - Norovirus
                  - Enteric Adenovirus
                  - Rotavirus 
                - Parasites:                       - Cryptosporidium species
                  - Giardia lamblia
                  - Entamoeba histolytica
                  - Cyclospora cayetanensis 

The AMRI Focus Area **END STATE** is increased global surveillance of MDROs and other militarily relevant infections, whether nosocomial, community-acquired, wound, sexually transmitted, or gastrointestinal. This End State will be achieved through an integrated and collaborative laboratory network conducting surveillance across human, animal, and environmental domains, ultimately to improve the health and readiness of U.S. military forces.

## Importance of AMR, STI, and Enteric Infection Surveillance

Antimicrobial resistance has been accelerated by inappropriate antibiotic use and infection control practices, overuse of antibiotics in non-healthcare contexts, 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. 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 infections. Multidrug-resistant organisms have been found to contaminate the wounds of injured U.S. personnel in military treatment facilities and the field, demonstrating that robust surveillance efforts are necessary to better understand and prevent these exposures. ESKAPE+ pathogens pose a particular threat due to their clinical relevance, virulence, capacity for developing drug-resistant genes, and ability to transfer drug-resistant genes to other bacteria.

As a population, U.S. military personnel tend to be young and sexually active. They have been shown to be at higher risk for contracting an STI compared to other groups, and the incidence of STIs among U.S. military personnel remains high. Some STIs, such as *Neisseria gonorrhoeae* and *Mycoplasma genitalium*, have demonstrated the capacity for dangerous drug resistance and warrant vigilant surveillance efforts to monitor for this threat.

U.S. military personnel deploy to austere environments where the risk of exposure to enteric diseases may be significant. In these environments, routine preventive health efforts are not always practical or sufficient and enteric diseases can rapidly spread through units. Enteric pathogens have played a significant role in the outcomes of military campaigns throughout history, and diarrheal illness continues to threaten operational capability through mission degradation, lost duty time, and propensity for causing outbreaks. Many of the causative bacterial enteric pathogens also have the capacity to develop drug resistance, further emphasizing their importance for surveillance efforts.

## AMRI Focus Area Surveillance Categories

                - Surveillance of ESKAPE+ pathogens via laboratory (strain-based) surveillance
                - Surveillance of ESKAPE+ pathogens from trauma-related infections
                - Surveillance of MDROs within the Military Health System
                - Surveillance of sexually transmitted infections
                - Surveillance of acute gastroenteritis and acute diarrhea
                - Surveillance of global travelers' diarrhea

## Key Reach Back Partners & Support

See what GEIS is doing to combat 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.

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