Form HAIC.400.3 2024 HAIC Multi-site Gram-negative Surveillance Initiati

Form approved
OMB No. 0920-0978

2024 HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance
Officer Survey
Please answer the following questions for the year 2024, unless otherwise specified. The purpose of the
survey is to verify and document current surveillance procedures, including isolate collection and testing
methods at clinical laboratories. Please enter your responses into the corresponding REDCap database. If
you have questions, please contact Julian Grass (hij3@cdc.gov) and Joshua Brandenburg (ode4@cdc.gov).

Site: ___ CA ___ CO ___ CT ___ GA ___ MD ___ MI___ MN ___ NM ___ NY ___ OR ___ TN
Person(s) Completing the Form: ___________________________
Please note that the information collected in the sections below about specific MuGSI pathogens should
only be completed for those sites that participate in those surveillance activities.
Surveillance Area Characteristics
1.

What counties are under surveillance for MuGSI activities at your site?
a. Carbapenem-resistant Enterobacterales (CRE) surveillance area, please
specify:______________________________________________________________
b. Carbapenem-resistant Acinetobacter baumannii (CRAB) surveillance area, please
specify:______________________________________________________________
c. Extended-spectrum β-lactamases-producing Enterobacterales (ESBL-E) surveillance
area, please specify:____________________________________________________
d. Invasive Escherichia coli (iEC) surveillance area, please specify:
____________________________________________________________________

2. Is CRE reportable at your state/site? ___ yes

___ no

a. If yes:
i. Please describe your state reportable definition of CRE:______________
ii. Where in your state is CRE reportable?
_______ Statewide
_______ Defined area, such as a county(ies). Please specify__________
iii. Is isolate submission to the State Health Department Laboratory required?
_______ yes _______ no
specify __________________
b. If no:
i. What mechanism do you have in place that allows for surveillance officers (SOs)
to have access to CRE laboratory reports and medical records?
_______ Agent of the state
_______ State Health Department Regulation
_______ Other, please explain: __________________________________
ii. Does your state/site plan to make CRE reportable? ___ yes ___ no ___ unknown
1. If yes, when does your state/site plan to make CRE reportable?
Public reporting burden of this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it displays a current valid OMB control number. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Rd NE, MS D-74, Atlanta, Georgia 30329;
ATTN: PRA (0920-0978)

____________________________________________________________
3.

Is CRAB reportable at your state/site? ___ yes

___ no

a. If yes:
i. Please describe your state reportable definition of CRAB:______________
ii. Where in your state is CRAB reportable?
_______ Statewide
_______ Defined area, such as a county(ies). Please specify__________
iii. Is isolate submission to the State Health Department Laboratory required?
_______ yes
_______ no
b. If no:
i. What mechanism do you have in place that allows for SOs to have access to
CRAB laboratory reports and medical records?
_______ Agent of the state
_______ State Health Department Regulation
_______ Other, please explain: __________________________________
ii. Does your state/site plan to make CRAB reportable? ___ yes ___ no ___
unknown
1. If yes, when does your state/site plan to make CRAB reportable?
_______________________________________________________
4. Is ESBL-E reportable at your state/site? ___ yes

___ no

a. If yes:
i. Please describe your state reportable definition of ESBL-E:______________
ii. Where in your state is ESBL-E reportable?
_______ Statewide
_______ Defined area, such as a county(ies). Please specify__________
iii. Is isolate submission to the State Health Department Laboratory required?
_______ yes
_______ no
b. If no:
i. What mechanism do you have in place that allows for SOs to have access to
ESBL-E laboratory reports and medical records?
_______ Agent of the state
_______ State Health Department Regulation
_______ Other, please explain: __________________________________
ii. Does your state/site plan to make ESBL-E reportable? ___ yes ___ no ___
unknown
1. If yes, when does your state/site plan to make ESBL-E reportable?
____________________________________________________________

5. Is iEC reportable at your state/site? ___ yes ___ no
a. If yes:
i. Please describe your state reportable definition of iEC:______________
ii. Where in your state is iEC reportable?
_______ Statewide
_______ Defined area, such as a county(ies). Please specify__________
iii. Is isolate submission to the State Health Department Laboratory required?
_______ yes
_______ no
b. If no:
i. What mechanism do you have in place that allows for SOs to have access to iEC
laboratory reports and medical records?
_______ Agent of the state
_______ State Health Department Regulation
_______ Other, please explain: __________________________________
ii. Does your state/site plan to make iEC reportable? ___ yes ___ no ___ unknown
1. If yes, when does your state/site plan to make IEC reportable?
_______________
Laboratory Participation and Isolate Testing – Part 1
1. Please describe the clinical laboratories in the MuGSI catchment area:
a. CRE
i. Proportion of clinical laboratories serving the MuGSI CRE surveillance area with
queries installed on their automated testing instrument (ATI) or laboratory
information system (LIS): ___________________
ii. Numerator: Number of clinical laboratories serving the MuGSI CRE surveillance
area with queries installed on their ATI or LIS: ___________________
iii. Denominator: Total number of clinical laboratories that receive and process
specimens from residents of the MuGSI CRE surveillance area:______________
iv. Please describe how MuGSI CRE surveillance is conducted at laboratories where
ATI/LIS queries are not installed (e.g., HL7 messages from LabCorp):
__________________________________________________________________
b. CRAB
i. Proportion of clinical laboratories serving the MuGSI CRAB surveillance area
with queries installed on their ATI or LIS: ___________________
ii. Numerator: Number of clinical laboratories serving the MuGSI CRAB
surveillance area with queries installed on their ATI or LIS: _________________
iii. Denominator: Total number of clinical laboratories that receive and process
specimens from residents of the MuGSI CRAB surveillance area: _____________
iv. Please describe how MuGSI CRAB surveillance is conducted at laboratories
where ATI/LIS queries are not installed (e.g., HL7 messages from LabCorp):
__________________________________________________________________
c. ESBL-E
i. Proportion of clinical laboratories serving the MuGSI ESBL-E surveillance area
with queries installed on their ATI or LIS: ___________________

ii. Numerator: Number of clinical laboratories serving the MuGSI ESBL-E
surveillance area with queries installed on their ATI or LIS: _________________
iii. Denominator: Total number of clinical laboratories that receive and process
specimens from residents of the MuGSI ESBL-E surveillance area:____________
iv. Please describe how MuGSI ESBL-E surveillance is conducted at laboratories
where ATI/LIS queries are not installed (e.g., HL7 messages from LabCorp):
__________________________________________________________________
d. iEC
i. Proportion of clinical laboratories serving the MuGSI iEC surveillance area with
queries installed on their ATI or LIS: ___________________
ii. Numerator: Number of clinical laboratories serving the MuGSI iEC surveillance
area with queries installed on their ATI or LIS: ___________________
iii. Denominator: Total number of clinical laboratories that receive and process
specimens from residents of the MuGSI iEC surveillance area:______________
iv. Please describe how MuGSI iEC surveillance is conducted at laboratories where
ATI/LIS queries are not installed (e.g., HL7 messages from LabCorp):
_________________________________________________________________
2. Did any laboratories drop out of participation in 2023? _______ yes

_______ no

a. If yes, how many? _________
b. Why did these laboratories drop out of participation?
________________________________________________________________________
________________________________________________________________________
3. In 2023, did you identify additional laboratories, regardless of location, which identify MuGSI
isolates from persons who are residents of the MuGSI surveillance area at your site?
_______ yes
_______ no
a. If yes, how many? _________
b. If yes, how many of these laboratories were added? _______
i. If all new laboratories identified were not added, why not?
__________________________________________________________________
__________________________________________________________________
c. If yes, how did you identify these new laboratories?
_____________________________________________________________________
d. Approximately how many cases are identified at the new laboratories each year among
residents of the MuGSI surveillance area? ________
4. Did your site send any MuGSI isolates to CDC for characterization in calendar year 2023?
_______ yes _______ no
a. If yes, please describe how your site determines which MuGSI isolates to send to CDC:
i. CRE: _____________________________________________________________
ii. CRAB: ___________________________________________________________
iii. ESBL: ____________________________________________________________
iv. iEC: ____________________________________________________________
b. If yes, how many clinical laboratories contributed MuGSI isolates:
i. CRE: _____________________________________________________________
ii. CRAB: ___________________________________________________________

iii. ESBL: ____________________________________________________________
iv. iEC: _____________________________________________________________
5. How many isolates with a specimen collection date in 2023 did you expect to be able to collect
from the clinical laboratories?
_______ CRE; _______ CRAB; _______ ESBL; ________iEC
6. What was the total number of isolates with a specimen collection date in 2023 that were
collected from the clinical laboratories?
_______ CRE; _______ CRAB; _______ ESBL; _______iEC

Form approved
OMB No. 0920-0978

Laboratory Participation and Isolate Testing – Part 2
Please complete the following information for each clinical laboratory participating in MuGSI surveillance at your site in 2023:
1. Laboratory ID:_____________________
2. Type of laboratory:
_____clinical laboratory
_____public health laboratory
_____research laboratory
_____reference laboratory
3. MuGSI pathogen(s) under surveillance:
_____CRE
_____CRAB
_____ESBL
_____iEC
4. Method for sharing laboratory reports with your site:
_____electronic messaging, such as HL7
_____e-mail
_____fax
_____EIP staff manually generate reports on-site
_____other, please specify_____________________
_____unknown
5. Method for case identification:
_____automated testing instrument
_____laboratory information system
_____medical record
_____other, please specify_____________________
_____unknown
6. Type of ATI and card:_______________________________
Public reporting burden of this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current valid OMB control number. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Rd NE, MS D-74, Atlanta, Georgia 30329; ATTN: PRA (0920-0978)

7. Carbapenem confirmatory testing method
a. Please report the carbapenem confirmatory testing method(s) performed for each MuGSI organism separately.
kirby bauer:
other, please specify:_____________________
laboratory not testing
unknown

_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC

8. Carbapenemase testing method
a. Please report the carbapenemase testing method(s) performed for each MuGSI organism separately.
Non-molecular test methods
carbaNP:
carbapenemase inactivation method:
CPO detect:
disk diffusion/ROSCO disk e-test:
modified carbapenemase inactivation method:
modified hodge test:
RAPIDEC:
Other, please specify:____________________
laboratory not testing:
unknown:
Molecular test methods
automated molecular assay:
carba-R:
check points:
MALDI-TOF MS:
next generation nucleic acid sequencing:
polymerase chain reaction:
streck ARM-D:
other, please specify:____________________
laboratory not testing:
unknown:

_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC

9. ESBL production testing method
a. Please report the ESBL production testing method(s) performed for each MuGSI organism separately.
broth microdilution – ESBL well:
broth microdilution – ATI flag:
broth microdilution – manual:
disk diffusion:
e-test:
molecular test, please specify:___________________
other non-molecular test, please specify:___________
laboratory not testing:
unknown:

_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC
_____CRE _____CRAB _____ESBL _____iEC

10. Organism identification method†
a. Please report the organism identification method(s) performed for each MuGSI organism separately.
MALDI-TOF:
_____CRE _____CRAB _____ESBL _____iEC
polymerase chain reaction:
_____CRE _____CRAB _____ESBL _____iEC
whole genome sequencing:
_____CRE _____CRAB _____ESBL _____iEC
DNA sequencing, please specify:_________________
_____CRE _____CRAB _____ESBL _____iEC
rRNA gene sequencing, please specify:____________
_____CRE _____CRAB _____ESBL _____iEC
biochemical tests, please specify:_________________
_____CRE _____CRAB _____ESBL _____iEC
immunological techniques, please specify:__________
_____CRE _____CRAB _____ESBL _____iEC
other, please specify:___________________________
_____CRE _____CRAB _____ESBL _____iEC
laboratory not testing:
_____CRE _____CRAB _____ESBL _____iEC
unknown:
_____CRE _____CRAB _____ESBL _____iEC
b. Please specify the database or library for the instrument(s) selected above:___________________________
11. Culture-independent diagnostic test:
_____yes, please specify the type of test___________________________________________________________________________
If yes, is a positive test result always followed up by a culture? _______ yes
_______ no _______ unknown
_____no
_____unknown
12. Isolate submission to state public health laboratory

_____yes
_____no
_____unknown
13. Most recent year a check-in was completed for the laboratory: _____________________
14. Please describe the participating laboratory’s policy on maximum duration of referral for antimicrobial susceptibility testing for successive
isolates of the same MuGSI organism. Successive isolates are defined as two microorganisms with similar identification that was cultured
from the same patient at two different time points. Please indicate if the policy differs depending on whether successive isolates were cultured
from the same specimen source or different specimen source.
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Additional information on MuGSI surveillance activities
1. Does your site complete a survey for any of the following types of facilities:
a. Physician/Outpatient provider: _______ yes
_______ no
i. If yes, the last survey was completed in: _________________
b. LTCF: _______ yes
_______ no
i. If yes, the last survey was completed in:_________________
c. LTACH: _______ yes
_______ no
i. If yes, the last survey was completed in: _________________
d. Dialysis center: _______ yes
_______ no
i. If yes, the last survey was completed in: _________________
e. Hospital laboratory: _______ yes
_______ no
i. If yes, the last survey was completed in: _________________
2. In 2023, did your site update its inventory of facilities within the MuGSI surveillance area? _______ yes
_______ no
a. If no, why not?
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
b. If yes, how many facilities serve the MuGSI surveillance area? _________

c. If yes, how many facilities have you identified the clinical laboratory that serves it?__________
3. Does your site run a data edit program in addition to the CDC edit program that is sent out monthly? This could include the data edits
available on the MuGSI Case Management System dashboard.
_______ yes
_______ no
a. If yes, how often:
_______ Monthly
_______ Quarterly
_______ Other time frame, specify: ______________________________________
_______ Never
b. If yes, what type of edits are you running? Do you think they would be helpful to add to edits generated by CDC?
_________________________________________________________________________________________________________________
4. Did your site geocode MuGSI cases in 2023? _____ yes ______ no
a. If yes, what is the most recent year of surveillance data that was geocoded? ___________________
b. If no, why not?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
5. Did your site match MuGSI cases to the state vital statistics death registry in 2023? _____ yes ______ no
a. If yes, what is the most recent year of surveillance data that was matched?___________________
b. If no, why not?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
6. Did your site complete CRF re-abstractions in 2023? _____ yes ______ no
a. If yes, what was the most recent year of surveillance data with CRFs re-abstracted? ___________________
b. If no, why not?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
7. What is the IRB determination for MuGSI at your site? ____Research ____Non-Research ____Other ____Unknown

8. General comments
__________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________