,,ii #aacth ,,congress #b;d ,session ,s4 #bbcf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,april #aj1 #bjad,mr4 ,brown introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend the ,public ,health ,service ,act to enhance efforts to address antimicrobial resistance1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,strategies to ,address ,antimicrobial ,resistance ,act4 #b4 ,findings ,the ,congress finds as follows3 7#a7 ,the advent of the antibiotic era has saved millions of lives and allowed for incredible medical progress2 however1 the increased use and overuse of antimicrobial drugs have correlated with increased rates of antimicrobial resistance4 7#b7 ,through mutation as well as other mechanisms1 bacteria and other infectious disease-causing organisms--viruses1 fungi1 and parasites--develop resistance to antimicrobial drugs over time4 ,the more antimicrobial drugs are used1 whether appropriately or inappropriately1 the more this contributes to the development of antimicrobial resistance4 7#c7 ,scientific evidence suggests that the development of antimicrobial resistance in humans is not due only to use of antimicrobial drugs in humans1 but also may be caused by the use of antimicrobial drugs in food-producing animals4 7#d7 ,a study estimates that in #bjje more than #id1jjj invasive methicillin-resistant ,staphylococcus aureus 7,,mrsa7 bacterial infections occurred in the ,united ,states and more than #ah1ejj of these infections resulted in death--#g times more than a decade earlier4 7#e7 ,the #bjji ,influenza ,a3 ,h#a,n#a virus outbreak1 and the yearly seasonal influenza outbreaks1 exacerbate concerns about antiviral resistance given that so few antivirals are available to treat influenza as well as secondary bacterial infections due to ,,mrsa1 antibiotic-resistant ,streptococcus pneumonia1 and other bacteria that cause respiratory diseases4 ,given that1 during the #aiah influenza pandemic1 many thousands of deaths were caused by complications due to secondary bacterial infections and not by the influenza virus itself4 7#f7 ,each year1 nearly #b1jjj1jjj people contract bacterial infections in hospitals and approximately #ij1jjj of these people die from these infections4 ,many of these infections are resistant to one or more commonly used antibiotics4 7#g7 ,a #bjab study conducted at ,columbia ,university 7,clinical ,infectious ,disease1 ,september #bjab7 found that each antibiotic-resistant infection costs1 on average1 over #ae1jjj more to treat than susceptible infections4 7#h7 ,the costs of antimicrobial-resistant infections in terms of lives lost and the economy will only rise as antimicrobial resistance continues to spread4 #c4 ,antimicrobial resistance task force ,section #cai;,e of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;d-#e7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in the subsection heading1 by striking ,task ,force and inserting the following3 ,antimicrobial ,resistance ,office1 ,task ,force1 and ,advisory ,board2 7,b7 in paragraph 7#a7-- 7i7 by striking as of the date of the enactment of this section and inserting as of ,september #cj1 #bjjf2 and 7ii7 by adding at the end the following3 ,the ,secretary shall1 not later than #a year after the date of enactment of the ,strategies to ,address ,antimicrobial ,resistance ,act1 direct the ,assistant ,secretary of ,health to establish an ,antimicrobial ,resistance ,office and appoint a director to that ,office4 ,the ,secretary shall1 not later than #a year after the date of enactment of such ,act1 establish the ,public ,health ,antimicrobial ,advisory ,board as an advisory board to the ,director of the ,antimicrobial ,resistance ,office4 ,the ,director of the ,antimicrobial ,resistance ,office shall serve as the ,director of the ,antimicrobial ,resistance ,task ,force4 ,to avoid duplication and ensure that ,federal resources are used efficiently and effectively1 the ,director shall work in conjunction with the ,federal agencies represented on the ,task ,force to coordinate all antimicrobial resistance activities undertaken and supported by the ,federal ,government1 including the activities and budgetary allocations of the ,office1 ,task ,force1 and ,public ,health ,antimicrobial ,advisory ,board42 7,c7 by amending paragraph 7#b7 to read as follows3 7#b7 ,members 7,a7 ,members of the antimicrobial resistance task force ,the task force described in paragraph 7#a7 shall be composed of representatives of such ,federal agencies as the ,secretary determines necessary1 including representation of the following3 7i7 ,the ,antimicrobial ,resistance ,office4 7ii7 ,the ,assistant ,secretary for ,preparedness and ,response4 7iii7 ,the ,biomedical ,advanced ,research and ,development ,authority4 7iv7 ,the ,centers for ,disease ,control and ,prevention4 7v7 ,the ,food and ,drug ,administration4 7vi7 ,the ,national ,institutes of ,health4 7vii7 ,the ,agency for ,healthcare ,research and ,quality4 7viii7 ,the ,centers for ,medicare ,medicaid ,services4 7ix7 ,the ,health ,resources and ,services ,administration4 7x7 ,the ,department of ,agriculture4 7xi7 ,the ,department of ,education4 7xii7 ,the ,department of ,defense4 7xiii7 ,the ,department of ,veterans ,affairs4 7xiv7 ,the ,environmental ,protection ,agency4 7xv7 ,the ,department of ,homeland ,security4 7xvi7 ,the ,united ,states ,agency for ,international ,development4 7,b7 ,members of the public health antimicrobial advisory board 7i7 ,in general ,the ,public ,health ,antimicrobial ,advisory ,board shall be composed of #ai voting members1 appointed by the ,secretary4 ,such members shall include experts from the medical professions 7including hospital and community-based physicians71 pharmacy1 public health1 veterinary1 research1 and international health communities1 as well as one representative from a public interest group4 7ii7 ,terms ,each member appointed under clause 7i7 shall be appointed for a term of #c years1 except that of the #ai members first appointed-- 7,i7 #f shall be appointed for a term of #ab months2 and 7,,ii7 #f shall be appointed for a term of #b years4 7iii7 ,chair ,the ,secretary shall appoint a ,chair of the ,public ,health ,antimicrobial ,advisory ,board from among its members to lead and supervise the activities of the ,advisory ,board4 7iv7 ,disclosure of financial interests ,prior to a meeting of the ,public ,health ,antimicrobial ,advisory ,board1 each member of the ,advisory ,board shall disclose to the ,secretary any potential1 relevant financial interests as defined under section #bjh7;a7 of title #ah1 ,united ,states ,code4 2 7,d7 in paragraph 7#c77;,b71 by striking in consultation with the task force described in paragraph 7#a7 and and inserting acting through the ,director of the ,antimicrobial ,resistance ,office and the ,director of the ,centers for ,disease ,control and ,prevention1 and in consultation with2 and 7,e7 by amending paragraph 7#d7 to read as follows3 7#d7 ,meetings and duties 7,a7 ,antimicrobial resistance office duties ,the ,director of the ,antimicrobial ,resistance ,office1 working in conjunction with the ,federal agencies that are represented on the task force described in paragraph 7#a71 shall issue an update to the ,public ,health ,action ,plan to ,combat ,antimicrobial ,resistance within #a year of the establishment of the ,office and annually thereafter4 ,the updates shall include enhanced plans for addressing antimicrobial resistance in the ,united ,states and internationally4 ,the ,director of the ,office shall post on a website these updates as well as summaries of all non-proprietary data the ,task ,force makes available4 ,the ,director of the ,antimicrobial ,resistance ,office shall work in conjunction with the ,federal agencies that are represented on the task force described in paragraph 7#a71 and in consultation with the ,public ,health ,antimicrobial ,advisory ,board1 to-- 7i7 establish benchmarks for achieving the goals set forth in the action plan2 7ii7 assess the ongoing1 observed patterns of emergence of antimicrobial resistance1 and their impact on clinical outcomes in terms of how patients feel1 function1 or survive2 7iii7 assess how antimicrobial products are being used in humans1 animals1 plants1 and the environment and the risks and benefits of those uses in furthering the development of resistance and the implications thereof for patient safety and public health2 7iv7 establish a priority list of human infectious diseases with the greatest need for development of new point-of-care and other diagnostics1 antimicrobial drugs1 and vaccines1 and in particular serious and life-threatening resistant infections1 for which there are few or no diagnostic1 treatment1 or prevention options2 7v7 recommend basic1 clinical1 epidemiological1 prevention1 and translational research where additional federally supported studies may be beneficial2 7vi7 recommend how to support antimicrobial development through ,food and ,drug ,administration activities1 including through the agency's ,critical ,path ,initiative and the ,reagan-,udall ,foundation2 7vii7 recommend how best to strengthen and link antimicrobial resistance-related surveillance and prevention and control activities2 and 7viii7 collaborate with the ,assistant ,secretary for ,preparedness and ,response to ensure that strategies to address antimicrobial-resistance are coordinated with initiatives aimed at pandemic influenza1 severe acute respiratory syndrome1 and bioterrorism4 7,b7 ,antimicrobial resistance task force meetings and duties 7i7 ,meetings ,the ,antimicrobial ,resistance ,task ,force shall convene periodically as the ,director of the ,antimicrobial ,resistance ,task ,force determines to be appropriate1 but not fewer than twice a year1 to consider issues relating to antimicrobial resistance4 7ii7 ,public health action plan ,at least twice a year1 the task force described in paragraph 7#a7 shall have a meeting to review1 discuss1 and further develop the ,public ,health ,action ,plan to ,combat ,antimicrobial ,resistance first issued by the interagency task force on antimicrobial resistance in #bjja4 ,among other issues1 the task force may discuss and review1 based on current need or concern-- 7,i7 antimicrobial clinical susceptibility concentrations proposed1 established1 or updated by the ,food and ,drug ,administration2 7,,ii7 data obtained by government agencies and1 as possible1 by private sources on emerging antimicrobial resistance related to clinical outcomes as well as data related to how antimicrobial drugs may have been used inappropriately2 7,,iii7 surveillance data and prevention and control activities regarding emerging antimicrobial resistance from reliable sources including the ,centers for ,disease ,control and ,prevention1 the ,food and ,drug ,administration1 the ,department of ,defense1 the ,department of ,veterans ,affairs1 the ,department of ,agriculture1 the ,environmental ,protection ,agency1 and as feasible from private sources and international bodies2 7,,iv7 data on the amount of antimicrobial products used in humans1 animals1 plants1 and the environment from reliable sources1 including data from the ,centers for ,disease ,control and ,prevention1 the ,food and ,drug ,administration1 the ,environmental ,protection ,agency1 the ,department of ,veterans ,affairs1 the ,centers for ,medicare ,medicaid ,services1 the ,department of ,homeland ,security1 and the ,department of ,agriculture1 and as feasible from private sources and international bodies2 7,v7 the impact of antimicrobial resistance on human health resulting from the approval of antimicrobial drugs for use in humans1 animals1 or plants 7including consideration of and recommendations on potential management plans to limit and reduce the negative impacts of such resistance on human health and consideration of the benefits to animal health and food safety72 7,,vi7 reports of federally supported antimicrobial resistance research and antimicrobial drug1 related diagnostics1 and vaccine development for antimicrobial resistant infections 7such as methicillin-resistant ,staphylococcus aureus 7,,mrsa77 and other research activities 7including clinical1 epidemiological1 prevention1 and translational research7 obtained from ,federal agencies1 as well as reports of research sponsored by other countries1 industry1 and non-governmental organizations2 7,,vii7 reports on efforts by the ,food and ,drug ,administration to develop policies and guidance which encourage antimicrobial drug1 related diagnostics1 and vaccine development and appropriate use while maintaining high standards for safety and effectiveness2 7,,viii7 quality measures1 which may include health plan employer data and information set 7,,hedis7 measures1 pertaining to appropriate use of antimicrobial drugs2 and 7,,ix7 other data and issues the task force described in paragraph 7#a7 identifies as relevant to the issue of antimicrobial resistance4 7iii7 ,pending applications ,the ,food and ,drug ,administration may consult with the ,director of the ,antimicrobial ,resistance ,office concerning the pending application of any antimicrobial drug application submitted to the ,secretary under section #eje or #eab of the ,federal ,food1 ,drug1 and ,cosmetic ,act or the ,public ,health ,service ,act4 7,c7 ,public health antimicrobial advisory board meetings and duties 7i7 ,meetings ,the ,public ,health ,antimicrobial ,advisory ,board shall meet as the ,chair of the ,public ,health ,antimicrobial ,advisory ,board determines to be appropriate1 preferably in conjunction with meetings of the ,antimicrobial ,resistance ,task ,force1 but not fewer than #b times each year4 7ii7 ,recommendations ,the ,public ,health ,antimicrobial ,advisory ,board shall make recommendations to the ,secretary1 and the ,antimicrobial ,resistance ,office1 regarding-- 7,i7 ways to encourage the availability of an adequate supply of safe and effective antimicrobial products1 related diagnostics1 and vaccines2 7,,ii7 research priorities and other measures 7such as antimicrobial drug resistance management plans7 to enhance the safety and efficacy of antimicrobial products2 7,,iii7 how best to implement and update the goals of the ,public ,health ,action ,plan to ,combat ,antimicrobial ,resistance2 7,,iv7 incentives necessary to establish uniform mechanisms 7which could include electronic surveillance systems7 and data sets for ,state and local reporting of resistance2 7,v7 the adequacy of existing ,united ,states antimicrobial resistance and use surveillance2 7,,vi7 the development of a national plan for the collection and analysis of isolates of resistant pathogens1 including establishing priorities as to which isolates should be collected2 and 7,,vii7 areas for government1 nongovernment1 and international cooperation to strengthen implementation of the ,public ,health ,action ,plan to ,combat ,antimicrobial ,resistance4 7,d7 ,availability of information ,the ,antimicrobial ,resistance ,office shall ensure that all information shall be made available to the public on the website described in subparagraph 7,a7 consistent with section #i of the ,strategies to ,address ,antimicrobial ,resistance ,act4 2 7#b7 by amending subsection 7b7 to read as follows3 7b7 ,antimicrobial resistance strategic research plan ,the ,secretary1 acting through the ,director of the ,national ,institutes of ,health1 working in consultation with the ,director of the ,centers for ,disease ,control and ,prevention1 the ,assistant ,secretary for ,preparedness and ,response1 the ,director of the ,biomedical ,advanced ,research and ,development ,authority1 the ,director of the ,antimicrobial ,resistance ,office1 the ,public ,health ,antimicrobial ,advisory ,board1 and other non-government experts1 including representatives from professional societies and the pharmaceutical1 vaccine1 and medical device industries1 and other ,federal agencies shall develop a blue-ribbon antimicrobial resistance strategic research plan that strengthens existing epidemiological1 interventional1 clinical1 behavioral1 translational1 and basic research efforts to advance the understanding of-- 7#a7 the development1 implementation1 and efficacy of interventions to prevent and control the emergence and transmission of antimicrobial resistance2 7#b7 how best to optimize antimicrobial effectiveness while limiting the emergence of resistance1 including addressing issues related to duration of therapy1 effectiveness of therapy in self-resolving diseases1 and determining populations most likely to benefit from antimicrobial drugs2 7#c7 the extent to which specific uses of antimicrobial products in humans1 animals1 plants1 and other uses accelerate development and transmission of antimicrobial resistance2 7#d7 the natural histories of infectious diseases 7including defining the disease1 diagnosis1 severity1 and the time course of illness72 7#e7 the development of new therapeutics1 including antimicrobial drugs1 biologics1 and devices against resistant pathogens1 and in particular diseases for which few or no therapeutics are in development2 7#f7 the development and testing of medical diagnostics to identify patients with infectious disease and identify the exact cause of infectious diseases syndromes1 particularly with respect to the detection of pathogens resistant to antimicrobial drugs2 7#g7 the epidemiology1 pathogenesis1 mechanisms1 and genetics of antimicrobial resistance2 and 7#h7 the sequencing of the genomes1 or other ,,dna analysis1 or other comparative analysis of priority pathogens 7as determined by the ,public ,health ,antimicrobial ,advisory ,board71 in collaboration with the ,department of ,defense and the ,joint ,genome ,institute of the ,department of ,energy4 2 7#c7 in subsection 7c7-- 7,a7 by inserting acting through the ,director of the ,antimicrobial ,resistance ,office1 after ,the ,secretary12 and 7,b7 by striking members of the task force described in subsection 7a712 7#d7 in subsection 7d77#a71 by inserting 1 through the ,antimicrobial ,resistance ,office1 after ,the ,secretary2 7#e7 in subsection 7e7-- 7,a7 by amending the subsection heading to read as follows3 ,improving ,uptake and ,measurement of ,antimicrobial ,stewardship2 7,b7 in paragraph 7#a7-- 7i7 by inserting 1 acting through the ,director of the ,antimicrobial ,resistance ,office1 after ,the ,secretary2 and 7ii7 by striking judicious use of antimicrobial drugs or control the spread of antimicrobial-resistant pathogens and inserting the uptake and measurement of antimicrobial stewardship programs in the ,nation's health care facilities2 7,c7 in paragraph 7#b71 by striking laboratory2 7,d7 in paragraph 7#c71 by inserting 1 acting through the ,antimicrobial ,resistance ,office1 after ,the ,secretary2 and 7,e7 by adding at the end the following new paragraphs3 7#d7 ,definition of antimicrobial stewardship ,for purposes of this subsection and ,act1 antimicrobial stewardship means coordinated interventions designed to improve and measure the appropriate use of antimicrobial agents1 including promoting the use of antimicrobials only when clinically indicated1 and1 when antimicrobials are indicated1 promoting the selection of the optimal antimicrobial drug regimen including dosing1 duration of therapy1 and route of administration4 7#e7 ,preference in making awards ,in making awards under paragraph 7#a71 the ,secretary shall give preference to eligible entities that will use grant funds to establish demonstration projects that lead to the development of quality measures for health care providers prescribing antimicrobial drugs4 2 7#f7 by redesignating subsections 7f7 and 7g7 as subsections 7i7 and 7j71 respectively2 and 7#g7 by inserting after subsection 7e7 the following new subsections3 7f7 ,appropriate antimicrobial use ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall take such additional actions as follows3 7#a7 ,to pilot and test health care quality measures to help providers1 facilities1 and health systems measure and benchmark appropriate antimicrobial use4 ,as appropriate1 the ,director shall work with standard setting organizations 7such as the ,national ,quality ,forum1 the ,joint ,commission1 and the ,national ,committee for ,quality ,assurance7 to determine if any such measure is suitable for national quality reporting efforts4 7#b7 ,to develop methods to help providers1 facilities1 and health systems measure and improve appropriate antimicrobial use1 including methods and tools to assess the change in antimicrobial use1 the impact on antibiotic resistance and adverse effects 7such as ,clostridium difficile infections71 and the economic impact and cost savings of antimicrobial stewardship programs4 7g7 ,collection of human antimicrobial consumption and resistance trend data 7#a7 ,antimicrobial ,use ,data ,the ,director of the ,centers for ,disease ,control and ,prevention shall work with private vendors1 health care organizations1 pharmacy benefit managers1 and other entities to obtain reliable and comparable human antimicrobial drug consumption data 7including volume antimicrobial distribution data and antimicrobial use1 including prescription data7 by ,state or metropolitan area4 7#b7 ,antimicrobial ,resistance ,trend ,data ,the ,director of the ,centers for ,disease ,control and ,prevention shall intensify and expand their efforts to collect antimicrobial resistance data including through the establishment of an ,antimicrobial ,resistance ,surveillance and ,laboratory ,network1 established in section #d of the ,strategies to ,address ,antimicrobial ,resistance ,act1 and development of a fully automated antimicrobial resistance and use module within the ,national ,healthcare ,safety ,network4 ,the ,director shall seek to collect data from electronic medication administration reports 7e,m,a,r7 and laboratory systems to produce regular reports on antimicrobial resistance patterns and antimicrobial use4 7#c7 ,meaningful ,use ,reporting ,the ,office of the ,national ,coordinator for ,health ,information ,technology shall work with the ,director of the ,centers for ,disease ,control and ,prevention to determine how best antimicrobial use1 susceptibility1 and resistance data can be incorporated into meaningful use reporting4 7#d7 ,report ,not later than #b years after the date of the enactment of the ,strategies to ,address ,antimicrobial ,resistance ,act1 and every two years thereafter1 the ,director of the ,centers for ,disease ,control and ,prevention shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and make available on the agency's website a report summarizing key trends and major issues related to antimicrobial resistance and use in the ,united ,states4 ,each such report shall include the most relevant and up-to-date data available from the infectious diseases and surveillance programs of the ,centers for ,disease ,control and ,prevention4 ,each such report shall-- 7,a7 outline major issues and threats in antimicrobial resistance facing the ,united ,states2 7,b7 provide data on the incidence1 prevalence1 morbidity1 mortality1 and general societal burden1 including economic1 of antimicrobial resistant pathogens2 7,c7 provide updates on resistance patterns and antimicrobials use data and potential impacts on human health and patient safety2 7,d7 articulate activities of the ,centers for ,disease ,control and ,prevention targeted toward measuring and preventing the spread of drug resistant pathogens2 7,e7 describe any international developments that may impact antimicrobial resistance in the ,united ,states2 and 7,f7 identify the major gaps that the ,nation faces in the areas of antimicrobial resistance surveillance1 prevention1 use1 and antimicrobial stewardship4 7h7 ,ensure access to antimicrobial resistance data and research ,the ,director of the ,antimicrobial ,resistance ,office shall work with the ,federal agencies represented on the ,antimicrobial ,resistance ,task ,force to identify relevant data and formats1 and mechanisms for communicating such data to the ,antimicrobial ,resistance ,office and ,antimicrobial ,resistance ,task ,force and1 in a manner consistent with section #i of the ,strategies to ,address ,antimicrobial ,resistance ,act1 with the ,public ,health ,antimicrobial ,advisory ,board and the public1 including relevant data obtained by the agencies through contracts with other organizations1 including-- 7#a7 use and clinical outcomes data on patients receiving antimicrobial drugs for the treatment1 prevention1 or diagnosis of infection or infectious diseases2 7#b7 surveillance data regarding emerging antimicrobial drug resistance and existing resistance patterns2 7#c7 susceptibility data related to antimicrobial drug use2 7#d7 data related to the amount of antimicrobial products used in humans1 animals1 plants1 and the environment2 7#e7 data from federally funded research intended to support antimicrobial drug1 vaccine1 and related diagnostics development2 7#f7 data demonstrating the impact of research1 surveillance1 and prevention and control initiatives in understanding and controlling antimicrobial resistance2 and 7#g7 data regarding implementation and evaluation of interventions to improve antimicrobial drug prescribing practices4 4 #d4 ,antimicrobial resistance surveillance and laboratory network 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall establish at least #aj ,antimicrobial ,resistance ,surveillance and ,laboratory ,network sites1 building upon the intramural and extramural programs and laboratories of the ,centers for ,disease ,control and ,prevention1 to intensify1 strengthen1 and expand the national capacity to-- 7#a7 monitor the emergence and changes in the patterns of antimicrobial resistant pathogens2 7#b7 describe1 confirm1 and as necessary facilitate a response to local or regional outbreaks of resistant pathogens2 7#c7 assess and describe antimicrobial resistance patterns to inform public health and improve prevention practices2 7#d7 obtain isolates of pathogens1 and in particular1 pathogens that show new or atypical patterns of resistance adversely affecting public health2 7#e7 study the epidemiology of infections from such pathogens2 7#f7 evaluate commonly used antimicrobial susceptibility testing methods to improve the accuracy of resistance testing and reporting2 and 7#g7 as necessary1 develop novel diagnostic tests capable of detecting new or emerging resistance in pathogens4 7b7 ,geographic distribution ,the sites established under subsection 7a7 shall be geographically distributed across the ,united ,states4 7c7 ,nonduplication of current national capacity ,the sites established under subsection 7a7 may be based in academic centers1 health departments1 and existing surveillance and laboratory sites4 #e4 ,clinical trials network on antibacterial resistance 7a7 ,in ,general ,the ,secretary1 acting through the ,director of the ,national ,institute of ,allergy and ,infectious ,diseases1 shall establish a ,clinical ,trials ,network on ,antibacterial ,resistance to enhance1 strengthen1 and expand research on clinical science1 antibacterial and diagnostic development1 and optimal usage strategies1 and shall1 at a minimum-- 7#a7 facilitate research to better understand resistance mechanisms and how to prevent1 control1 and treat resistant organisms2 7#b7 advance clinical trial efforts to develop antimicrobial therapies1 vaccines and diagnostics1 and evaluate and optimize their usage2 7#c7 conduct clinical research to develop natural histories of resistant infectious diseases2 7#d7 examine patient outcomes with currently available antimicrobial therapy and validate and improve upon biomarkers and other surrogate endpoints2 and 7#e7 study shorter treatment duration and early cessation of antimicrobial therapy for treatment efficacy and effect on development of resistance4 7b7 ,leadership ,group for a ,clinical ,research ,network on ,antibacterial ,resistance ,the ,secretary1 acting through the ,director of the ,national ,institute of ,allergy and ,infectious ,diseases1 shall establish a ,leadership ,group for the ,clinical ,research ,network on ,antibacterial ,resistance described in subsection 7a7 to develop and implement a comprehensive clinical research agenda to address antibacterial resistance that takes into consideration the recommendations contained in the ,strategic ,research ,plan on ,antimicrobial ,resistance developed in accordance with section #cai;,e of the ,public ,health ,service ,act4 ,the ,leadership ,group shall provide support for the following components-- 7#a7 scientific leadership and operations2 7#b7 network laboratories2 and 7#c7 statistical and data management4 7c7 ,appropriations ,there are authorized to be appropriated from the existing budget of the ,national ,institute of ,allergy and ,infectious ,diseases1 #ajj1jjj1jjj annually for each of fiscal years #bjae through #bjba to carry out this section4 #f4 ,regional prevention collaboratives ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall work with ,state health departments to support regional prevention collaboratives designed to interrupt and prevent the transmission of significant antibiotic resistant pathogens being transmitted across health care settings in a geographic region4 ,such regional prevention collaboratives shall work to-- 7#a7 identify significant drug resistant pathogens being transmitted across health care settings locally2 7#b7 implement evidence-based interventions to interrupt and prevent the transmission of such pathogens2 and 7#c7 evaluate the impact of such measures on hospital readmissions1 transitions of care1 rates of health care associated infections1 or any other relevant measures that characterize the health or economic impact of the collaboratives4 #g4 ,prevention ,epicenters ,to provide the regional prevention collaboratives established under section #f with tools1 strategies1 and evidence-based interventions1 the ,director of the ,centers for ,disease ,control and ,prevention may intensify and expand academic public health partnerships through the work of the ,prevention ,epicenters ,program of the ,centers for ,disease ,control and ,prevention4 ,the ,centers for ,disease ,control and ,prevention and the epicenters participating in such program shall work with the regional prevention collaboratives to-- 7#a7 evaluate new and existing interventions to prevent or limit the emergence of antimicrobial resistance throughout the geographic region of the collaboratives2 7#b7 facilitate public health research on the prevention and control of resistant organisms2 and 7#c7 assess the feasibility1 cost-effectiveness1 and appropriateness of surveillance and prevention programs in differing health care and institutional settings4 #h4 ,continuation of current programs ,subsection 7j7 of section #cai;,e of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;d-#e71 as redesignated by section #c7f71 is amended by inserting and for each of the fiscal years #bjae through #bjai after #bjjf4 #i4 ,protection of confidential and national security information ,except as otherwise required by law1 this ,act 7and the amendments made by this ,act7 shall not permit public disclosure of trade secrets1 confidential commercial information1 or material inconsistent with national security that is obtained by any person under this ,act 7or amendments made by this ,act74