,,ii #aad? ,,congress #b;d ,session ,s4 #cagf ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,july #ac1 #bjaf,mr4 ,br[n introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ,a ,,bill ,to am5d ! ,public ,heal? ,s]vice ,act to enhance ef=ts to address antibiotic resi/ance1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,/rategies to ,address ,antibiotic ,resi/ance ,act or ! ,,/a> ,act4 #b4 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,! adv5t ( ! antibiotic era has sav$ millions ( lives & all[$ = incr$ible m$ical progress2 h[ev]1 ! increas$ use & ov]use ( antibiotic drugs h correlat$ ) increas$ rates ( antibiotic resi/ance4 7#b7 ,?r\gh mutation z well z o!r me*anisms1 bact]ia develop resi/ance to antibiotic drugs ov] "t4 ,ov]use & o!r inappropriate use ( antibiotics less5 _! effectiv5ess & contribute to ! developm5t ( antibiotic resi/ance4 7#c7 ,sci5tific evid5ce sugge/s t ! developm5t ( antibiotic resi/ance 9 human pa?og5s is due n only to use ( antibiotic drugs 9 humans1 b also may be caus$ by ! use ( antibiotics 9 food-produc+ animals4 7#d7 ,ea* ye>1 ne>ly #b1jjj1jjj p become infect$ ) bact]ia t are resi/ant to antibiotics & at lea/ #bc1jjj p die z a result ( su* infections4 ,_m m die f o!r conditions t 7 complicat$ by an antibiotic-resi/ant infection4 7#e7 ,accord+ to a #bjac report f ! ,c5t]s = ,disease ,control & ,prev5tion1 c>bap5em-resi/ant ,ent]obact]iaceae 7,,cre7 bact]ia are on ! rise among pati5ts 9 m$ical facilities4 ,,cre bact]ia h become resi/ant to all or ne>ly all ! antibiotics curr5tly available4 ,invasive infections1 su* z a blood/ream infection1 ) ,,cre bact]ia are associat$ ) mortality rates exce$+ #dj p]c5t4 7#f7 ,a #bjab /udy conduct$ at ,columbia ,univ]sity 7,cl9ical ,infecti\s ,disease1 ,septemb] #bjab7 f\nd t ea* antibiotic-resi/ant infection co/s1 on av]age1 ov] #ae1jjj m to treat ?an antibiotic-susceptible infections4 7#g7 ,! co/s ( antibiotic-resi/ant infections 9 t]ms ( lives lo/ & ! economy w only rise z antibiotic resi/ance cont9ues to spread4 7#h7 ,antibiotic resi/ance is "o ( ! greate/ ?reats to human heal? worldwide1 call+ = increas$ prev5tion1 antibiotic /ew>d%ip1 surveillance1 & rese>* & developm5t = new antibiotics & rapid diagno/ics4 7#i7 ,! ,presid5t's ,national ,action ,plan = ,combat+ ,antibiotic-,resi/ant ,bact]ia1 issu$ 9 ,m>* #bjae 7ref]r$ to 9 ?is section z ! ,action ,plan71 :i* 0 develop$ 9 response to ,executive ,ord] #acfgf1 dat$ ,septemb] #ah1 #bjad 7#gi ,f$4 ,reg4 #efica2 relat+ to combat+ antibiotic-resi/ant bact]ia71 outl9es specific /eps to address antibiotic resi/ance4 7#aj7 ,! ,action ,plan includes ! dome/ic & int]national ef=ts ( ! ,unit$ ,/ates to prev5t1 detect1 & control illness & dea? relat$ to infections caus$ by antibiotic-resi/ant bact]ia by implem5t+ measures to mitigate ! em]g5ce & spread ( antibiotic resi/ance & ensur+ ! cont9u$ availability ( !rapeutics = ! treatm5t ( bact]ial infections4 7#aa7 ,misuse & ov]use ( antibiotics has contribut$ to antibiotic resi/ance4 ,a rec5t /udy on antibiotic prescrib+ practices f\nd t #a 9 #c antibiotic prescriptions 7 det]m9$ unnecess>y or inappropriate4 #c4 ,task =ce = combat+ antibiotic-resi/ant bact]ia2 advisory c\ncil on combat+ antibiotic-resi/ant bact]ia 7a7 ,task =ce ,section #cai;,e ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdg;d-#e7 is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 9 p>agraph 7#a71 by /rik+ ,! ,secret>y %all e/abli% & ins]t+ ,9 accordance ) ! objectives ( ,executive ,ord] #acfgf1 dat$ ,septemb] #ah1 #bjad 7#gi ,f$4 ,reg4 #efica2 relat+ to combat+ antibiotic-resi/ant bact]ia71 ! ,secret>y %all e/abli%2 7,b7 by am5d+ p>agraph 7#b7 to read z foll[s3 7#b7 ,memb]s ( ! antimicrobial resi/ance task =ce ,! task =ce describ$ 9 p>agraph 7#a7 %all be co-*air$ by ! ,secret>ies ( ,heal? & ,human ,s]vices1 ,agriculture1 & ,def5se1 & %all be compos$ ( repres5tatives ( relevant ,f$]al ag5cies & su* executive dep>tm5ts1 ag5cies1 or (fices z ! co-*airs may designate4 2 7,c7 by am5d+ p>agraph 7#d7 to read z foll[s3 7#d7 ,meet+s ,at lea/ twice a ye>1 ! task =ce describ$ 9 p>agraph 7#a7 %all h a public meet+ to assess progress & ob/acles to implem5t+ ! ,presid5t's ,national ,action ,plan = ,combat+ ,antibiotic-,resi/ant ,bact]ia1 issu$ 9 ,m>* #bjae 7ref]r$ to 9 ?is section z ! ,action ,plan74 ,among o!r issues1 ! task =ce may discuss & review1 bas$ on ne$ or conc]n-- 7,a7 ,f$]al activities to sl[ ! em]g5ce ( resi/ant bact]ia & prev5tion ( ! spread ( resi/ant infections1 includ+ promotion ( ! optimal use ( vacc9es to prev5t infections1 & implem5tation ( heal? c>e policies & antibiotic /ew>d%ip programs t improve pati5t outcomes2 7,b7 ,f$]al activities to /r5g!n national ,"o-,heal? surveillance ef=ts z describ$ 9 ! ,action ,plan to combat resi/ance1 includ+ enhancem5t & integration ( data f surveillance sy/ems t monitor human pa?og5s1 includ+ ! ,national ,heal?c>e ,safety ,network1 ! ,em]g+ ,infections ,program1 & ! ,national ,antimicrobial ,resi/ance ,monitor+ ,sy/em1 ) data f surveillance sy/ems t monitor animal pa?og5s1 includ+ ! ,national ,animal ,heal? ,monitor+ ,sy/em1 ! ,national ,animal ,heal? ,laboratory ,network1 & ! ,vet]9>y ,laboratory ,inve/igation & ,response ,network2 7,c7 ,f$]al ef=ts to advance ! developm5t & use ( rapid & innovative diagno/ic te/s = id5tification & *>act]ization ( resi/ant bact]ia2 7,d7 ,f$]al ef=ts to accel]ate basic & appli$ rese>* & developm5t = new antibiotics1 o!r !rapeutics1 & vacc9es2 & 7,e7 improvem5ts 9 int]national collaboration & capacities = antibiotic-resi/ance prev5tion1 surveillance1 control1 & antibiotic rese>* & developm5t4 2 & 7,d7 by add+ at ! end ! foll[+3 7#e7 ,availability ( in=mation ,! task =ce1 to ! ext5t p]mitt$ by law1 %all-- 7,a7 provide ! ,advisory ,c\ncil describ$ 9 section #cai;,e-#a ) su* in=mation z may be requir$ = c>ry+ out ! functions ( su* ,advisory ,c\ncil1 includ+ in=mation on progress 9 advanc+ ! ,action ,plan1 meet+ m9utes1 & o!r key in=mation ( ! task =ce2 & 7,b7 ensure t all in=mation describ$ 9 subp>agraph 7,a7 is made available on ! websites ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 ! ,dep>tm5t ( ,agriculture1 & ! ,dep>tm5t ( ,def5se4 2 & 7#b7 by add+ at ! end ! foll[+3 7h7 ,annual progress report to ,congress on implem5tation ( national action plan = combat+ antibiotic-,resi/ant bact]ia ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ! ,/rategies to ,address ,antibiotic ,resi/ance ,act1 & annually !reaft]1 ! ,secret>y1 9 coop]ation ) ! ,secret>y ( ,agriculture1 ! ,secret>y ( ,def5se1 & ! task =ce describ$ 9 subsection 7a7 %all submit to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives1 & make available on ! websites ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 ! ,dep>tm5t ( ,agriculture1 & ! ,dep>tm5t ( ,def5se1 a report on ! progress made 9 implem5t+ ! goals ( ! ,action ,plan4 4 7b7 ,advisory c\ncil ,"p ,b ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdc et seq47 is am5d$ by ins]t+ aft] section #cai;,e ! foll[+3 #cai;,e-#a4 ,presid5tial ,advisory ,c\ncil on ,combat+ ,antibiotic-,resi/ant ,bact]ia 7a7 ,9 g5]al ,! ,presid5tial ,advisory ,c\ncil on ,combat+ ,antibiotic-,resi/ant ,bact]ia e/abli%$ ?r\gh ,executive ,ord] #acfgf1 dat$ ,septemb] #ah1 #bjad 7#gi ,f$4 ,reg4 #efica2 relat+ to combat+ antibiotic-resi/ant bact]ia7 7ref]r$ to 9 ?is section z ! ,advisory ,c\ncil71 %all provide advice1 in=mation1 & recomm5dations to ! ,secret>y reg>d+ programs & policies int5d$ to support & evaluate ! implem5tation ( su* ,executive ,ord] #acfgf1 includ+ ! ,national ,/rategy = ,combat+ ,antibiotic-,resi/ant ,bact]ia & ! ,presid5t's ,national ,action ,plan = ,combat+ ,antibiotic-,resi/ant ,bact]ia1 issu$ 9 ,m>* #bjae4 7b7 ,meet+s & duties 7#a7 ,meet+s ,! ,advisory ,c\ncil %all meet z ! ,*air det]m9es to be appropriate b n less ?an twice p] ye>1 &1 to ! ext5t practicable1 9 conjunction ) meet+s ( ! task =ce describ$ 9 section #cai;,e4 7#b7 ,recomm5dations ,! ,advisory ,c\ncil %all make recomm5dations to ! ,secret>y1 9 consultation ) ! ,secret>y ( ,agriculture & ! ,secret>y ( ,def5se1 reg>d+ programs & policies int5d$ to-- 7,a7 pres]ve ! effectiv5ess ( antibiotics by optimiz+ _! use2 7,b7 advance rese>* to develop improv$ me?ods = combat+ antibiotic resi/ance & conduct+ antibiotic /ew>d%ip2 7,c7 /r5g!n surveillance ( antibiotic-resi/ant bact]ial infections2 7,d7 prev5t ! transmission ( antibiotic-resi/ant bact]ial infections2 7,e7 advance ! developm5t ( rapid po9t-(-c>e & agricultural diagno/ics2 7,f7 fur!r rese>* on new treatm5ts = bact]ial infections2 7,g7 develop alt]natives to antibiotics = agricultural purposes2 7,h7 maximize ! dissem9ation ( up-to-date in=mation on ! appropriate & prop] use ( antibiotics to ! g5]al public & human & animal heal? c>e provid]s2 & 7,i7 improve int]national coord9ation ( ef=ts to combat antibiotic resi/ance4 4 #d4 ,surveillance & report+ ( antibiotic use & resi/ance ,"p ,b ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdc et seq471 z am5d$ by section #c7;b71 is fur!r am5d$ by ins]t+ aft] section #cai;,e-#a ! foll[+3 #cai;,e-#b4 ,surveillance & report+ ( antibiotic use & resi/ance 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all use ! ,national ,heal?c>e ,safety ,network & o!r appropriate surveillance sy/ems to assess-- 7#a7 appropriate conditions1 outcomes1 & measures causally relat$ to antibact]ial resi/ance1 includ+ types ( infections1 ! causes = infections1 & :e!r infections are acquir$ 9 a community or hospital sett+1 increas$ l5g?s ( hospital /ay1 increas$ co/s1 & rates ( mortality2 & 7#b7 *anges 9 bact]ial resi/ance to drugs 9 relation to pati5t outcomes1 includ+ *anges 9 p]c5t resi/ance1 preval5ce ( antibiotic-resi/ant infections1 & o!r su* *anges4 7b7 ,antibiotic use data ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all "w ) ,f$]al ag5cies 7includ+ ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,dep>tm5t ( ,def5se71 private v5dors1 heal? c>e organizations1 ph>macy b5efit manag]s1 & o!r entities z appropriate to obta9 reliable & comp>able human antibiotic drug consumption data 7includ+1 z available & appropriate1 volume antibiotic di/ribution data & antibiotic use1 includ+ prescription data7 by ,/ate or metropolitan areas4 7c7 ,antibiotic resi/ance tr5d data ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all int5sify & exp& ef=ts to collect antibiotic resi/ance data & enc\rage adoption ( ! antibiotic resi/ance & use module )9 ! ,national ,heal?c>e ,safety ,network among all heal? c>e facilities across ! cont9uum ( c>e1 includ+1 z appropriate1 acute c>e hospitals1 dialysis facilities1 nurs+ homes1 & ambulatory surgical c5t]s4 ,! ,director %all seek to collect data f electronic m$ication adm9i/ration reports & laboratory sy/ems to produce regul> reports on antibiotic resi/ance patt]ns & antibiotic use4 7d7 ,public availability ( data ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all1 = ! purposes ( improv+ ! monitor+ ( important tr5ds 9 pati5t outcomes 9 relation to antibact]ial resi/ance-- 7#a7 make ! data d]iv$ f surveillance "u ?is section publicly available on a regul> basis t is n less ?an annually2 & 7#b7 exam9e opportunities to make su* data available 9 ne> real "t4 4 #e4 ,detect network ( antibiotic resi/ance regional laboratories 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all e/abli% n less ?an #g ,antibiotic ,resi/ance ,surveillance & ,laboratory ,network sites1 build+ ^u ! intramural & extramural programs & laboratories ( ! ,c5t]s = ,disease ,control & ,prev5tion1 to int5sify1 /r5g!n1 & exp& ! national capacity to-- 7#a7 monitor ! em]g5ce & *anges 9 ! patt]ns ( antibiotic-resi/ant bact]ia2 7#b7 describe1 confirm1 &1 z necess>y1 facilitate a response to1 local or regional outbreaks ( resi/ant bact]ia2 7#c7 assess & describe antibiotic resi/ance patt]ns to in=m public heal? & improve prev5tion practices2 7#d7 obta9 isolates ( pa?og5s1 & 9 p>ticul>1 bact]ia t %[ new or atypical patt]ns ( resi/ance adv]sely affect+ public heal?2 7#e7 assi/ 9 /udy+ ! epidemiology ( infections f su* pa?og5s2 7#f7 evaluate commonly us$ antibiotic susceptibility te/+ me?ods to improve ! accuracy ( resi/ance te/+ & report+2 7#g7 z necess>y1 develop or evaluate novel diagno/ic te/s capable ( detect+ new or em]g+ resi/ance 9 bact]ia2 7#h7 l9k data g5]at$ by regional laboratory networks "u exi/+ public heal? surveillance networks & relevant gov]nm5t ag5cies2 & 7#i7 provide laboratory assi/ance & ref]5ce te/+ ( antibiotic-resi/ant bact]ia to enhance infection control & facilitate outbreak detection & response 9 heal? c>e & community sett+s4 7b7 ,geographic di/ribution ,! sites e/abli%$ "u subsection 7a7 %all be geographically di/ribut$ across ! ,unit$ ,/ates4 7c7 ,nonduplication ( curr5t national capacity ,! sites e/abli%$ "u subsection 7a7 may be bas$ 9 academic c5t]s1 heal? dep>tm5ts1 & exi/+ surveillance & laboratory sites4 #f4 ,cl9ical trials network on antibact]ial resi/ance 7a7 ,9 ,g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,national ,in/itute ( ,all]gy & ,infecti\s ,diseases1 %all ma9ta9 a ,cl9ical ,trials ,network on ,antibact]ial ,resi/ance to enhance1 /r5g!n1 & exp& rese>* on cl9ical sci5ce1 antibact]ial & diagno/ic developm5t1 & optimal usage /rategies1 & %all1 at a m9imum-- 7#a7 facilitate rese>* to bett] und]/& resi/ance me*anisms & h[ to prev5t1 control1 & treat resi/ant organisms2 7#b7 l9k data g5]at$ by regional laboratory networks "u exi/+ public heal? surveillance networks & indu/ry2 7#c7 advance cl9ical trial ef=ts to develop antibiotics diagno/ics1 & evaluate & optimize ! usage ( su* antibiotics2 7#d7 conduct cl9ical rese>* to develop natural hi/ories ( resi/ant infecti\s diseases2 7#e7 exam9e pati5t outcomes ) curr5tly available antibiotic !rapy & validate & improve ^u biom>k]s & o!r surrogate endpo9ts2 & 7#f7 /udy %ort] treatm5t duration & e>ly cessation ( antibiotic !rapy = treatm5t efficacy & effect on developm5t ( resi/ance4 7b7 ,antibiotic resi/ance lead]%ip gr\p ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,national ,in/itute ( ,all]gy & ,infecti\s ,diseases1 %all ma9ta9 an antibiotic resi/ance lead]%ip gr\p 7ref]r$ to 9 ?is section z ! lead]%ip gr\p7 to advance ! developm5t & implem5tation ( a compreh5sive cl9ical rese>* ag5da to address antibact]ial resi/ance t takes into consid]ation ! recomm5dations conta9$ 9 ! ,presid5t's ,national ,action ,plan = ,combat+ ,antibiotic-,resi/ant ,bact]ia1 issu$ 9 ,m>* #bjae4 ,! lead]%ip gr\p %all provide support = ! foll[+ compon5ts-- 7#a7 sci5tific lead]%ip & op]ations2 7#b7 cl9ical /udies design & implem5tation2 7#c7 network laboratories2 & 7#d7 /ati/ical & data managem5t4 7c7 ,appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjag ?r\gh #bjbc4 #g4 ,regional prev5tion collaborative ef=ts ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all "w ) ,/ate & local heal? dep>tm5ts to support ! expansion ( collaborative ef=ts by gr\ps ( heal? c>e facilities t focus on prev5t+ ! spread ( antibiotic-resi/ant bact]ia t pose a s]i\s ?reat to public heal?1 & t are design$ to int]rupt & prev5t ! transmission ( significant antibiotic-resi/ant pa?og5s be+ transmitt$ across heal? c>e sett+s 9 a geographic region4 ,su* collaborative ef=ts %all-- 7#a7 id5tify significant drug resi/ant pa?og5s be+ transmitt$ across heal? c>e sett+s locally2 7#b7 implem5t evid5ce-bas$ int]v5tions to int]rupt & prev5t ! transmission ( infections associat$ ) heal? c>e & antibiotic-resi/ant /ra9s ( bact]ia1 includ+ evid5ce-bas$ transmission prev5tion guidel9es1 rigor\s h& hygi5e protocols1 & infection control & prev5tion measures2 7#c7 assess compliance & id5tify b>ri]s to adh]5ce to su* measures2 7#d7 evaluate ! impact ( su* measures on hospital readmissions1 9 heal? c>e facilities across ! cont9uum ( c>e1 rates ( heal? c>e associat$ infections1 or any o!r relevant measures t *>act]ize ! heal? or economic impact ( ! collaborative ef=ts2 & 7#e7 provide recomm5dations = improv$ outcomes & compliance ) su* measures4 #h4 ,prev5tion ,epic5t]s 7a7 ,9 g5]al ,to provide ! regional prev5tion collaborative ef=ts e/abli%$ "u section #g ) tools1 /rategies1 & evid5ce-bas$ int]v5tions1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion may int5sify & exp& academic public heal? p>tn]%ips ?r\gh ! "w ( ! ,prev5tion ,epic5t]s ,program ( ! ,c5t]s = ,disease ,control & ,prev5tion4 ,! ,c5t]s = ,disease ,control & ,prev5tion & ! epic5t]s p>ticipat+ 9 su* program %all "w ) entities1 includ+ ! regional prev5tion collaborative ef=ts1 to-- 7#a7 evaluate new & exi/+ int]v5tions to prev5t or limit infection rates 9 heal? c>e facilities across ! cont9uum ( c>e & 9 community sett+s2 7#b7 facilitate public heal? rese>* on ! prev5tion & control ( resi/ant organisms2 & 7#c7 assess ! feasibility1 co/ effectiv5ess1 & appropriat5ess ( surveillance & prev5tion programs 9 diff]+ heal? c>e & in/itutional sett+s4 7b7 ,educational mat]ials ,! ,c5t]s = ,disease ,control & ,prev5tion %all use ! rese>* & evid5ce f ! epic5t]s p>ticipat+ 9 ! ,prev5tion ,epic5t]s ,program to create & dissem9ate educational mat]ials focus$ on infection prev5tion & control = use 9 heal? c>e facilities across ! cont9uum ( c>e & 9 community sett+s4 #i4 ,cont9uation ( curr5t programs ,subsection 7g7 ( section #cai;,e ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdg;d-#e7 is am5d$ by /rik+ #dj1jjj1jjj & all t foll[s ?r\gh ! p]iod at ! end & ins]t+ su* sums z may be necess>y = ea* ( ! fiscal ye>s #bjag ?r\gh #bjba44 #aj4 ,protection ( confid5tial & national security in=mation ,except z o!rwise requir$ by law1 ?is ,act 7& ! am5dm5ts made by ?is ,act7 %all n be con/ru$ to p]mit an o!rwise-prohibit$ disclosure ( trade secrets1 confid5tial comm]cial in=mation1 or mat]ial inconsi/5t ) national security t is obta9$ by any p]son "u ?is ,act 7or any am5dm5t made by ?is ,act74