,,ii  #aafth ,,congress  #ast ,session  
,s4 #bcjd  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,july #bi1     
#bjai,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 antibiotic resistance1 and for  
other purposes4  #a4 ,short title ,this 
,act may be cited as the ,strategies ,to
 ,address ,antibiotic ,resistance ,act  
or the ,,staar ,act4  #b4 ,combating    
antimicrobial resistance ,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 paragraph 7#a71 in the first    
sentence1 by striking and coordinate    
,federal programs relating to           
antimicrobial resistance and inserting  
relating to antimicrobial resistance1   
coordinate ,federal programs relating to
 antimicrobial resistance1 and implement

 the objectives of the ,national ,action
 ,plan for ,combating                   
,antibiotic-,resistant ,bacteria1       
published in ,march #bjae in response to
 ,executive ,order #acfgf of ,september 
#ah1 #bjad 7#gi ,fed4 ,reg4 #efica2     
relating to combating                   
antibiotic-resistant bacteria7 7referred
 to in this section as the ,action      
,plan72  7,b7 by amending paragraph 7#b7
 to read as follows3  7#b7 ,members of  
task force ,the task force described in 
paragraph 7#a7 shall be co-chaired by   
the ,secretary of ,health and ,human    
,services1 the ,secretary of            
,agriculture1 and the ,secretary of     
,defense1 and shall be composed of      
representatives of relevant ,federal    
agencies and such executive departments1
 agencies1 or offices as the co-chairs  
may designate4  2  7,c7 by amending     
paragraph 7#d7 to read as follows3  7#d7
 ,meetings ,at least twice a year1 the  
task force described in paragraph 7#a7  
shall have a public meeting to assess   

progress and obstacles to implementing  
the objectives of the ,action ,plan4    
,the task force may discuss and review  
based on need or concern the following  
7among other issues73  7,a7 ,federal    
activities to slow the emergence of     
antimicrobial-resistant bacteria and    
prevent the spread of resistant         
infections4 ,such activities may include
 optimal use of vaccines and other      
infection control measures to prevent   
infections1 implementation of health    
care policies and antimicrobial         
stewardship programs that improve       
patient outcomes1 regional efforts to   
control transmission across community   
and health care settings1 and public    
awareness campaigns4  7,b7 ,federal     
activities to strengthen national       
,one-,health surveillance efforts1 which
 are efforts addressing the interactions
 between human1 animal1 and             
environmental health1 to combat         
antibiotic resistance4 ,one-,health     
surveillance efforts to combat          

antibiotic resistance may include       
enhanced data sharing and coordination  
of surveillance and laboratory systems  
across human and animal settings1 and   
enhanced monitoring of sales1 usage1    
resistance1 and management practices of 
antibiotic drugs along the              
food-production chain4 ,such            
surveillance and laboratory systems may 
include the ,national ,healthcare       
,safety ,network1 the ,emerging         
,infections ,program1 the ,national     
,antimicrobial ,resistance ,monitoring  
,system1 the ,national ,animal ,health  
,monitoring ,system1 the ,national      
,animal ,health ,laboratory ,network1   
the ,veterinary ,laboratory             
,investigation and ,response ,network1  
and the ,antibiotic ,resistance         
,laboratory ,network4  7,c7 ,federal    
efforts to advance the development and  
use of rapid and innovative diagnostic  
tests for identification and            
characterization of antibiotic-resistant
 bacteria4 ,such efforts may include    

development of new diagnostic tests and 
expansion of their availability and use 
to improve treatment1 infection control1
 and outbreak response4  7,d7 ,federal  
efforts to accelerate basic and applied 
research and development for new        
antibiotic drugs1 other therapeutics1   
prevention efforts1 and vaccines4 ,such 
efforts may include support for basic   
and applied research1 provision of      
scientific services and guidance to     
researchers1 and fostering of           
public-private partnerships4  7,e7      
,federal efforts to improve             
international collaboration and         
capacities for antibiotic-resistance    
prevention1 surveillance1 and control   
and antibiotic research and development4
 ,such efforts may include              
collaborations with foreign ministries  
of health and agriculture1 the ,world   
,health ,organization1 the ,food and    
,agriculture ,organization1 the ,world  
,organization for ,animal ,health1 and  
other multinational organizations4  2   

and  7,d7 by adding at the end the      
following3  7#e7 ,availability of       
information ,the task force described in
 paragraph 7#a71 to the extent permitted
 by law1 shall--  7,a7 provide the      
,presidential ,advisory ,council on     
,combating ,antibiotic-,resistant       
,bacteria described in section #eje of  
the ,pandemic and ,all-,hazards         
,preparedness and ,advancing ,innovation
 ,act of #bjai with such information as 
may be required for carrying out the    
functions of such ,advisory ,council1   
including information on progress in    
advancing the ,action ,plan1 meeting    
minutes1 and other key information of   
the task force2 and  7,b7 ensure that   
all information described in            
subparagraph 7,a7 is made available on  
the websites of the ,department of      
,health and ,human ,services1 the       
,department of ,agriculture1 and the    
,department of ,defense4  2  7#b7 in    
subsection 7h7--  7,a7 in the heading1  
by striking ,information related to2    

7,b7 by striking ,the ,secretary and    
inserting the following3  7#a7          
,dissemination of information ,the      
,secretary  2 and  7,c7 by adding at the
 end the following3  7#b7 ,encouraging  
antimicrobial stewardship programs ,the 
,secretary shall encourage health care  
facilities to establish antimicrobial   
stewardship programs that are consistent
 with documents issued by the ,centers  
for ,disease ,control and ,prevention   
relating to the core elements of        
antimicrobial stewardship programs4     
7#c7 ,definition of antimicrobial       
stewardship ,for purposes of this       
section1 the term antimicrobial         
stewardship means coordinated           
interventions designed to improve and   
evaluate the appropriate use of         
antimicrobial agents1 including         
promoting the use of antimicrobial drugs
 only when clinically indicated1 and1   
when antimicrobial drugs are clinically 
indicated1 promoting the selection of   
the optimal antimicrobial drug regimen1 

including through factors such as       
dosage1 duration of therapy1 and route  
of administration4  2  7#c7 in          
subsection 7m71 by striking #dj1jjj1jjj 
and all that follows through the period 
at the end and inserting such sums as   
may be necessary for each of fiscal     
years #bjbj through #bjbf42 and  7#d7 by
 adding at the end the following3  7n7  
,annual report on implementing the      
,action ,plan objectives ,not later than
 #a year after the date of the enactment
 of the ,strategies ,to ,address        
,antibiotic ,resistance ,act1 and       
annually thereafter1 the ,secretary1 in 
cooperation with the ,secretary of      
,agriculture1 the ,secretary of         
,defense1 and the task force described  
in subsection 7a71 shall submit to the  
,committee on ,health1 ,education1      
,labor1 and ,pensions of the ,senate and
 the ,committee on ,energy and ,commerce
 of the ,house of ,representatives1 and 
make available on the websites of the   
,department of ,health and ,human       

,services1 the ,department of           
,agriculture1 and the ,department of    
,defense1 a report on the progress made 
in implementing the objectives of the   
,action ,plan4  4  #c4 ,additional      
strategies for combating antibiotic     
resistance ,part ,b of title ,,iii of   
the ,public ,health ,service ,act 7#db  
,u4,s4,c4 #bdc et seq47 is amended by   
inserting after section #cai;,e the     
following3  #cai;,e-#a4 ,surveillance   
and reporting of antibiotic use and     
resistance  7a7 ,in general ,the        
,secretary1 acting through the ,director
 of the ,centers for ,disease ,control  
and ,prevention1 shall use the ,national
 ,healthcare ,safety ,network and other 
appropriate surveillance systems to     
assess--  7#a7 appropriate conditions1  
outcomes1 and measures causally related 
to antibacterial resistance1 including  
types of infections1 the causes for     
infections1 and whether infections are  
acquired in a community or hospital     
setting1 increased lengths of hospital  

stay1 increased costs1 and rates of     
mortality2 and  7#b7 changes in         
bacterial resistance to drugs in        
relation to patient outcomes1 including 
changes in percent resistance1          
prevalence of antibiotic-resistant      
infections1 and other such changes4  7b7
 ,antibiotic use data ,the ,secretary1  
acting through the ,director of the     
,centers for ,disease ,control and      
,prevention1 shall work with ,federal   
agencies 7including the ,department of  
,veterans ,affairs1 the ,department of  
,defense1 and the ,centers for ,medicare
  ,medicaid ,services71 private vendors1
 health care organizations1 pharmacy    
benefit managers1 and other entities as 
appropriate to obtain reliable and      
comparable human antibiotic drug        
consumption data 7including1 as         
available and appropriate1 volume       
antibiotic distribution data and        
antibiotic use data1 including          
prescription data7 by ,state or         
metropolitan areas4  7c7 ,antibiotic    

resistance trend data ,the ,secretary1  
acting through the ,director of the     
,centers for ,disease ,control and      
,prevention1 shall intensify and expand 
efforts to collect antibiotic resistance
 data and encourage adoption of the     
antibiotic resistance and use module    
within the ,national ,healthcare ,safety
 ,network among all health care         
facilities across the continuum of care1
 including1 as appropriate1 acute care  
hospitals1 dialysis facilities1 nursing 
homes1 ambulatory surgical centers1 and 
other ambulatory health care settings in
 which antimicrobial medications are    
routinely prescribed4 ,the ,secretary   
shall seek to collect such data from    
electronic medication administration    
reports and laboratory systems to       
produce the reports described in        
subsection 7d74  7d7 ,public            
availability of data ,the ,secretary1   
acting through the ,director of the     
,centers for ,disease ,control and      
,prevention1 shall1 for the purposes of 

improving the monitoring of important   
trends in patient outcomes in relation  
to antibacterial resistance--  7#a7 make
 the data derived from surveillance     
under this section publicly available   
through reports issued on a regular     
basis that is not less than annually2   
and  7#b7 examine opportunities to make 
such data available in near real time4  
#cai;,e-#b4 ,detecting network of       
antibiotic resistance regional          
laboratories  7a7 ,in general ,the      
,secretary1 acting through the ,director
 of the ,centers for ,disease ,control  
and ,prevention1 shall establish not    
less than #g ,antibiotic ,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 antibiotic-resistant 
bacteria2  7#b7 describe1 confirm1 and1 

as necessary1 facilitate a response to1 
local or regional outbreaks of resistant
 bacteria2  7#c7 assess and describe    
antibiotic resistance patterns to inform
 public health and improve prevention   
practices2  7#d7 obtain isolates of     
pathogens1 and in particular1 bacteria  
that show new or atypical patterns of   
resistance adversely affecting public   
health2  7#e7 assist in studying the    
epidemiology of infections from such    
pathogens2  7#f7 evaluate commonly used 
antibiotic susceptibility testing       
methods to improve the accuracy of      
resistance testing and reporting2  7#g7 
as necessary1 develop or evaluate novel 
diagnostic tests capable of detecting   
new or emerging resistance in bacteria2 
7#h7 link data generated by regional    
laboratory networks under existing      
public health surveillance networks and 
relevant government agencies2 and  7#i7 
provide laboratory assistance and       
reference testing of                    
antibiotic-resistant bacteria to enhance

 infection control and facilitate       
outbreak detection and response in      
health care and community settings4  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  #cai;,e-#c4      
,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 maintain a ,clinical   
,trials ,network on ,antibacterial      
,resistance to enhance1 strengthen1 and 
expand research on clinical science1    
antibacterial and diagnostic            
development1 and optimal usage          
strategies with respect to addressing   
antibacterial resistance4 ,such ,network

 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 antibiotics diagnostics1 and    
evaluate and optimize the usage of such 
antibiotics diagnostics2  7#c7 conduct  
clinical research to develop natural    
histories of resistant infectious       
diseases2  7#d7 examine patient outcomes
 with currently available antibiotic    
therapy and validate and improve upon   
biomarkers and other surrogate          
endpoints2 and  7#e7 study shorter      
treatment duration and early cessation  
of antibiotic therapy for treatment     
efficacy and the effect on development  
of resistance4  7b7 ,authorization of   
appropriations ,there are authorized to 
be appropriated to carry out this       
section such sums as may be necessary   
for each of fiscal years #bjbj through  
#bjbf4  #cai;,e-#d4 ,regional prevention
 collaborative efforts  7a7 ,in general 

,the ,secretary1 acting through the     
,director of the ,centers for ,disease  
,control and ,prevention1 shall work    
with ,state and local health departments
 to support the expansion of            
collaborative efforts by groups of      
health care facilities that focus on    
preventing the spread of                
antibiotic-resistant bacteria that pose 
a serious threat to public health1 and  
that are designed to interrupt and      
prevent the transmission of significant 
antibiotic-resistant pathogens being    
transmitted across health care settings 
in a geographic region4 ,such           
collaborative efforts shall--  7#a7     
identify significant drug resistant     
pathogens being transmitted across      
health care settings locally2  7#b7     
implement evidence-based interventions  
to interrupt the transmission of        
antibiotic-resistant strains of bacteria
 and prevent the infections caused by   
such bacteria1 including evidence-based 
transmission prevention guidelines1     

rigorous hand-hygiene protocols1 and    
infection control and prevention        
measures2  7#c7 assess compliance and   
identify barriers to adherence to such  
measures2  7#d7 evaluate the impact of  
such measures1 to the extent possible1  
on hospital readmissions in health care 
facilities across the continuum of care1
 rates of health care associated        
infections1 or any other relevant       
measures that characterize the health or
 economic impact of the collaborative   
efforts2 and  7#e7 provide              
recommendations for improved outcomes   
and compliance with such measures4  7b7 
,prevention epicenters  7#a7 ,expansion 
,the ,secretary1 acting through the     
,director of the ,centers for ,disease  
,control and ,prevention1 may intensify 
and expand academic public health       
partnerships through the ,prevention    
,epicenters ,program to provide the     
regional prevention collaboration       
efforts described in subsection 7a7 with
 tools1 strategies1 and evidence-based  

interventions4  7#b7 ,evaluations and   
research ,the ,director of the ,centers 
for ,disease ,control and ,prevention   
and the epicenters participating in the 
,prevention ,epicenters ,program shall  
work with entities1 including the       
entities participating in the regional  
prevention collaborative efforts1 to--  
7,a7 evaluate new and existing          
interventions to prevent or limit       
infection rates in health care          
facilities across the continuum of care 
and in community settings2  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  7c7   
,educational materials ,the ,secretary1 
acting through the ,director of the     
,centers for ,disease ,control and      
,prevention1 shall use the evaluations1 
research1 and assessments described in  

subsection 7b7 to create and disseminate
 educational materials focused on       
infection prevention and control for use
 in health care facilities across the   
continuum of care and in community      
settings4  4  #d4 ,protection of        
confidential and national security      
information ,this ,act1 and the         
amendments made by this ,act1 shall not 
be construed to permit the disclosure of
 any trade secret1 confidential         
commercial information1 or material     
inconsistent with national security1    
that is otherwise prohibited by law4