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Name Sort descending	Updated	Required form	Specimen Collection and Submission Instructions	Pre-approval Requirement Procedure, if applicable	Methodology	Testing Frequency	Turnaround Time (business days)	Comments	Footnotes	Contact	Notifiable Conditions Info
Candida auris screening Candida	09/20/2024	ARLN Requisition Form (webform)	Collect isolates by swabbing the patient's axilla and groin. Transport in a BD Eswab with 1.0mL Amies Buffer. Submit Eswab isolates immediately on ice to be tested within 9 days of collection. Collection and submission instructions: SCSI-ARLN-Candida-Screening	Pre-approval required. Must be approved by submitter jurisdiction's Healthcare-Associated Infections (HAI) coordinator prior to submitting to ARLN.	Real-Time PCR performed to confirm C. auris Culture based testing will be performed on positives and discordant results, this will affect turnaround time.	Daily, on regular business days	2-3 business days (PCR) 7-14 business days (culture-based screening)		*This screening method was developed by the Centers for Disease Control and Prevention (CDC). Its performance characteristics have been validated by the WA State PHL. An inability to recover or isolate C. auris does not exclude the possibility of patient colonization. Results are not approved by the FDA and are for infection control and epidemiological purposes, and should not be used for the sole basis of diagnosis or patient treatment.	ARLN Laboratory (206) 418-5478 Mike Tran (206) 418-5459	Notifiable Conditions Overview List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
Candida species Identification and Fungal Susceptibility Testing Candida, Fungal, AFST	12/30/2024	ARLN Requisition Form (webform)	Submit clonal Isolates (selected from a single colony) on a Sabouraud's Dextrose agar slant or other appropriate media at room temperature. Isolates are stable for 2-3 weeks and may be stored for batch submission. Please refer to additional collection and submission instructions: SCSI-ARLN-Candida-AFST.	Pre-approval not required. Testing limited to Candida spp. excluding C. albicans.	Confirmatory identification performed using MALDI-TOF on Candida isolates, excluding Candida albicans. Beginning January 1, 2025, only Candida isolates originating from sterile sites (blood, internal body sites, CSF, etc.) and urine will undergo antifungal susceptibility testing (AFST). AFST on isolates from noneligible sterile sites may be requested by emailing ARLN@doh.wa.gov Antifungal susceptibility tested by broth microdilution and Etest strips (Amphotericin B), following the most current CLSI interpretations.	Daily, on regular business days.	7 business days	For Washington State only: As of January 1, 2023, Candida auris is a notifiable condition in Washington State. Washington State health care providers and facilities must notify their local health jurisdiction within 24 hours of C.auris identification. Laboratories must notify the local health jurisdiction within 24 hours and submission to WA PHL is required. Please reference here for additional information		ARLN Laboratory (206) 418-5478 Mike Tran (206) 418-5459	Notifiable Conditions Overview List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
Neisseria gonorrhoeae Antimicrobial Susceptibility Testing N. gonorrhoeae, GC	09/17/2019		Submit isolates derived from urethral discharge specimens and other anatomic sites (e.g., vaginal, endocervical, pharyngeal, and/or rectal specimen-derived isolates), and collected from patients presenting at CDC-selected sexually transmitted disease clinics (sentinel sites). N. gonorrhoeae isolates will be initially processed at CDC-selected sentinel site laboratories. Those presumptively identified as N. gonorrhoeae by Gram stain and oxidase reaction will be shipped for bacterial identification and antimicrobial susceptibility testing. Please refer to additional collection and submission instructions: SCSI-ARLN-GC		Identification of all isolates presumed to be N. gonorrhoeae confirmed by carbohydrate utilization and DNA hybridization. Antimicrobial susceptibility performed by agar dilution.	Twice monthly, or as needed.	1-2 weeks			ARLN Laboratory (206) 418-5478 Mike Tran (206) 418-5459	Notifiable Conditions Overview List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
Carbapenem-resistant Acinetobacter CR-Acinetobacter, CRAB, CR-AB	12/13/2023	ARLN Requisition Form (webform)	Submit Acinetobacter resistant to imipenem, meropenem, or doripenem by standard susceptibility testing methods (i.e., minimum inhibitory concentrations of >=8 μg/mL). Transport on Tryptic Soy Agar Slant or equivalent at room temperature. Please refer to additional collection and submission instructions: SCSI-ARLN-CRAB		Bacterial identification and confirmation performed using MALDI-TOF mass spectrometry. Antimicrobial susceptibility testing performed using Kirby Bauer disk diffusion, microbroth dilution, and/or Etest. Detection of carbapenemase genes KPC, NDM, OXA-48 like, VIM, and IMP by laboratory developed PCR method or Cepheid GeneXpert Carba-R Assay.*	Daily, on regular business days.	2-3 business days	Interested clinical labs may enroll as sentinel labs. Sentinel labs will receive benefits such as free materials for isolate submission. Please contact the AR Lab Network if interested.	*Multiplex PCR assay has been modified and validated by the WA State PHL. It has not been cleared or approved by the FDA for diagnostic testing. Microbroth dilution test was developed and its performance characteristics determined by the Centers for Disease Control and Prevention (CDC). This method has been validated by the WA State PHL, it has not been approved by the FDA and is not intended for clinical patient management. Results are for epidemiological and infection control purposes and are not to be used as the sole means for clinical diagnosis, patient management, or treatment monitoring.	ARLN Laboratory (206) 418-5478 Mike Tran (206) 418-5459	Notifiable Conditions Overview List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
Carbapenem-resistant Pseudomonas CR-Pseudomonas, CRPA, CR-PA, Pseudomonas aeruginosa	11/04/2024	ARLN Requisition Form (webform)	Submit P. aeruginosa isolates that are resistant to imipenem, meropenem, or doripenem by standard susceptibility testing methods (i.e., minimum inhibitory concentrations of >=8 μg/mL) AND non-susceptible or resistant to ceftazidime or cefepime (i.e. minimum inhibitory concentrations of >16 ug/mL. Transport on a Tryptic Soy Agar Slant or equivalent at room temperature. Please refer to additional collection and submission instructions: SCSI-ARLN-CRPA	Pre-approval not required.	Bacterial identification and confirmation performed using MALDI-TOF mass spectrometry. Antimicrobial susceptibility testing performed using Kirby Bauer disk diffusion, microbroth dilution, and/or Etest. Phenotypic detection of carbapenemase production by CLSI Modified Carbapenem Inactivation Method (mCIM). Detection of carbapenemase genes KPC, NDM, OXA-48 like, VIM, and IMP by laboratory developed PCR method or Cepheid GeneXpert Carba-R Assay.*	Daily, on regular business days	2-3 business days	Only pure isolates will be tested; Mucoid isolates should be excluded. Washington State DOH requests voluntary submission of carbapenem-resistant Pseudomonas from Washington sentinel labs.	*Multiplex PCR assay has been modified and validated by the WA State PHL. It has not been cleared or approved by the FDA for diagnostic testing. Modified Carbapenem Inactivation Method is a CLSI standard and is not approved by the FDA. Performance characteristics have been verified by the WA State PHL. Microbroth dilution test was developed and its performance characteristics determined by the Centers for Disease Control and Prevention (CDC). This method has been validated by the WA State PHL. It has not been approved by the FDA, and is not intended for clinical patient management. Results are for epidemiological and infection control purposes and are not to be used as the sole means for clinical diagnosis, patient management, or treatment monitoring.	ARLN Laboratory (206) 418-5478 Mike Tran (206) 418-5459	Notifiable Conditions Overview List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
Carbapenem-resistant Enterobacterales (CRE) E.coli, Klebsiella, Enterobacter, CRE, Multi-drug resistant organism, MDRO	11/04/2024	ARLN Requisition Form (webform)	Submit Escherichia coli, Klebsiella spp, and Enterobacter spp that are resistant to imipenem, meropenem, doripenem, or ertapenem by standard susceptibility testing methods (i.e. minimum inhibitory concentrations of >=4 μg/mL for doripenem, imipenem or meropenem or >=2 μg/mL for ertapenem). Transport on a Tryptic Soy Agar Slant or equivalent at room temperature. Please refer to additional collection and submission instructions: SCSI-CRE-Testing	Pre-approval not required.	Bacterial identification and confirmation performed using MALDI-TOF mass spectrometry. Antimicrobial susceptibility testing performed using Kirby Bauer disk diffusion, microbroth dilution, and/or Etest. Phenotypic detection of carbapenemase production by CLSI Modified Carbapenem Inactivation Method (mCIM). Detection of carbapenemase genes KPC, NDM, OXA-48 like, VIM, and IMP by laboratory developed PCR method or Cepheid GeneXpert Carba-R Assay.*	Daily, on regular business days.	2-3 business days	For Washington State only: As of January 1, 2023, Carbapenem-resistant and carbapenemase-producing Enterobacterales must be sent to WA PHL within 2 business days of detection.	*Multiplex PCR assay has been modified and validated by the WA State PHL. It has not been cleared or approved by the FDA for diagnostic testing. Modified Carbapenem Inactivation Method is a CLSI standard and is not approved by the FDA. Performance characteristics have been verified by the WA State PHL. Microbroth dilution test was developed and its performance characteristics determined by the Centers for Disease Control and Prevention (CDC). This method has been validated by the WA State PHL.It has not been approved by the FDA, and is not intended for clinical patient management. Results are for epidemiological and infection control purposes and are not to be used as the sole means for clinical diagnosis, patient management, or treatment monitoring.	ARLN Laboratory (206) 418-5478 Mike Tran (206) 418-5459	Notifiable Conditions Overview List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
Carbapenemase-producing Organism (CPO) Colonization Surveillance Screening	11/04/2024	ARLN Requisition Form (webform)	Collect rectal swabs using the Copan dual-swab for testing using the Cepheid GeneXpert assay. Insert swab in the tube’s universal transport media. Ship at room temperature (15- 28C) to the Regional Laboratory within 1 day of collection. Collection and submission instructions: SCSI-CRE-Surveillance	Pre-approval required. Must be approved by submitter jurisdiction's Healthcare-associated Infections (HAI) coordinator prior to submitting to ARLN.	FDA approved Cepheid GeneXpert Carba-R assay for the detection of Carbapenemase genes KPC, NDM, VIM, IMP-1 group and OXA-48 (also covering OXA-181 and OXA-232).*	As needed (available on regular business days).	1-3 business days	Patient swabs should be mailed immediately following collection. Avoid shipping on Fridays. Copan dual swabs are viable for testing <5 days after patient collection.	*Detection of resistance mechanisms is restricted to the target capacity of the assay’s primers and probes. Non-detected targets does not exclude the presence of variants, or other rare carbapenemase genes or resistance mechanisms. Results are for epidemiological and infection control purposes and are not to be used as the sole means for clinical diagnosis, patient management, or treatment monitoring.	ARLN Laboratory (206) 418-5478 Mike Tran (206) 418-5459	Notifiable Conditions Overview List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
Detection of IMP-variants	12/13/2023	ARLN Requisition Form (webform)	Submit isolates that are mCIM positive, but negative for KPC, NDM, VIM, OXA-48, and IMP with molecular testing. Transport on a Tryptic Soy Agar slant or equivalent at room temperature Please refer to additional collection and submission instructions: SCSI-ARLN-IMP		Real-Time PCR to detect IMP-1, IMP-4, IMP-13, IMP-14, IMP-18, IMP-26, and IMP-27 in a single reaction with lysates prepared from gram negative bacteria.	Every other week based on testing volume	7-10 business days	This test is performed when phenotypic results are discordant with standard molecular methods for detection of common carbapenemase producing genes.		ARLN Laboratory (206) 418-5478 Mike Tran (206) 418-5459	Notifiable Conditions Overview List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
Detection of OXA-variants	11/04/2024	ARLN Requisition Form (webform)	Submit Acinetobacter resistant to imipenem, meropenem, or doripenem by standard susceptibility testing methods (i.e., minimum inhibitory concentrations of >=8 ug/mL). Transport on a Tryptic Soy Agar slant or equivalent at room temperature Please refer to additional collection and submission instructions: SCSI-ARLN-OXA		Real-Time PCR to detect OXA-23-like, OXA-24/40-like, OXA-58-like, and OXA-235-like in a single reaction with lysates prepared from gram negative bacteria.	as needed	7-10 business days	This test is performed when antibiotic susceptibility testing results are discordant with standard molecular methods for detection of common carbapenemase producing genes.		ARLN Laboratory (206) 418-5478 Mike Tran (206) 418-5459	Notifiable Conditions Overview List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
Expanded Antimicrobial Susceptibility Testing for Hard to Treat Infections (ExAST)	12/13/2023	ARLN Requisition Form (webform)	This project is intended to inform clinical decisions for highly resistant infections. Submit Enterobacterales isolates that: test non-susceptible to all beta-lactams, including either ceftazidime-avibactam or meropenem-vaborbactam have NDM, VIM, or IMP genes confirmed by molecular testing Transport on a Tryptic Soy Agar slant or equivalent at room temperature Please refer to additional collection and submission instructions: SCSI-ARLN-ExAST	Pre-authorization is required. Please contact ARLN@doh.wa.gov	Isolates will be tested to confirm carbapenem resistance, carbapenemase production, and to identify carbapenemase gene-coded resistance. Isolates that meet inclusion criteria will be tested for susceptibility to ceftazidime+avibactam, aztreonam and avibactam+aztreonam	as needed	3 business days			ARLN laboratory (206) 418-5478 Mike Tran (206) 418-5459	Notifiable Conditions Overview List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
Gradient Strip Neisseria gonorrhoeae Antimicrobial Susceptibility Testing (pre-approval required)	11/16/2021		Submit N. gonorrhoeae isolates or clinical samples associated with suspected treatment failures. Isolates of either confirmed or suspected N. gonorrhoeae grown in pure culture on media slants OR clinical samples collected from patients and inoculated onto an InTray are accepted. Pre-approval is required, specimens sent without approval will not be tested. Please email ARLN@doh.wa.gov Testing is conducted at the AR Lab Network Partner Laboratory (University of Washington Neisseria Reference Laboratory), do not send specimens to WA PHL Please refer to additional collection and submission instructions: SCSI-ARLN-GC-E-TEST Required Form: ARLN-GC E-test Requisition Form		Antimicrobial susceptibility testing (AST) by gradient strip (Biomerieux E-test strips).	As needed	10 business days	This test is performed when treatment failure is suspected		ARLN Laboratory (206) 418-5478 ARLN@doh.wa.gov Mike Tran (206) 418-5459	Notifiable Conditions Overview List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)
Targeted surveillance screening	11/04/2024	ARLN Requisition Form (webform)	Collect Copan LQ Stuart Transytem (Catalog number 900-0370) for either culture-based testing or PCR-based testing (testing protocols based on carbapenemase target and/or collection site. Please consult public health on appropriate collection site and prescribed test. Targeted Surveillance by PCR Rectal swab for OXA-variants (OXA-23-like, OXA-58-like, OXA-24/40-like, OXA-235-like) commonly found in CRAB (carbapenem-resistant Acinetobacter baumannii) surveillance Rectal swab for IMP-variants that not detected by the Cepheid Xpert Carba-R Targeted Surveillance by Culture Non-rectal swabs for IMP, KPC, NDM, OXA-48-like and IMP, as well as OXA-variants if target is CRAB After collection, insert swab into the tube's universal transport media. Ship at room temperature (15-18C) to the regional laboratory within 5 days of collection. Please refer to additional collection and submission instructions: SCSI-ARLN-Targeted Surveillance Screening	Pre-approval required. Must be approved by submitter jurisdiction's healthcare-associated infections (HAI) coordinator prior to submitting to the AR Lab Network.	Depending on swab collection source and carbapenemase target: Isolates extracted from culture-based screening will be tested for targets of interest. Direct PCR from collected swabs for OXA-variants	As needed (available on regular business days)	Depending on swab collection source and carbapenemase target: PCR- 2-5 business days Culture- 7-10 business days	Patient swabs should be mailed immediately following collection. For PCR, testing requires 2 consecutive days of work, swabs received on Friday may have to go to culture. Copan dual swabs are viable for testing <5 days after patient collection.	Detection of resistance mechanisms is restricted to the target capacity of the assay's primers and probes. Non-detected targets does not exclude the presence of variants, or other rare carbapenemase genes or resistance mechanisms. Results are for epidemiological and infection control purposes and are not to be used as the sole means for clinical diagnosis, patient management, or treatment monitoring.	ARLN Laboratory (206) 418-5478 Mike Tran (206) 418-5459	Notifiable Conditions Overview List of Notifiable Conditions (includes links to reporting forms, guidelines for public health investigations, and case definition)