Form I9 Gonococcal (GC) Antimicrobial Susceptibility Testing (AS

Form Approved

OMB Control No.: 0920-1310

Expiration date: XX/XX/XXXX

Annual Evaluation and Performance Measurement Report (I.9- GONOCOCCAL (GC) ANTIMICROBIAL SUSCEPTIBILITY TESTING (AST) IN JURISDICTION)

Annually, each funded laboratory is required to report to CDC evaluation and performance measures. Data are used to indicate progress made toward program outcomes. These summary reports have to be uploaded to the ELC CAMP at the end of each funding year. Required performance measures are listed below.

1. Proportion of isolates transported per program guidance to CDC:

1. Numerator: Number of isolates transported to CDC

2. Denominator: Total number of isolates requested

3. Calculated: Percent of isolates transported upon request to CDC

2. Proportion of AST results reported to submitters within 3 weeks of submission:

1. Numerator: Number of AST results reported to sentinel sites within 3 weeks of submission

2. Denominator: Number of GC isolates received at AR Lab Network

3. Calculated: Percentage of AST results reported to sentinel sites within 3 weeks of submission

3. Proportion of contaminated specimens submitted by each laboratory, by site:

Contaminated Specimens
Site:	Submitting Laboratory Site Name (pulled from question 1)	Number of contaminated specimens submitted	Number of Specimens submitted (pulled from question 1)	Calculated: Percent of contaminated specimens submitted
1
2

4. Describe any challenges you've faced with conducting AST and/or reporting results back to submitting laboratories within 3 weeks of submission.

5. Proportion of isolates with AST results for zoliflodacin:

   1. Numerator: Number of isolates with zoliflodacin AST results.

   2. Denominator: Total number of isolates submitted for AST.

   3. Calculated: Percentage of isolates with zoliflodacin AST results.

6. Proportion of isolates with AST results for doxycycline:

   1. Numerator: Number of isolates with doxycycline AST results.

   2. Denominator: Total number of isolates submitted for AST.

   3. Calculated: Percentage of isolates with doxycycline AST results.

7. Proportion of isolates with AST results for ertapenem:

   1. Numerator: Number of isolates with ertapenem AST results.

   2. Denominator: Total number of isolates submitted for AST.

   3. Calculated: Percentage of isolates with ertapenem AST results.

8. Total number of laboratory proficient in GC AST methods.

9. Total number of Etest AST requests received

   1. Number of different submitters

10. Number and proportion of types of samples received by anatomical site for Etest

Anatomical Site	Number of Etest AST requests	Number of Etests with results reported to submitter

11. Proportion of 'Alert' isolates:

a. Numerator: Number of isolates with 'Alert' minimum inhibitory concentrations (MICs)

b. Denominator: Number of isolates tested for antimicrobial susceptibility

c. Calculated: Percentage of isolates with 'Alert' MICs of all isolates tested for antimicrobial susceptibility

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 currently 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 Road NE, MS H21-8, Atlanta, Georgia 30333; ATTN: PRA 0920-1310