Antibiotic Resistance Monitoring & Reference Laboratory (ARMRL)

ARMRL is the national reference laboratory responsible for the detection and investigation of antibiotic resistance.

In its Antibiotic Resistance and Evaluation Unit (Unit Head, Dr Robert Hill), ARMRL tests referred isolates (listed below), principally those thought by the senders to have unusual resistances. Minimum inhibitory concentrations (MICs) of relevant antibiotics are determined for these isolates, and ARMRL advises on which agents may be appropriate therapy, and on any public health risk.

In its Resistance Mechanisms Monitoring Unit (Unit Head, Dr Neil Woodford), ARMRL offers molecular detection of the genetic determinants (outlined below) of certain key resistances.

Reference and Diagnostic Testing Services

• MIC tests on isolates from endocarditis
• Confirmation of unusual resistances. The table below lists those resistances that are so unusual as to demand confirmation. However, ARMRL is happy to help confirm other resistances and to help laboratories encountering their first few ESBL producers, glycopeptide-resistant enterococci, penicillin-resistant pneumococci etc.
• Interpretative antibiogram reading - predicting mechanisms
• Testing new antibiotics vs. problem isolates. These may be available pre-launch for compassionate use.
• Detection of mecA and mupA in staphylococci by PCR and real-time PCR
• Detection of a G2576T linezolid resistance mutation in 23S rRNA genes of enterococci or staphylococci
• Detection of genes conferring   in Enterococcus faecium and staphylococci
• Detection of carbapenemase production in Pseudomonas spp. Acinetobacter spp and Enterobacteriaceae.
• ARMRL does not have its own request forms for the above services:
  • streptococci should be referred using the Request Form R3 (PDF, 87 KB)
    Streptococcus & Diphtheria Reference Unit Request Form
  • staphylococci and nosocomial gram-negatives should be referred using the LHCAI forms:
    • Request Form H2 (PDF, 88 KB)
      For the submission of any single isolate for identification and/or typing
    • Request Form H1 (PDF, 89 KB)
      For the submission of multiple isolates of the same species for typing
• ARMRL does NOT undertake antimicrobial assays for therapeutic monitoring. These are available from the Regional Antimicrobial Reference Laboratory in Bristol.

Key

Unless indicated above, confirmation of resistance should be by ARMRL. Exceptions:-

* Confirmation by HPA Meningococcal Reference Unit, Manchester.

!Send gonococci to the Sexually Transmitted Bacteria Reference Laboratory, CfI.

@ Confirmation by HPA Anaerobe Reference Unit, Cardiff.

# Send Salmonellae, Shigellae to Laboratory of Enteric Pathogens, CfI.