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Multi-Drug Resistant Gram Negative Bacilli (MUGSI) Surveillance


MUGSIMulti-drug resistant gram-negative bacilli (MuGSI) are common causes of infections in both healthcare and community settings. Examples of gram-negative bacilli include E. coli and K. pneumoniae. These bacteria are increasingly becoming resistant to some antibiotics commonly used to treat them. To monitor trends in the incidence of MuGSI, we conduct population based surveillance among residents of Monroe County, NY.

Goals and Objectives

  • Evaluate the population-based incidence of carbapenem-nonsusceptibility among common strains of Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter species and describe how the incidence changes over time
  • Better characterize carbapenem-nonsusceptible strains in sites submitting data in order to inform prevention efforts
  • Describe known resistance mechanisms among a subset of carbapenem-nonsusceptible Enterobacteriaceae


Working with laboratories in Monroe County, the surveillance team identifies carbapenem resistant organisms, as well as those resistant to third generation cephalosporins. Demographic data, as well as data about the nature of the identified bacterial culture are collected to identify potential risk factors for infection and to classify cases as  Hospital-onset (HO), healthcare-associated community onset (HACO), or community-associated (CA). Selected isolates are sent to the Centers for Disease Control and Prevention (CDC) for further study.


Classification of MuGSI* cases - Monroe County, 2013-2016

MuGSI graph

*includes carbapenem-resistant E. coli, Klebsiella pneumoniae, Klebsiella oxytoca), Enterobacter aerogenes, E. cloacae complex, Acinetobacter baumannii, A. baumannii complex, and A. calcoaceticus-baumannii complex.


  • Wozniak JE; Band VI; Conley A; Rishishwar L; Burd EM; Satola SW; Hardy D; Tsay R; Farley MM; Jacob JT; Dumyati G; Jordan IK; Weiss DS.  A Nationwide Screen of carbapenem-resistant reveals an isolate with enhanced virulence and clinically undetected colistin-heteroresistance. Antimicrob agents and chemother. 2019;Epub 2019 Feb 25. doi: 10.1128/AAC.00107-19.
  • Guh, A: Bulens., SN; Mu, Y; Jacob, JT; Reno, J; Scott, J; Wilson, LE, Sc,M; Vaeth, E; Lynfield, R; Shaw, KM; Snippes, PM; Vagnone, MT(ASCP); Bamberg, WM; Janelle, SJ; Dumyati, G; Concannon, C; Beldavs, Z; Cunningham, M; Cassidy, M; Phipps, EC; Kenslow, N; Travis, T; Lonsway, D; Rasheed, JK; Limbago, BM; Kallen, AJ. Epidemiology of Carbapenem-Resistant Enterobacteriaceae in 7 US Communities, 2012-2013. Journal of the American Medical Association. 5 October 2015. Article Link
  • Magill, SS; Dumyati, G; Ray, SM; Fridkin, SK. Evaluating Epidemiology and Improving Surveillance of Infections Associated with Health Care, United States. Emerging infectious diseases. 2015 Sep; 21(9):1537-42. Article Link