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Additional file 3. Supplementary Results.

Additional file 2: Fig. S1. Method for the delineation of segments shared between plasmids. Fig. S2. Workflow to identify geographic signatures. Fig. S3. Phylogenetic tree for each of the 15 species in our collection with at least five representatives. Fig. S4. Resistance mechanisms were diverse, with many shared across species. Fig. S5. Carbapenemase-carrying isolates tended to have a higher minimum inhibitory concentration than those with other resistance mechanisms. Fig. S6. High level of diversity and phylogenetic range among predicted plasmids. Fig. S7. Plasmids of diverse groups carried carbapenemases and were found in different species, and hospitals. Fig. S8. Limited tracing of carbapenemase localized spread using Tn4401 isoforms and their immediate flanking sequences. Fig. S9. Signatures were present across diverse sequence types. Fig. S10. Signatures carried genes important for hospital adaptation and signature mobility. Fig. S11. Details of signature content. Fig. S12. Signatures were highly conserved and likely derived from a common ancestral sequence. Fig. S13. Geographic signatures with blaKPC can occur in multiple configurations across several species and plasmid groups. Fig. S14. Geographic signatures with blaKPC occurred in multiple configurations across several species and plasmid groups.

In this IDSA policy paper, we review the current diagnostic landscape, including unmet needs and emerging technologies, and assess the challenges to the development and clinical integration of improved tests. To fulfill the promise of emerging diagnostics, IDSA presents recommendations that address a host of identified barriers. Achieving these goals will require the engagement and coordination of a number of stakeholders, including Congress, funding and regulatory bodies, public health agencies, the diagnostics industry, healthcare systems, professional societies, and individual clinicians.