Using the NARMS to Obtain Critical Information
NARMS is dedicated to the protection of human and animal health through integrated monitoring of antimicrobial resistance among enteric bacteria. The NARMS program is critical to accomplishing the missions of the U.S. Department of Health and Human Services and FDA, and ultimately in protecting the health of Americans through safer food. It consists of representatives from FDA, the U.S. Department of Agriculture (USDA), and the Centers for Disease Control and Prevention (CDC).
During FY 2011, CVM announced the availability of the National Antimicrobial Resistance Monitoring System (NARMS) Strategic Plan, a dynamic roadmap that outlines the program’s commitment to sustained food safety through monitoring and research. The plan resulted from a recommendation of an External Subcommittee of the Science Board to FDA (which conducted a review of the NARMS program in 2007), public comments, and recommendations resulting from several internal and public meetings. The latter culminated in a stakeholder meeting in July 2011 following the American Veterinary Medical Association’s annual convention.
The Strategic Plan lists the NARMS accomplishments since the program’s 1996 inception, strategic goals and objectives, and challenges and opportunities. NARMS has established four strategic goals. These goals build on progress made since the program’s inception, with special emphasis on the recommendations made by the FDA Science Board subcommittee review:
- To make sampling more representative and more applicable to trend analysis;
- To develop advanced information technology tools that will optimize data acquisition, analysis, and reporting;
- To strengthen collaborative research projects; and
- To collaborate with international institutions that promote food safety, especially those that focused on mitigating the spread of antimicrobial-resistant bacteria.
In August 2011, NARMS was cited by the CDC and the USDA’s Food Safety Inspection Service for its pivotal role in a multistate Salmonella Heidelberg outbreak. Ground turkey was identified as the likely source of the outbreak as a result of the routine testing that selected states conduct for the NARMS retail meat program. Once retail meats are collected and cultured for enteric bacteria, the genetic fingerprints of these bacteria are uploaded into the CDC PulseNet database. In this instance, the genetic fingerprints of Salmonella isolated from ground turkey matched those of the outbreak strain, leading CDC to investigate ground turkey as a possible source of the outbreak
Prevalence of Methicillin-Resistant Staphylococcus Aureus (MRSA) and Vancomycin-Resistant Enterococci (VRE)
During FY 2011, CVM conducted a 12-month study to estimate the prevalence of MRSA (often pronounced “mersa”) and VRE in retail meats from participating states of the NARMS retail meat program. This work was prompted by concerns from Europe and elsewhere that food may be a source of these disease-causing bacteria, which are of great public health concern because of their resistance properties. VRE was not recovered from any retail meat samples during the study period. Analysis of the MRSA data was underway at the end of FY 2011 and will be completed in FY 2012.
In July 2011, CVM’s Office of Research held a public meeting in St. Louis, MO, to solicit input on a new NARMS retail and food animal sampling strategy. The Office of Research organized the meeting in response to comments concerning sampling strategy received during the 2007 external subcommittee review. Attendees included representatives from the three NARMS-sponsoring agencies, epidemiologists from academic institutions, the Canadian Integrated Program for Antimicrobial Resistance, and representatives from industry and consumer groups. After the meeting, NARMS created action items to implement modifications in its existing sampling program. These modifications included: (1) strategic addition of retail testing sites that are representative by both geography and population; (2) limited collection of on-farm food animal isolates; and (3) investigation into alternate sources of nationally representative random isolates from slaughter plants.
NARMS took implementation steps during the year, including initiating the recruitment of three additional sites for the retail food study. Then, in September 2011, NARMS began a collaborative study with the National Program Office of the USDA Agricultural Research Service to collect food animal isolates directly from farms. For 4 months, scientists from academic institutions isolated Salmonella, Campylobacter, and E. coli from chickens, turkeys, and cattle and sent the isolates to the CVM Office of Research for confirmatory analysis and susceptibility testing. This study will provide an opportunity for FDA to collect animal-level antimicrobial use data. Moreover, the results of this pilot study will allow NARMS to assess the importance of testing on-farm isolates for the surveillance of antimicrobial resistance, and will inform the future direction of NARMS on-farm isolate collection.
We published both the 2008 and 2009 NARMS Executive Reports during FY 2011. The reports summarize, in an integrated format, NARMS data on non-typhoidal Salmonella and Campylobacter isolates recovered in 2008 and 2009 from humans, retail meats, and food animals at Federally inspected plants. The report also includes susceptibility data on Escherichia coli isolates recovered from retail meats and chickens. Summary data from prior years are also included.
In addition, we published the 2009 NARMS Retail Meat Report in FY 2011. This report provides a comprehensive analysis of antimicrobial-resistant bacteria from ground beef, ground turkey, chicken breast, and pork chops collected in 10 states throughout the year.