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U.S. Department of Health and Human Services

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National Antimicrobial Resistance Monitoring System (NARMS) Retail Data

National Antimicrobial Resistance
Monitoring System (NARMS) Retail Data
 

Dr. David G. White
Center for Veterinary Medicine
U.S. FDA

Veterinary Medicine Advisory Committee
September 25, 2006

National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 1

Slide 2

NARMS

  • The National Antimicrobial Resistance Monitoring System (NARMS) is a national collaborative network between the FDA, CDC and USDA as well as public health laboratories in all 50 states and local health departments in four major cities
  • NARMS was developed to monitor changes in susceptibility/resistance of select zoonotic bacterial pathogens and commensal organisms recovered from animals, retail meats and humans to antimicrobial agents of human and veterinary importance 
  • NARMS monitors susceptibility/resistance phenotypes using three testing sites:
    • FDA/CVM (retail meat and poultry)
    • CDC (humans)
    • USDA (animal/slaughter)
National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 2

Slide 3

NARMS/Retail Meats Overview

  • 10 FoodNet sites
  • Similar sampling scheme
    • Random sampling of stores
    • Each site purchases 10 packages each of chicken breasts, pork chops, ground turkey, and ground beef
  • All ten sites culture meat and poultry rinsates for Salmonella and Campylobacter
  • In addition, four sites (GA, MD, OR and TN) culture rinsates for E. coli and Enterococcus
  • Isolates are sent to FDA-OR for confirmation of identification and antimicrobial susceptibility testing 
National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 3

Slide 4

NARMS Retail meats sampled for Salmonella

 

 2002 2003 2004 2005 
Chicken breast 616    897 1172 1192 
Ground turkey 642    857 1165 1195 
Ground beef 642    880 1186 1196 
Pork chop 613    899 1176 1196 
Total 2513    3533 4699 4779 
National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 4

Slide 5

NARMS/Retail food preliminary data
Salmonella 2002 - 2005
 

National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 5

Slide 6

NARMS/Retail food Salmonella
Ceftriaxone MIC Distributions by Year
 

National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 6

Slide 7

NARMS/Retail food Salmonella
Ceftriaxone MIC Distributions by Meat Type
 

National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 7

Slide 8

NARMS/Retail food Salmonella Ceftiofur
MIC Distributions by Year
 

National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 8

Slide 9

NARMS/Retail food Salmonella
Ceftiofur MIC Distributions by Meat Type
 

National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 9

Slide 10

ß-lactamases

  • Can be either chromosomal or plasmid borne
  • Plasmid mediated TEM-1 and TEM-2 ?-lactamases are the most widely disseminated among Gram negative bacteria
  • Class A extended-spectrum ß-lactamases (ESBLs) (CTX-M or enzymes derived from the classic TEM-1 and SHV-1) and plasmidic class C ß-lactamases (FOX and CMY, among others) have been described among Salmonella and E. coli isolates recovered from animals
National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 10

Slide 11

ß-lactamases among NARMS
Salmonella recovered from retail meats
2002 - 2005

 

NARMS Retail:

1044 Salmonella isolates collected 
 between 2002 – 2005

   138 isolates > 8 µg/ml ceftiofur

   Chicken breast =  98 isolates
   Ground turkey =  29 isolates
   Pork chop =  3 isolates
   Ground beef =  8 isolates

   blaCTX-M genes 0/138
   blaCMY genes 132/138
 

National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 11

Slide 12

Ceftiofur vs. Cefquinome MIC Distributions among
Ampicillin Resistant Salmonella Recovered from
Retail Foods (N=97)
 

National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 12

Slide 13

Cefquinome MIC Distributions among
Ceftiofur Susceptible and Resistant
Salmonella isolates (N=97)
 

National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 13

Slide 14

NARMS Retail meats sampled for E. coli 

 

 2002 2003 2004 2005 
Chicken breast 390    477 476 480 
Ground turkey395 447 466 480 
Ground beef       399 470 480 480 
Pork chop390 479 478 480 
Total1574 1873 1900 1920  
Only four sites (GA, MD, OR and TN) culture rinsates for  E. coli and Enterococcus
National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 14

Slide 15

NARMS/Retail food preliminary data
E. coli 2002 - 2005
 

National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 15

Slide 16

NARMS/Retail food E. coli 
Ceftriaxone MIC Distributions by Year
 

National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 16

Slide 17

NARMS/Retail food E. coli
Ceftriaxone MIC Distributions by Meat Type
 

National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 17

Slide 18

NARMS/Retail food E. coli
Ceftiofur MIC Distributions by Year
 

National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 18

Slide 19

NARMS/Retail food E. coli
Ceftiofur MIC Distributions by Meat Type
 

National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 19

Slide 20

ß-lactamases among NARMS E. coli
recovered from retail meats 2002 - 2004

 

layout
NARMS Retail: 

3669 E. coli isolates collected 
between 2002 – 2004

   89 isolates > 8 µg/ml ceftiofur

   Chicken breast =  73 isolates
   Ground turkey =  8 isolates
   Pork chop =  4 isolates
   Ground beef =  4 isolates

   blaCTX-M genes 0/89
   blaCMY genes 82/89

National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 20

Slide 21

Summary

  • NARMS currently monitors susceptibility to several ß-lactam antimicrobials including cefoxitin, ceftiofur, and ceftriaxone among Salmonella and E. coli isolates
  • Among 1,044 Salmonella recovered from retail foods between 2002 – 2005
    • 13.2% ceftiofur resistant (> 8 µg/ml)
    • 0.7% ceftriaxone resistant (> 64 µg/ml)
  • Among 3,669 E. coli recovered from retail foods between 2002 – 2004
    • 2.4% ceftiofur resistant (> 8 µg/ml)
    • 0% ceftriaxone resistant (> 64 µg/ml)
National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 21

Slide 22

Summary

  • NARMS secondary ESBL plate includes the 4th generation cephalosporins, cefepime and cefquinome
    • 0.06 – 32 µg/ml
    • In 2007, all ampicillin resistant Salmonella and E. coli will be further
       tested on secondary ESBL plate
  • Detection of ß-lactamases among ceftiofur resistant Salmonella and E. coli
    • No CTX-M extended-spectrum ß-lactamases (ESBL) were detected
    • CMY genes most commonly identified
      • Are not currently associated wtih resistance to 4th generation cephalosporins
      • Associated with shifts in cefquinome MICs to a less susceptible population, however, MICs are still below CLSI resistant breakpoint established for other 4th generation cephalosporin (cefepime > 32 µg/ml)
  • NARMS will continue to monitor any shifts in decreased susceptibility to cefquinome and other cephalosporins of animal and human health significance
National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 22

Slide 23

Acknowledgements

  • FDA
    Dr. Elvira Hall-Robinson
    Dr. Heather Harbottle
    Dr. Patrick McDermott
    Dr. Terry Proescholdt
    Dr. Robert Walker
    Dr. Antoinette Walker
    Dr. Marleen Wekell
     
  • CDC
    Lauren Stancik-Rosenthal
    Felicita Medalla
    Dr. Tom Chiller
    Dr. Fred Angulo 
  • FDA
    Jason Abbott
    Sherry Ayers
    Karen Blickenstaff
    Sonya Bodeis-Jones
    Peggy Carter
    Patti Cullen
    Linda English
    Sharon Friedman
    Althea Glenn
    Susannah Hubert
    Stuart Gaines
    Shawn McDermott
    Sadaf Qaiyumi 
 
  • FoodNet EIP funded sites 
 
  • CDC PulseNet 
 
  • USDA
    - Dr. Paula Fedorka-Cray 
 
National Antimicrobial Resistance Monitoring System (NARMS) Retail Data - Slide 23