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Antimicrobial resistance (AMR) is considered one of the most important global health challenges. Many factors contribute to the emergence of antimicrobial resistant microorganisms, but the use of antimicrobials in medicine and agriculture is considered the most important factor. Considering the serious consequences of AMR to public health and the economy locally and globally, the White House has announced a National Strategy for Combating Antibiotic Resistant Bacteria (CARB) with specific goals and priorities. A prominent feature of the National Strategy is surveillance.
The 2014 National Antimicrobial Resistance Monitoring System (NARMS) Integrated Report is the result of a collaborative effort of the Centers for Disease Control and Prevention (CDC), the U.S. Department of Agriculture (USDA) and the Food and Drug Administration (FDA). NARMS gathers surveillance data from human clinical samples, slaughter samples and retail meat samples. This “One Health” approach to integrated surveillance provides information needed to assess the nature and magnitude of resistance in bacteria moving through the food supply and causing illnesses in humans.
- Read the 2014 NARMS Integrated Report
- See how antibiotic resistance for four bacteria transmitted commonly through food has changed over time through the Interactive Data Displays
The points listed below summarize important observations from the 2014 NARMS Integrated Report. There are few changes from the 2012-2013 Integrated NARMS Report. Overall resistance continues to remain low for most human infections and there have been measurable improvements in resistance levels in some important areas. A summary of the most important trends is presented below.
- The prevalence of Salmonella in both retail chicken meat (9.1%) and retail ground turkey (5.5%) was at its lowest level since retail meat testing began in 2002. The prevalence of Campylobacter in retail chicken meat samples has gradually declined over time to 33%, the lowest level since testing began.
- Approximately 80% of human Salmonella isolates are not resistant to any of the tested antibiotics. This has remained relatively stable over the past ten years. Resistance for three critically-important drugs (ceftriaxone, azithromycin and ciprofloxacin) in human non-typhoidal Salmonella isolates remained below 3%.
- Over the past ten years, multidrug resistance (MDR) has remained largely unchanged in human Salmonella isolates (~10%) and cattle (~20%) Salmonella isolates collected via USDA Pathogen Reduction/Hazard Analysis and Critical Control Point program (PR/HACCP). Over the past 4 years there has been a consistent decline in the proportion of retail chicken meat Salmonella isolates that are multi-drug resistant.
- Overall, ceftriaxone resistance continued to decline in nontyphoidal Salmonella from all NARMS sources with the exception of retail turkey meat isolates, where it rose slightly. This was paralleled by a decline in ceftriaxone-resistant E. coli from retail chicken meat (from 13% in 2011 to 6.6% in 2014). In cattle PR/HACCP Salmonella isolates, ceftriaxone resistance reached its lowest level (7.6%) since 1999. In 2014, ceftriaxone resistance in human Salmonella Heidelberg isolates was 8.5%, down from a peak of 24% in 2010.
- Among all Salmonella serotypes, the percentage of human isolates resistant to at least ACSSuT continued a steady decline to 3.1%, the lowest since testing began in 1996 (8.7%). Similarly, ACSSuT resistance in cattle PR/HACCP S. Typhimurium isolates declined sharply from 67% in 2009 to 7% in 2014, the lowest level since this testing began in 1997.
- Erythromycin resistance in C. jejuni isolates from both human and chicken sources remains low (< 2%).
- With the exception of five isolates in the past ten years, no resistance has been detected in Enterococcus bacteria isolates to three important drugs: daptomycin, linezolid, and vancomycin.
While a majority of the observations in the 2014 NARMS Integrated Report show desirable trends, there are a few findings of potential concern:
- Decreased susceptibility to ciprofloxacin has increased in human and cattle (PR/HACCP) Salmonella serotype Dublin isolates since 2003, with slight declines since 2012. While the incidence of human Salmonella Dublin infections is relatively low, it can cause invasive disease with more severe outcomes, and ranks among the top 4 serotypes isolated from retail ground beef and cattle PR/HACCP samples.
- MDR Salmonella from turkey PR/HACCP samples has increased from approximately from 27% to 41% over the past ten years.
- High and increasing levels of ciprofloxacin resistance were detected in C. jejuni from human (26.7%) and chicken PR/HACCP samples (28%) in 2014, and remained above 35% in C. coli from humans.