What is NARMS?
What does NARMS do?
What kind of information does NARMS collect?
Why is resistance monitoring important?
What kind of data and reports are published by NARMS?
How are NARMS data used?
Help for consumers
Antibiotic resistance is an adverse event associated with the use of antibiotics. It is directly related to the safety and effectiveness of antibiotics, which FDA is responsible for ensuring. Its main function is to serve the FDA Center for Veterinary Medicine (CVM) as a source of data for the approval of new animal antibiotics and for the post-approval safety monitoring of these compounds. Thus, NARMS is used to assess the risks associated with new drugs and to monitor the continued safe use of older agents. NARMS was established in 1996 as a partnership between the FDA, the Centers for Disease Control and Prevention (CDC), and the U.S. Department of Agriculture (USDA) to track antibiotic resistance in foodborne bacteria from humans (CDC), retail meats (FDA), and food animals (USDA).
- Monitor trends in antimicrobial resistance among foodborne bacteria from humans, retail meats, and animals
- Disseminate timely information on antimicrobial resistance to promote interventions that reduce resistance among foodborne bacteria
- Conduct research to better understand the emergence, persistence, and spread of antimicrobial resistance
- Assist the FDA in making decisions related to the approval of safe and effective antimicrobial drugs for animals
In addition to monitoring antimicrobial resistance, NARMS partners collaborate on epidemiologic investigations and microbiologic research studies. Data and targeted research studies are reported at scientific meetings and published in peer reviewed scientific journals.
NARMS performs whole-genome sequencing (WGS) as part of routine processes in the analysis of Salmonella and Campylobacter, in addition to some sequencing of resistant strains of E. coli and Enterococcus. This information is primarily used to understand the mechanisms underlying observed resistance phenotypes, and as a result, NARMS has begun reporting resistance genotypes of Salmonella isolated from retail meats, food-producing animals, and humans. In addition, WGS information is being used for bacterial speciation, serotyping, and to improve the understanding of emerging resistance phenomena and the passage of resistant bacteria through the food chain.
Historically, NARMS examined foodborne bacteria for genetic relatedness using pulsed-field gel electrophoresis (PFGE) and stored the results in CDC’s PulseNet database or USDA’s VetNet database. Whole genome sequencing is becoming the tool of choice for this work, and is expected to replace PFGE in the future. More information on the impact of new advanced detection methods can be found here.
- Document resistance levels in different reservoirs (Baselines)
- Describe the spread of resistant bacterial strains and resistance genes (Spread)
- Identify temporal and spatial trends in resistance (Trends)
- Generate hypotheses about sources and reservoirs of resistant bacteria (Attribution)
- Understand the association between use practices and resistance (Veterinary Use)
- Identify risk factors and clinical outcomes of infections caused by antimicrobial resistant bacteria
- Provide data for education on current and emerging hazards (Education)
- Guide evidence-based policies and guidelines to control antimicrobial use in hospitals, communities, agriculture, aquaculture, and veterinary medicine (Policy)
- Pre-approval – Support risk analysis of foodborne antimicrobial resistance hazards (GFI 152)
- Post-approval – Identify interventions to contain resistance and evaluate their effectiveness (Extra-label use, fluoroquinolones in poultry, GFI 209)
Antimicrobial drugs have been widely used in human and veterinary medicine for more than 60 years, with tremendous benefits to both human and animal health. The development of resistance to these medicines poses a serious public health threat. Antimicrobial drug use creates selective evolutionary pressure that enables antimicrobial resistant bacteria to increase in numbers and thus increases the opportunity for individuals to become infected by resistant bacteria. When antimicrobial drugs are used in food-producing animals, they can enrich the resistant strains that reach humans via the food supply.
- NARMS publishes an annual integrated report that consolidates data from humans, retail meats, and food animals into one format. Since 2009, these reports describe the most salient data points. Download the new NARMS Integrated Report.
- NARMS publishes interactive graphs of antimicrobial resistance data over time from bacteria isolated from humans, retail meats, and food animals to accompany the NARMS Integrated Report. Genetic data associated with particular antimicrobial resistances can also be dynamically graphed. Access the NARMS Interactive Data Displays.
- Interagency partners publish source specific annual summary reports on antimicrobial resistance among select bacteria isolated from the sources tested by each agency. Summary reports for each of these sources can be found at the following links: Human, Retail Meats, Food Animals
The FDA's Center for Veterinary Medicine is responsible for the regulation of antibiotics used in animals, including animals raised for food. The FDA arm of NARMS provides data about resistance in bacteria isolated from retail meats. This is important, because these data represent the major route of human exposure.
FDA uses NARMS to:
- understand how resistance emerges, persists, and spreads;
- support risk analysis of foodborne antimicrobial resistance hazards when evaluating a new animal antibiotic for safety;
- help understand the nature and magnitude of antibiotic resistance trends;
- help guide evidence-based action to limit or reverse worsening antibiotic resistance trends;
- measure the impact of new FDA policies and regulations that relate to the use of antibiotics in animal agriculture;
- assist USDA and CDC with outbreak detection.
CDC NARMS helps protect public health by providing ongoing surveillance of enteric bacteria causing antibiotic resistant infections in people. CDC scientists track antibiotic resistance and study emerging resistance in bacteria that infect people commonly through food. The CDC arm of NARMS provides data about resistance in both sporadic cases and outbreaks. Investigations of outbreaks of resistant enteric infections provide data about the sources of both sporadic and outbreak-associated infections.
Preventing enteric (intestinal) infections caused by food and other sources reduces both antibiotic-susceptible and antibiotic-resistant infections.
CDC helps protect public health by using NARMS data to:
- detect and track resistant infections;
- study how resistance emerges and spreads;
- estimate how many resistant infections occur in the United States;
- determine the health impact of resistant infections;
- determine the sources of resistant infections;
- improve antibiotic prescribing and use;
- educate consumers and industry about food safety; and
- prevent infections.
The Food Safety and Inspection Service (FSIS) is the public health agency in the U. S. Department of Agriculture (USDA) responsible for ensuring that the nation’s commercial supply of meat, poultry (e.g., young chickens and turkeys), and egg products (e.g., liquid eggs) are safe, wholesome, and properly labeled. Within the FSIS mission, the agency examines the hazards and risks associated with FSIS-regulated products to reduce human exposure to foodborne pathogens and prevent foodborne illness. As such, FSIS collaborates with the USDA Animal Plant Health Inspection Service (APHIS), USDA Agriculture Research Service (ARS), FDA, and CDC to monitor and characterize foodborne pathogens and bacteria isolated from humans and animals to identify patterns of resistance in antibiotics of human health concern through the NARMS program.
FSIS uses NARMS data to:
- increase scientific knowledge regarding the emergence, persistence, and spread of antimicrobial resistance among foodborne bacteria;
- evaluate potential associations between antimicrobial resistance in preharvest, postharvest and other production settings in collaboration with other USDA agencies;
- communicate the significance of PFGE patterns, serotypes, and AST results to industry on a case by case basis;
- support hypothesis generation during outbreak investigations;
- continuously evaluate and seek to understand and employ new or innovative mission-supporting processes, methodologies, and technologies; and
- collaborate with other USDA agencies to develop an action plan for a comprehensive, integrated approach for future surveillance, research and development, and education and outreach activities.
Consumers should always follow four basic food safety tips to prevent against bacteria, including antibiotic resistant bacteria: clean, separate, cook, chill. Learn more at http://www.foodsafety.gov/keep/basics/index.html.