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  1. The National Antimicrobial Resistance Monitoring System

 


What is NARMS?
Who are the NARMS partners?
What does NARMS do?
What bacteria are tested in NARMS?
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


What is NARMS?

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).

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Who are the NARMS partners?

The National Antimicrobial Resistance Monitoring System (NARMS) is a U. S. public health surveillance system that tracks antimicrobial resistance in foodborne and other enteric bacteria. NARMS works closely with a number of partners who play complementary roles in antibiotic resistance to address this important issue.

The National Antimicrobial Resistance Monitoring System (NARMS) is a U. S. public health surveillance system that tracks antimicrobial resistance in foodborne and other enteric bacteria. NARMS works closely with a number of partners who play complementary roles in antibiotic resistance to address this important issue.

Sources represented by NARMS: Humans Retail Meats Food-Producing Animals
Who is involved in NARMS?
  • Centers for Disease Control and Prevention (CDC)
  • Health departments in 50 states
  • U.S. Food and Drug Administration (FDA)
  • Health departments in 15 states
  • Institutions of higher education in 4 states
  • United States Department of Agriculture (USDA) including:
    • Food Safety and Inspection Service (FSIS)
    • Agricultural Research Service (ARS)
    • Animal Plant Health Inspection Service (APHIS)
Where do the samples that are tested come from?
  • Ill persons
Retail meats from consumer grocery stores including:
  • Chicken
  • Ground Turkey
  • Ground Beef
  • Pork
Ceca and regulatory samples§ from farm animals including:
  • Chickens
  • Turkeys
  • Cattle
  • Swine
What bacteria does NARMS test for resistance?
  • Salmonella
  • Campylobacter
  • Escherichia coli 0157
  • Vibrio
  • Shigella
  • Salmonella
  • Campylobacter
  • Escherichia coli
  • Enterococcus
 
  • Salmonella
  • Campylobacter
  • Escherichia coli
  • Enterococcus

California, Colorado, Connecticut, Georgia, Louisiana, Maryland, Minnesota, Missouri, New Mexico, New York, Oregon, Pennsylvania, South Carolina, Tennessee, and Washington have health departments participating. As of September 2016 Kansas State University, Iowa State University, Texas Tech University, and South Dakota State University participate in the NARMS retail meat surveillance program.

Each USDA NARMS agency tests bacteria samples taken from food-producing animals at different stages of production.

§Regulatory samples include ground products (chicken, turkey, beef), carcass swabs (turkey, cattle, swine), and carcass rinsates (chicken).

Most Escherichia coli and Enterococcus do not cause human illness, but antibiotic resistance in these bacteria can be transferred to other bacteria that can make people sick.

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What does NARMS do?

  • 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

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What bacteria are tested in NARMS?

NARMS monitors antibiotic resistance among the following four major foodborne bacteria: Salmonella, Campylobacter, Escherichia coli, and Enterococcus. This section describes these bacteria and the importance of monitoring their resistance to antibiotics. CDC also conducts surveillance of resistance among Vibrio species other than V. cholera, and the non-foodborne enteric organisms Shigella, and typhoidal Salmonella from humans. More information on these organisms can be found on the CDC website.

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What kind of information does NARMS collect?

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. 

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Why is resistance monitoring important?

  • 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.

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What kind of data and reports are published by NARMS?

  • 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. To view the newest report, click on Integrated Reports/Summaries.
  • 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. To access and download the data, click on Integrated Reports/Summaries.
  • 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

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How are NARMS data used?

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Help for consumers

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.  

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Additional Information

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