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  1. The National Antimicrobial Resistance Monitoring System

The National Antimicrobial Resistance Monitoring System Strategic Plan 2021-2025- Questions and Answers

The National Antimicrobial Resistance Monitoring System (NARMS) released the NARMS Strategic Plan: 2021-2025 in October 2020. Following recommendations from the FDA Science Advisory Board review of NARMS, internal deliberations of the participating NARMS agencies, analysis of the scientific literature, and the output from meetings with scientific experts, the NARMS partners enhanced the strategic plan to adopt a more holistic One Health approach to antimicrobial resistance monitoring and surveillance. 

NARMS partner agencies are working to help define and implement best practices in One Health antimicrobial resistance monitoring, while taking advantage of the latest technologies that provide the most useful data in a timely manner. This has led to significant changes to the scope of NARMS and an expansion of partnerships to include additional public health agencies and subject matter experts. The main questions received from public comments related to the Strategic Plan are briefly addressed below.

Why is NARMS looking at surface waters?

The environment is an essential component of One Health (human health, animal health and the environment). Our focus on surface waters relied in part on the report of the 2018 International Environmental AMR Forum. Surface waters act as key integrators. They are both receivers of human, livestock, agricultural and wildlife inputs, and sources for human and agricultural use including recreation and crop irrigation. Work by NARMS partners to understand the role of the environment in mediating resistance will greatly enhance our understanding of the ecology of resistance and may lead to enhanced public health approaches to keep people and animals safe. 

What is planned for surface water testing?

A three-phased approach is planned. In Phase 1 (2021-2022), NARMS partners at the U.S. Department of Agriculture’s (USDA) Agriculture Research Service (ARS) and the U.S. Environmental Protection Agency (EPA) evaluated methods for water processing and analysis for the purpose of monitoring both antibiotic resistant bacteria and their genes. Phase 2 (2022-2023) involves studies to evaluate method performance and examine the dynamics of resistance at the watershed level. This will be followed by Phase 3, a national point prevalence survey in collaboration with the EPA National Rivers and Streams Assessment to get a national snapshot of resistance in surface waters across the country. At the end of this work NARMS scientists will evaluate the value and feasibility of long-term environmental AMR monitoring. 

How will the environmental data be used to inform strategies to track AMR?

The data from this pilot effort will provide information necessary to track antimicrobial resistance in surface waters at national and watershed scales. This effort will also define the minimum data quality and reporting objectives needed to make comparisons between surface water studies. An explicit goal of the watershed study is to provide a template for future studies in other areas in order to build a network of watersheds across geographies that use consistent data collection and reporting methods.

Why test pet food and animal feed? 

The potential contribution of pet food and food animal feed to AMR spread is not well understood. Data indicate that some pet food and food animal ingredient components may carry AMR bacteria indistinguishable from those causing human illness. Testing pet food, animal feed, and feed components would provide necessary AMR information for this commodity group and help determine whether it contributes to the overall One Health AMR burden. Data is needed to determine whether long term testing of any animal food is necessary or beneficial.

Is whole genome sequencing (WGS) able to identify emerging resistance trends? 

Yes. With the advent of DNA sequencing technologies, the complete complement of resistance genes can be determined as a routine part of microbial analysis. NARMS scientists have carefully evaluated the strengths and limitations of WGS for AMR monitoring. For enteric bacteria like Salmonella and Campylobacter, the genes known to code for antimicrobial resistance are very well characterized. By “mining” the WGS data for known resistance genes, we can predict antimicrobial resistance in these bacteria with a high degree of confidence in a short amount of time. Moreover, surveillance at the level of DNA sequence adds a highly detailed level of analysis for comparing strains, describing the spread of antimicrobial resistance, and attributing resistance to particular sources. 

Can NARMS share data to address other food safety issues?

NARMS has always worked to make its data widely accessible to assist other agencies and public health officials in meeting their public health and food safety goals. For example, NARMS scientists work closely with staff in the USDA and Centers for Disease Control and Prevention’s Outbreak Response and Prevention Branch to investigate outbreaks caused by resistant enteric pathogens. The whole genome sequence data from all NARMS sources are quickly uploaded to the public database at the NIH so that all stakeholders can view the information almost as soon as it is generated, and act to address emergent situations. NARMS Now interactive online dashboards provide a simple interface to view the latest results, including data specific to human infections (NARMS Now: Human Data).

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