The National Antimicrobial Resistance Monitoring System: Role of State and Local Public Health Departments in Combating Antibiotic Resistant Bacteria

BACKGROUND: The National Antimicrobial Resistance Monitoring System (NARMS) tracks changes in antimicrobial susceptibility of enteric bacteria found in humans, retail meats, and food animals.   It involves collaboration among state and local public health departments, FDA, CDC, and USDA. Human isolate testing is conducted through a partnership between CDC and state health departments, and retail meat testing is conducted through a partnership between FDA and state departments of health or agriculture.  METHODS: Participating public health laboratories submit select Salmonella, Campylobacter, E. coli O157, Shigella, and non-cholera Vibrio to CDC for susceptibility testing and whole genome sequencing.  Fourteen state laboratories also collect a standard number of retail chicken, ground turkey, ground beef, and pork chop packages from local grocery stores, culture them for Salmonella, Campylobacter, E. coli and Enterococcus, and send the isolates to FDA for susceptibility testing and whole genome sequencing.  States also participate in pilot projects examining other meat types and bacterial species, and to develop new testing methods. RESULTS: Using data collected through NARMS surveillance, NARMS has been able to elucidate antimicrobial resistance trends of public health importance. Trended data are used by FDA to make regulatory decisions designed to preserve the effectiveness of antibiotics for humans and animals. Some examples of regulatory decisions have included the extra-label use prohibition of certain third generation cephalosporins and the withdrawal of approval of fluoroquinolones for use in poultry.  NARMS data are used to support outbreak investigations such as the 2011, 2012, and 2013 Salmonella Heidelberg outbreaks attributed to poultry, and to generate hypotheses about sources and reservoirs of resistant bacteria. NARMS data are also used to identify emerging hazards. CONCLUSIONS: NARMS is an important public health program that is built on partnerships between state and federal agencies.  Continued participation by State Health Departments is vital to the program’s success.