National Antimicrobial Resistance Monitoring System

Introduction to NARMS

The National Antimicrobial Resistance Monitoring System – Enteric Bacteria (NARMS) was established in 1996 as a collaborative effort between the Food and Drug Administration's Center for Veterinary Medicine (FDA CVM), U.S. Department of Agriculture (USDA), and the Centers for Disease Control and Prevention (CDC). The NARMS program monitors changes in antimicrobial drug susceptibilities of selected enteric bacterial organisms in humans, animals, and retail meats to a panel of antimicrobial drugs important in human and animal medicine. Bacterial isolates are collected from human and animal clinical specimens, from healthy farm animals, and raw product from food animals. Retail meats collected from grocery stores were recently added to NARMS sampling. The primary objectives of NARMS include:

• To provide descriptive data on the extent and temporal trends of antimicrobial drug susceptibility in Salmonella and other enteric bacterial organisms from human and animal populations, as well as retail meats.

• To facilitate the identification of antimicrobial drug resistance in humans, animals, and retail meats as it arises;

• To provide timely information to veterinarians and physicians on antimicrobial drug resistance patterns.

Additionally, NARMS provides a national source of enteric bacterial isolates that are invaluable for research such as diagnostic test development, discovering new genes and molecular mechanisms associated with resistance, studying mobile gene elements, and for virulence and colonization studies.

The ultimate goal of these activities is to prolong the lifespan of approved drugs by promoting prudent and judicious use of antimicrobial drugs and to identify areas for more detailed investigation.

NARMS Program Highlights

The NARMS program consists of three areas or arms:

• Animal Arm
  

• Human Arm

• Retail Arm

A pilot study of animal feed ingredients is also included in NARMS. Human-origin isolates are submitted by state and local public health laboratories across the country. All testing of human isolates is conducted at the National Center for Infectious Disease (NCID), CDC, in Atlanta , Georgia . Animal specimens for NARMS are collected from federally inspected slaughter and processing facilities, from healthy animals on farms, and from Veterinary Diagnostic Laboratories including USDA's National Veterinary Services Laboratories. These samples are then tested for antimicrobial drug susceptibility at the USDA, Agricultural Research Service's (ARS) Russell Research Center in Athens , Georgia . Animal and human isolates currently monitored in NARMS are non-typhoid Salmonella , Campylobacter , E. coli , and Enterococci. CDC also tests additional human isolates including Salmonella typhi, Listeria and Shigella . Susceptibility testing of Salmonella , Campylobacter , E. coli , and Enterococci isolates from Retail Meats and Animal Feed Ingredients is conducted at FDA, CVM's Office of Research Lab in Laurel , MD.

When the NARMS program began in 1996, Salmonella was the sentinel organism tested. NARMS results for Salmonella are available since 1997. The program has adapted to antimicrobial drug resistance research needs by adding different species of bacteria and antimicrobial drugs for evaluation. Campylobacter , E. coli , and Enterococci organisms were added to the testing program over time. Examples of program evolution include the following:

• In 2001, the NARMS program was expanded to include a pilot study of isolates from retail meats samples collected across the state of Iowa . Testing of Salmonella, Campylobacter , E. coli , and Enterococci isolates from the pilot study was conducted at the CVM's Office of Research Laboratory in Laurel , MD.

• In 2001, Listeria and Vibrio were added to list of human isolates tested by CDC.

• In January 2002, a FoodNet Retail Meat Surveillance study began in collaboration with states participating in the FoodNet program.

• A pilot study of animal feed ingredients collected at rendering plants across the country was also started in 2002.

• In January 2003, collection of human samples was expanded to all 50 states including three local health departments ( District of Columbia , Los Angeles County and New York City ).

The CDC and USDA provide the NARMS results annually in comprehensive summary reports. These reports are available on the CDC, USDA, and FDA/CVM web sites (see NARMS Data section below). An annual report describing results of the retail meat and animal feed ingredient testing is also planned. In addition, periodic public meetings are held to present NARMS results and provide a forum for presentation of other related antimicrobial resistance research.

NARMS Data

• Human – CDC NARMS Human Data

• Animal – USDA NARMS Animal Data

• Retail Meat – NARMS Retail Meat Annual Report, 2002

  • Iowa Pilot Study

  • FoodNet Retail Meat

• Animal Feed Ingredient Data - (will be posted at a future date)

NARMS Public Meetings

• 2004 National Antimicrobial Resistance Monitoring System – Enteric Bacteria (NARMS) Scientific Meeting, March 4-5, Decatur , GA

• 2002 National Antimicrobial Resistance Monitoring Systems (NARMS) Scientific Meeting, Hilton Head, SC, November 19-22, 2002

• 2001 National Antimicrobial Resistance Monitoring System (NARMS) Scientific Meeting; Public Meeting, March 15 and 16, 2001 Rockville , MD

NARMS Presentations

• FDA sponsored NARMS Scientific Meeting, March 2001

• Presentations from the CDC sponsored NARMS Scientific Meeting, March 2004

NARMS Publications

• NARMS Brochures

  • English - National Antimicrobial Resistance Monitoring System - Enteric Bacteria (NARMS), revised and updated May 2003 | htm | | pdf |

  • Spanish - Sistema Nacional de Monitoreo de la Resistencia Antimicrobiana - Bacterias Enteri | doc |

• FDA Veterinarian Articles

  • CVM CDC Hosts NARMS Scientific Meeting, FDA Veterinarian, March/April 2004, 19(2)12.

  • CVM Conducts Retail Meat Pilot Study FDA Veterinarian, September/October 2003, 18(5)6-7.

  • Scientists gather for NARMS Scientific Meeting, FDA/Veterinarian, January/February 2003, 18(1)14-15.

  • Antimicrobial Susceptibility Patterns for Salmonella isolates of animal origin, NARMS 1999, FDA/Veterinarian, January/February 2001, 16(5)9.

  • Antimicrobial Resistance in Salmonella isolates from exotic animals, NARMS, 1997-1999, FDA Veterinarian, July/August 2001, 16(4)2.

  • Georgia meeting on antibiotic resistance attended by CVM, FDA Veterinarian, November 1998, 13(6)1-2.
    

• Peer Reviewed Publications

• Gupta A, Nelson JM, Barrett TJ, Tauxe RV, Rossiter SP, Friedman CR, Joyce KW, Smith KE, Jones TF, Hawkins MA, Shiferaw B, Beebe JL, Vugia DJ, Rabatsky-Ehr T, Benson JA, Root TP, and Angulo FJ for the NARMS Working Group. Antimicrobial resistance among Campylobacter strains, United States, 1997-2001. EID June 2004; 10(6)

• White, D .G., S. Zhao, S. Simjee, J. Meng, R.D. Walker, and P.F. McDermott. 2004. Chapter 20. Prevalence of antibiotic resistant bacteria in retail foods. In “Preharvest and Postharvest Food Safety: Contemporary Issues and Future Directions,” R. C. Beier, S. D. Pillai, T. D. Phillips, R. L. Ziprin (Eds.).  Blackwell Publishing, Ames , IA.

• Schroeder, C.M., D.G. White, and J. Meng. 2004. Retail meat and poultry as an important reservoir of antimicrobial-resistant Escherichia coli . Food Microbiol. 21:249-255.

• Doublet, B., A. Carattoli, J.M. Whichard, D.G. White , S. Baucheron, E. Chaslus-Dancla, and A. Cloeckaert. 2004. Plasmid-Mediated Florfenicol and Ceftriaxone Resistance Encoded by the floR and bla CMY2 Genes in Salmonella enterica serotypes Typhimurium and Newport Isolated in the United States . FEMS Microbiol. 233:301-305.

• Therese Rabatsky-Ehr, Jean Whichard, Shannon Rossiter, Ben Holland, Karen Stamey, Marcia L.Headrick, Timothy J. Barrett, Frederick J. Angulo, and the NARMS WorkingGroup. Multidrug-resistant Strains of Salmonella enterica Typhimurium , United States , 1997-1998., EID, Vol 10, No. 5, May 2004.

• DA Dargatz, et. al. Prevalence and antimicrobial susceptibility of Salmonella spp. Isolates from US cattle in feedlots: 1999-2000. Journal of Applied Microbiology. 2003; Oct; 95(4): 753-761.

• Ge, B., D.G. White , P.F. McDermott, W. Girard, S. Zhao, S. Hubert, and J. Meng. 2003. Antimicrobial resistant Campylobacter species from retail raw meats. Appl. Environ. Microbiol. 69:3005-3007.

• Hayes, J.R., L.L. English, P.J. Carter, T. Proescholdt, K.Y. Lee, D.D. Wagner, and D.G. White. 2003. Prevalence and antimicrobial resistance of Enterococcus spp. isolated from retail meats. Appl. Environ. Microbiol. 69:7153-7160.

• Zhao, S., S. Qaiyumi, S. Friedman, R. Singh, S.L. Foley, D.G. White, P.F. McDermott, T. Donkar, C. Bolin, S. Munro, E.J. Baron, and R.D. Walker. 2003. Characterization of Salmonella enterica serotype Newport isolated from humans and food animals. J. Clin. Microbiol. 41:5366-5371.

• Fedorka-Cray PJ, Englen MD, Gray JT, Hudson C, Headrick ML. Programs for monitoring antimicrobial resistance. Anim Biotechnol. 2002 May; 13 (1):43-55. Review.

• Dargatz, DA, Fedorka-Cray PJ, Ladely Sr, Ferris KE, Green AL, Headrick ML. Antimicrobial susceptibility patterns of Salmonella isolates from cattle in feedlots. Journal of the American Veterinary Medical Association 2002 Jul 15; 221 (2): 268-72.

• Ribot E, Wierzba R, Angulo F, Barrett T Salmonella enterica serotype Typhimurium DT104 isolated from humans, United States, 1985, 1990, and 1995 EID 2002; 8 (4): 387-391

• Zhao, T., Doyle, M.P., Fedorka-Cray, P.J., Zhao, P., and Ladely, S. Occurrence of Salmonella enterica serotype typhimurium DT104A in retail ground beef. J. Food Prot. 65(2):403-407. 2002.

• McDonald C, Rossiter S, Mackinson C, Wang Y, Johnson S, Sullivan M, Sokolow R, DeBess E, Gilbert L, Benson J, Hill B, Angulo F. Quinupristin/dalfopristin-resistant Enterococcus faecim from retail chickens and human stool specimens in the United States . ICEID; 2000, NEJM 2001; 345 (16): 1155-1160

• Fedorka-Cray, P.J. Surveillance resistance in animals and man: current programmes and possibilities. In Antimicrobial Resistance (eds. L. Soulsby and R. Wilbur), pp.177-181, Royal Society of Medicine Press Limited, London , UK . 2001. (Book Chapter)

• Marano, N.N., Rossiter, S., Stamey, K., Joyce, K., Barrett, T.J., Tollefson, L.K . , Angulo, F.J. The National Antimicrobial Resistance Monitoring System (NARMS) for Enteric Bacteria, 1996-1999: Surveillance for Action. Journal of the American Veterinary Medical Association, 217(12):1829-1830, 2000.

• Angulo FJ, Griffin P. Changes in antimicrobial resistance in Salmonella enterica serovar Typhimurium. EID 2000; 6(4): 436-7

• Tollefson, L., Fedorka-Cray, P.J., and Angulo FJ. Public health aspects of antibiotic resistance monitoring in the USA . Acta. Vet. Scand. Suppl. 92:67-75. 1999. (Review)

• Fedorka-Cray, P.J., Dargatz, D.A., Wells, S.J., Wineland, N.E., Miller, M.A., Tollefson, L., and Petersen, K.E. Impact of antimicrobic use in veterinary medicine. J. Am. Vet. Med. Assoc. 213(12):1739-1741. 1998.

• Tollefson, L., Angulo, F. and Cray, P.; National Surveillance for Antibiotic Resistance in Zoonotic Enteric Pathogens. (In) Hunt, E., and Tollefson, L. The Veterinary Clinics of North America , Food Animal Practice, Microbial Food Borne Pathogens. March 1998. W.B. Saunders Co., Philadelphia , PA , 14(1):141-150.

NARMS Point of Contact

Dr. Marcia Headrick, DVM, MPH, DACVPM
FDA/CVM NARMS Coordinator
MHeadrick@cvm.fda.gov

CVM A-Z Index | Contact CVM | About CVM | Site Map
FDA Home Page | Search FDA Site | FDA A-Z Index | Contact FDA | Privacy | Accessibility | HHS Home Page

FDA/Center for Veterinary Medicine