# Presentation: 186974

## National Antimicrobial Resistance Monitoring System (NARMS)      Retail Data

- Dr. David G. White
- Center for Veterinary Medicine
- U.S. FDA
- Veterinary Medicine Advisory Committee
- September 25, 2006

## The National Antimicrobial Resistance Monitoring System (NARMS) is a national collaborative network between the FDA, CDC and USDA as well as public health laboratories in all 50 states and local health departments in four major cities 

NARMS was developed to monitor changes in susceptibility/resistance of select zoonotic bacterial pathogens and commensal organisms recovered from animals, retail meats and humans to antimicrobial agents of human and veterinary importance  

NARMS monitors susceptibility/resistance phenotypes using three testing sites:
FDA/CVM (retail meat and poultry) 
CDC (humans) 
USDA (animal/slaughter)

**NARMS was developed to monitor changes in susceptibility/resistance of select zoonotic bacterial pathogens and commensal organisms recovered from animals, retail meats and humans to antimicrobial agents of human and veterinary importance  **
**NARMS monitors susceptibility/resistance phenotypes using three testing sites:**
**FDA/CVM (retail meat and poultry) **
**CDC (humans) **
**USDA (animal/slaughter)**

**NARMS**

## NARMS/Retail Meats Overview

**10 FoodNet sites **
**Similar sampling scheme**
**Random sampling of stores**
**Each site purchases ****10**** packages each of chicken breasts, pork chops, ground turkey, and ground beef**
**All ten sites culture meat and poultry rinsates for *****Salmonella***** and *****Campylobacter***
**In addition, four sites (GA, MD, OR and TN) culture rinsates for *****E. coli***** and *****Enterococcus***
**Isolates are sent to FDA-OR for confirmation of identification and antimicrobial susceptibility testing**

**Notes:**
Current sites: CT, GA, MD, MN, TN; GA, MD, TN  E. coli & Ecocci
*expanding to 9 sites in Jan 2003
Oregon began data collection August 2002; California, New York, and Colorado will begin January 2003.
Sampling scheme: 
The current sampling scheme is a convenience sample whereby sites go to at least one different grocery store per month and purchase as many different brands as possible of each commodity.
10 samples each of ground turkey, ground beef, chicken breasts, and pork chops per month.
If you sample more than once per month, it is important that you purchase all of one commodity during each grocery store visit.
All sites isolate Salmonella and Campylobacter; additionally, GA, MD, OR, and TN isolate E. coli and enterococci.
Log sheets: 
Standard numbering scheme
Complete – enter n/a if information is not available
Fax/e-mail to Jennifer w/ hard copy to David White
Retain copies of package labels
Susceptibility testing:
Salmonella, E. coli: Tested by broth microdilution (Sensititre, Trek Diagnostics) – for susceptibility to 16 antimicrobial agents:  amikacin, amox/clav, ampicillin, cefoxitin, ceftiofur, ceftriaxone, cephalothin, chloramphenicol, ciprofloxacin, gentamicin, kanamycin, nalidixic acid, streptomycin, sulfamethoxazole, tetracycline, and trimethoprim/sulfamethoxazole
Campylobacter: Tested by E-test for susceptibility to 8 antimicrobial agents: azithromycin, chloramphenicol, ciprofloxacin, clindamycin, erythromycin, gentamicin, nalidixic acid, and tetracycline.  Additionally, Campylobacter isolates are tested by agar dilution for susceptibility to: ciprofloxacin, doxycycline, erythromycin, and gentamicin
Enterococci: Tested by broth microdilution for susceptibility to 

## NARMS Retail meats sampled for Salmonella

**2002, 6 states; 2003, 8 states; 2004 and 2005, 10 states**

- 				_2002__	__2003__	__2004__	__2005_
- Chicken breast			616	897	1172	1192
- Ground turkey			642	857	1165	1195
- Ground beef			642	880	1186	1196
- Pork chop			613	899	1176	1196
- Total				2513	3533	4699	4779

## NARMS/Retail food preliminary data Salmonella 2002 - 2005 

**2002,  6 FoodNet sites,  n = 153**
**2003,  8 FoodNet sites,  n = 212**
**2004, 10 FoodNet sites, n = 324**
**2005, 10 Foodnet sites,  n = 355*******

- Preliminary data

**Notes:**
I would like to thank all of you for attending this important training course.  We feel that this study is groundbreaking in that it will provide baseline data on the prevalence of antimicrobial resistance in the retail food supply.  We appreciate your participation.  Thank you.

## NARMS/Retail food Salmonella Ceftriaxone MIC Distributions by Year 

- Preliminary data

**2002,  6 FoodNet sites,  n = 153**
**2003,  8 FoodNet sites,  n = 212**
**2004, 10 FoodNet sites, n = 324**
**2005, 10 Foodnet sites,  n = 355*******

- Total *Salmonella* = 1044 isolates

- N=7
-  0.07%

**Notes:**
I would like to thank all of you for attending this important training course.  We feel that this study is groundbreaking in that it will provide baseline data on the prevalence of antimicrobial resistance in the retail food supply.  We appreciate your participation.  Thank you.

## NARMS/Retail food Salmonella Ceftriaxone MIC Distributions by Meat Type 

- Total *Salmonella* = 1044 isolates: CB = 454; GT = 514; GB = 41; PC = 35

- Preliminary data

- N=7
-  0.07%

**Notes:**
I would like to thank all of you for attending this important training course.  We feel that this study is groundbreaking in that it will provide baseline data on the prevalence of antimicrobial resistance in the retail food supply.  We appreciate your participation.  Thank you.

## NARMS/Retail food Salmonella Ceftiofur MIC Distributions by Year 

- Preliminary data

**2002,  6 FoodNet sites,  n = 153**
**2003,  8 FoodNet sites,  n = 212**
**2004, 10 FoodNet sites, n = 324**
**2005, 10 Foodnet sites,  n = 355*******

- Total *Salmonella* = 1044 isolates

- N=138
-  13.2%

**Notes:**
I would like to thank all of you for attending this important training course.  We feel that this study is groundbreaking in that it will provide baseline data on the prevalence of antimicrobial resistance in the retail food supply.  We appreciate your participation.  Thank you.

## NARMS/Retail food Salmonella Ceftiofur MIC Distributions by Meat Type

- Total *Salmonella* = 1044 isolates: CB = 454; GT = 514; GB = 41; PC = 35

- Preliminary data

- N=138
-  13.2%

**Notes:**
I would like to thank all of you for attending this important training course.  We feel that this study is groundbreaking in that it will provide baseline data on the prevalence of antimicrobial resistance in the retail food supply.  We appreciate your participation.  Thank you.

## β-lactamases

**Can be either chromosomal or plasmid borne**
**Plasmid mediated ****TEM-1**** and ****TEM-2**** ********-lactamases are the most widely disseminated among Gram negative bacteria**
**Class A extended-spectrum ß-lactamases (ESBLs) (****CTX-M**** or enzymes derived from the classic TEM-1 and SHV-1) and plasmidic class C ß-lactamases (FOX and ****CMY****, among others) have been described** **among *****Salmonella***** and *****E. coli***** isolates recovered from animals**

## β-lactamases among NARMS Salmonella recovered from retail meats 2002 - 2005

**NARMS Retail:  ****	****1044***** Salmonella***** isolates collected **
**	****	****	****between 2002 – 2005**
**	****	****	****138**** isolates **_**>**_** 8 ****μ****g/ml ceftiofur**
**	****	****	****Chicken breast = ****	****98 isolates**
**	****	****	****Ground turkey = ****	****29 isolates**
**	****	****	****Pork chop = ****	****3 isolates**
**	****	****	****Ground beef = ****	****8 isolates**
**	****	****	*****bla*****CTX-M**** genes****	****0****/138**
**	****	****	*****bla*****CMY**** genes****	****132****/138**

## Ceftiofur vs. Cefquinome MIC Distributions among Ampicillin Resistant Salmonella Recovered from Retail Foods (N=97)

**2002,  6 FoodNet sites,  *****n=28 ampR isolates***
**2003,  8 FoodNet sites,  *****n=69 ampR isolates***

- Preliminary data

**Notes:**
I would like to thank all of you for attending this important training course.  We feel that this study is groundbreaking in that it will provide baseline data on the prevalence of antimicrobial resistance in the retail food supply.  We appreciate your participation.  Thank you.

## Cefquinome MIC Distributions among Ceftiofur Susceptible and Resistant Salmonella isolates (N=97)

***Salmonella***** MICs **_**<**_** 2 ****μ****g/ml = 52 isolates**
***Salmonella***** MICs **_**>**_** 8 ****μ****g/ml = 45 isolates**

- Preliminary data

**Notes:**
I would like to thank all of you for attending this important training course.  We feel that this study is groundbreaking in that it will provide baseline data on the prevalence of antimicrobial resistance in the retail food supply.  We appreciate your participation.  Thank you.

## NARMS Retail meats sampled for   E. coli

- 				_2002__	__2003__	__2004__	__2005_
- Chicken breast			390	477	476	480
- Ground turkey			395	447	466	480
- Ground beef			399	470	480	480
- Pork chop			390	479	478	480
- Total				1574	1873	1900	1920

**Only four sites (GA, MD, OR and TN) culture rinsates for  *****E. coli***** and *****Enterococcus***

## NARMS/Retail food preliminary data E. coli 2002 - 2005 

**2002,  6 FoodNet sites,  n = 1065**
**2003,  8 FoodNet sites,  n = 1258**
**2004, 10 FoodNet sites, n = 1346**
**2005, 10 Foodnet sites,  n = 1441*******

- Preliminary data

**Notes:**
I would like to thank all of you for attending this important training course.  We feel that this study is groundbreaking in that it will provide baseline data on the prevalence of antimicrobial resistance in the retail food supply.  We appreciate your participation.  Thank you.

## NARMS/Retail food E. coli  Ceftriaxone MIC Distributions by Year

**2002,  6 FoodNet sites,  n=1065 isolates**
**2003,  8 FoodNet sites,  n=1258 isolates**
**2004, 10 FoodNet sites, n=1346 isolates**

- Preliminary data

- N=0

- Total *E. coli* = 3669 isolates

**Notes:**
I would like to thank all of you for attending this important training course.  We feel that this study is groundbreaking in that it will provide baseline data on the prevalence of antimicrobial resistance in the retail food supply.  We appreciate your participation.  Thank you.

## NARMS/Retail food E. coli Ceftriaxone MIC Distributions by Meat Type

- Preliminary data

- N=0

- Total *E. coli* = 3669 isolates: CB = 1078; GT = 1013; GB = 944; PC = 634

**Notes:**
I would like to thank all of you for attending this important training course.  We feel that this study is groundbreaking in that it will provide baseline data on the prevalence of antimicrobial resistance in the retail food supply.  We appreciate your participation.  Thank you.

## NARMS/Retail food E. coli Ceftiofur MIC Distributions by Year

**2002,  6 FoodNet sites,  n=1065 isolates**
**2003,  8 FoodNet sites,  n=1258 isolates**
**2004, 10 FoodNet sites, n=1346 isolates**

- Preliminary data

- Total *E. coli* = 3669 isolates

- N=89
-  2.4%

**Notes:**
I would like to thank all of you for attending this important training course.  We feel that this study is groundbreaking in that it will provide baseline data on the prevalence of antimicrobial resistance in the retail food supply.  We appreciate your participation.  Thank you.

## NARMS/Retail food E. coli Ceftiofur MIC Distributions by Meat Type

- Preliminary data

- Total *E. coli* = 3669 isolates: CB = 1078; GT = 1013; GB = 944; PC = 634

- N=89
-  2.4%

**Notes:**
I would like to thank all of you for attending this important training course.  We feel that this study is groundbreaking in that it will provide baseline data on the prevalence of antimicrobial resistance in the retail food supply.  We appreciate your participation.  Thank you.

## β-lactamases among NARMS E. coli recovered from retail meats 2002 - 2004

**NARMS Retail:  ****	****3669***** E. coli***** isolates collected **
**	****	****	****between 2002 – 2004**
**	****	****	****89**** isolates **_**>**_** 8 ****μ****g/ml ceftiofur**
**	****	****	****Chicken breast = ****	****73 isolates**
**	****	****	****Ground turkey = ****	****8 isolates**
**	****	****	****Pork chop = ****	****4 isolates**
**	****	****	****Ground beef = ****	****4 isolates**
**	****	****	*****bla*****CTX-M**** genes****	****0/89**
**	****	****	*****bla*****CMY**** genes****	****82****/89**

## NARMS currently monitors susceptibility to several β-lactam antimicrobials including cefoxitin, ceftiofur, and ceftriaxone among Salmonella and   E. coli isolates

Among 1,044 Salmonella recovered from retail foods between 2002 – 2005
13.2% ceftiofur resistant (> 8 μg/ml)
0.7% ceftriaxone resistant (> 64 μg/ml)

Among 3,669 E. coli recovered from retail foods between 2002 – 2004
2.4% ceftiofur resistant (> 8 μg/ml)
0% ceftriaxone resistant (> 64 μg/ml)

**Among 1,044 *****Salmonella***** recovered from retail foods between 2002 – 2005**
**13.2% ceftiofur resistant (**_**>**_** 8 ****μ****g/ml)**
**0.7% ceftriaxone resistant (**_**>**_** 64 ****μ****g/ml)**
**Among 3,669 *****E. coli***** recovered from retail foods between 2002 – 2004**
**2.4% ceftiofur resistant (**_**>**_** 8 ****μ****g/ml)**
**0% ceftriaxone resistant (**_**>**_** 64 ****μ****g/ml)**

**Summary**

## NARMS secondary ESBL plate includes the 4th generation cephalosporins, cefepime and cefquinome
0.06 – 32 μg/ml
In 2007, all ampicillin resistant Salmonella and E. coli will be further 
	tested on secondary ESBL plate

Detection of β-lactamases among ceftiofur resistant Salmonella and E. coli
No CTX-M extended-spectrum β-lactamases (ESBL) were detected
CMY genes most commonly identified
Are not currently associated wtih resistance to 4th generation cephalosporins
Associated with shifts in cefquinome MICs to a less susceptible population, however, MICs are still below CLSI resistant breakpoint established for other 4th generation cephalosporin (cefepime > 32 μg/ml)

NARMS will continue to monitor any shifts in decreased susceptibility to cefquinome and other cephalosporins of animal and human health significance

**0.06 – 32 ****μ****g/ml**
**In 2007, all ampicillin resistant *****Salmonella***** and *****E. coli***** will be further **
**	****tested on secondary ESBL plate**
**Detection of ****β****-lactamases among ceftiofur resistant *****Salmonella***** and *****E. coli***
**No CTX-M extended-spectrum ****β****-****lactamases (ESBL) were detected**
**CMY genes most commonly identified**
**Are not currently associated wtih resistance to 4****th**** generation cephalosporins**
**Associated with shifts in cefquinome MICs to a less susceptible population, however, MICs are still below CLSI resistant breakpoint established for other 4****th**** generation cephalosporin (cefepime **_**>**_** 32 ****μ****g/ml)**
**NARMS will continue to monitor any shifts in decreased susceptibility to cefquinome and other cephalosporins of animal and human health significance**

**Summary**

## Acknowledgements

**FDA**
**Dr. Elvira Hall-Robinson**
**Dr. Heather Harbottle**
**Dr. Patrick McDermott**
**Dr. Terry Proescholdt**
**Dr. Robert Walker**
**Dr. Antoinette Walker**
**Dr. Marleen Wekell**
**CDC**
**Lauren Stancik-Rosenthal**
**Felicita Medalla**
**Dr. Tom Chiller**
**Dr. Fred Angulo**

**FDA**
**Jason Abbott**
**Sherry Ayers**
**Karen Blickenstaff**
**Sonya Bodeis-Jones**
**Peggy Carter**
**Patti Cullen**
**Linda English**
**Sharon Friedman**
**Althea Glenn**
**Susannah Hubert**
**Stuart Gaines**
**Shawn McDermott**
**Sadaf Qaiyumi**
**FoodNet EIP funded sites**
**CDC PulseNet**
**USDA**
**-****	****Dr. Paula Fedorka-Cray**

**Acknowledgements**