M. E. Ginevan, Blasland, Bouck & Lee, Inc., Reston, VA 20190, USA.
Int J Infect Dis. 2002 Dec;6 Suppl 3:3S8-14; discussion 3S14-5, 3S53-8. doi: 10.1016/s1201-9712(02)90178-5.
This paper reviews the United States National Antimicrobial Resistance Monitoring System (NARMS). The data from this system have been used as the core basis of a recent proposal to stop the use of fluoroquinolones in poultry production, in an effort to reduce or remove a perceived threat to human health due to alleged increasing fluoroquinolone resistance among human Campylobacter isolates. An increase in resistance has the potential to render fluoroquinolone therapy of human gastrointestinal infections less effective. This review finds no evidence in the NARMS data to suggest that a rise in resistant Campylobacter isolates has occurred since fluoroquinolones were introduced for use in poultry. In addition, this review identifies a number of shortcomings in the NARMS program. These include lack of an overall sampling design, biases in the collection of isolates from animal samples, noncompliance of state departments of public health with NARMS protocols, lack of such basic data as genotype information on the organisms isolated, and, for animal samples, lack of measurements of bacterial load. Taken together, these problems indicate that the present NARMS data very likely overestimate resistance levels, and, at best, do not provide reliable information to quantify the extent and temporal trends of antimicrobial resistance in Campylobacter and other enteric organisms from human and animal populations. Ways to improve the quantitative rigor of the NARMS program and identify other data such as 'meta' data for human and animal samples, and data on the magnitude of other potential reservoirs of infection, including healthy humans, are suggested. Implementing these proposals would greatly enhance the value of the NARMS program as a tool for quantitative decision-making and aid in improving the quality of our food supply and human health care.
本文回顾了美国国家抗菌药物耐药性监测系统（NARMS）。该系统的数据被用作最近提议停止在禽畜生产中使用氟喹诺酮类药物的核心依据，以努力减少或消除因据称人类空肠弯曲菌分离株中氟喹诺酮类药物耐药性增加而对人类健康造成的威胁。耐药性的增加有可能使氟喹诺酮类药物治疗人类胃肠道感染的效果降低。本文审查发现，NARMS 数据中没有证据表明自氟喹诺酮类药物被引入禽畜生产以来，耐药性空肠弯曲菌分离株的数量有所增加。此外，本文还发现 NARMS 计划存在一些缺陷。这些缺陷包括缺乏总体抽样设计、动物样本中分离株采集的偏差、州公共卫生部门不遵守 NARMS 协议、缺乏关于分离出的生物体的基因型等基本数据、以及对于动物样本，缺乏细菌载量的测量。总之，这些问题表明，目前的 NARMS 数据很可能高估了耐药水平，而且，最好的情况是，无法提供可靠的信息来量化人类和动物人群中空肠弯曲菌和其他肠道生物体的耐药程度和时间趋势。本文提出了改进 NARMS 计划定量严谨性的方法，并确定了其他数据，如人类和动物样本的“元”数据，以及其他潜在感染源（包括健康人群）的规模数据。实施这些建议将极大地提高 NARMS 计划作为定量决策工具的价值，并有助于提高我们的食品供应质量和人类医疗保健水平。
