Karp Beth E, Tate Heather, Plumblee Jodie R, Dessai Uday, Whichard Jean M, Thacker Eileen L, Hale Kis Robertson, Wilson Wanda, Friedman Cindy R, Griffin Patricia M, McDermott Patrick F
1 Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia .
2 Office of Research, Center for Veterinary Medicine , U.S. Food and Drug Administration, Laurel, Maryland.
Foodborne Pathog Dis. 2017 Oct;14(10):545-557. doi: 10.1089/fpd.2017.2283. Epub 2017 Aug 9.
Drug-resistant bacterial infections pose a serious and growing public health threat globally. In this review, we describe the role of the National Antimicrobial Resistance Monitoring System (NARMS) in providing data that help address the resistance problem and show how such a program can have broad positive impacts on public health. NARMS was formed two decades ago to help assess the consequences to human health arising from the use of antimicrobial drugs in food animal production in the United States. A collaboration among the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, the United States Department of Agriculture, and state and local health departments, NARMS uses an integrated "One Health" approach to monitor antimicrobial resistance in enteric bacteria from humans, retail meat, and food animals. NARMS has adapted to changing needs and threats by expanding surveillance catchment areas, examining new isolate sources, adding bacteria, adjusting sampling schemes, and modifying antimicrobial agents tested. NARMS data are not only essential for ensuring that antimicrobial drugs approved for food animals are used in ways that are safe for human health but they also help address broader food safety priorities. NARMS surveillance, applied research studies, and outbreak isolate testing provide data on the emergence of drug-resistant enteric bacteria; genetic mechanisms underlying resistance; movement of bacterial populations among humans, food, and food animals; and sources and outcomes of resistant and susceptible infections. These data can be used to guide and evaluate the impact of science-based policies, regulatory actions, antimicrobial stewardship initiatives, and other public health efforts aimed at preserving drug effectiveness, improving patient outcomes, and preventing infections. Many improvements have been made to NARMS over time and the program will continue to adapt to address emerging resistance threats, changes in clinical diagnostic practices, and new technologies, such as whole genome sequencing.
耐药细菌感染在全球范围内对公共卫生构成了严重且日益增长的威胁。在本综述中，我们描述了国家抗微生物药物耐药性监测系统（NARMS）在提供有助于解决耐药性问题的数据方面所发挥的作用，并展示了这样一个项目如何能够对公共卫生产生广泛的积极影响。NARMS成立于二十年前，旨在帮助评估美国食用动物生产中使用抗微生物药物对人类健康产生的后果。作为疾病控制与预防中心、美国食品药品监督管理局、美国农业部以及州和地方卫生部门之间的合作项目，NARMS采用综合的“同一健康”方法来监测来自人类、零售肉类和食用动物的肠道细菌中的抗微生物药物耐药性。NARMS通过扩大监测覆盖区域、检查新的分离株来源、增加细菌种类、调整抽样方案以及修改所检测的抗微生物药物，来适应不断变化的需求和威胁。NARMS数据不仅对于确保批准用于食用动物的抗微生物药物以对人类健康安全的方式使用至关重要，而且还有助于解决更广泛的食品安全优先事项。NARMS监测、应用研究以及疫情分离株检测提供了关于耐药肠道细菌的出现、耐药性的遗传机制、细菌群体在人类、食物和食用动物之间的传播以及耐药和敏感感染的来源与结果的数据。这些数据可用于指导和评估基于科学的政策、监管行动、抗微生物药物管理举措以及其他旨在保持药物有效性、改善患者治疗效果和预防感染的公共卫生努力所产生的影响。随着时间的推移，NARMS已经取得了许多改进，并且该项目将继续进行调整，以应对新出现的耐药性威胁、临床诊断实践的变化以及新技术，如全基因组测序。
