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How CDC Uses Antibiotic Resistance Data

Over the past year, you may have noticed that antimicrobial resistance information has been incorporated in the outbreak reports put out by the Centers for Disease Control and Prevention (CDC).

The agency recently introduced the measure to address the goal of the National Antimicrobial Resistance Monitoring System (NARMS) to get such information to the public.

An outbreak report on CDC’s website like the human Salmonella infections linked to live poultry states the number of isolates from victims tested, along with how many were antibiotic-resistant and how many were pansusceptible — meaning associated with a high likelihood of therapeutic success given all antibiotics tested.

Within the NARMS collaboration, CDC deals with isolates from humans, the Department of Agriculture deals with isolates from animals, and the Food and Drug Administration deals with isolates from retail meat.

CDC conducts antibiotic susceptibility testing on isolates from both sporadic cases and outbreaks of illness.

Public health laboratories in all states submit to CDC NARMS every 20th non-typhoidal Salmonella, Shigella, and E. coli O157 isolate they receive, along with every Salmonella serotype Typhi, serotype Paratyphi A, serotype Paratyphi C, and Vibrio (other than V. cholerae) isolate.

In addition, the 10 state health departments involved with CDC’s Foodborne Diseases Active Surveillance Network (FoodNet) send every fifth Campylobacter isolate. These states include Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, Tennessee, California, Colorado and New York.

Since 2004, CDC NARMS has been testing isolates from outbreaks and regularly increases testing in these situations. In 2013, NARMS tested more than 600 outbreak isolates.

In CDC’s outbreak investigations, information on antimicrobial resistance  helps not only in identifying patterns of emerging resistance, but also in hypothesizing about outbreak causes.

This can help investigators hypothesize about the source. For example, multi-drug resistance in Salmonella Newport is commonly associated with cattle and “associations like this may help the outbreak response group at CDC target the source of the outbreak more quickly,” CDC’s Regan Rickert-Hartman told attendees at the NARMS 2014 Scientific Meeting on August 12.

It can also help determine the difference between foods causing resistance versus those causing susceptible infections.

The agency publishes its NARMS data in an annual report to assist in tracking changes in resistance and publishes key trends online as a quick reference for stakeholders. Last year, CDC began posting resistance information on its outbreak pages and also launched online interactive graphs showing data through 2012.

And the web-based surveillance system that CDC launched two years ago not only allows for timelier communication of state testing results, but also allows for states health departments to view and download the results from their isolates in order to do data analysis at the local level.

In the future, CDC is working on getting data available faster, developing public access to susceptibility results online, data download capabilities and more data visualization.

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