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Developing a Pilot Environmental Effort for the National Antimicrobial Resistance Monitoring System (NARMS)
Citation:
Garland, J., A. Franklin, M. Bagley, S. Keely, N. Brinkman, L. Boczek, C. Nietch, AND R. Mitchell. Developing a Pilot Environmental Effort for the National Antimicrobial Resistance Monitoring System (NARMS). 7th World One Health Conference, Cincinnati, OH, November 07 - 11, 2022.
Impact/Purpose:
Present EPA ORD research on antomicrobial resistance monitoring to leaders in the field at an international meeting.
Description:
Antimicrobial resistance (AMR) is one of the major public health threats of the 21st century. The magnitude of the AMR public health issue impelled the worldwide development of multifaceted action plans to combat AMR, including improved stewardship of antibiotics, development of new antimicrobials, and advanced surveillance. The U.S. federal government established a national surveillance system to monitor antimicrobial resistance in zoonotic bacteria from food animals and humans. Led by the Food and Drug Administration (FDA) Center for Veterinary Medicine (CVM), the National Antimicrobial Resistance Monitoring System (NARMS) for enteric pathogens is a collaboration with the Centers for Disease Control (CDC) and the U.S. Department of Agriculture (USDA) Agricultural Research Service (ARS). A consensus has emerged among the greater public health profession to adopt an interdisciplinary one health model of infectious disease monitoring and control. The One Health paradigm recognizes 1) that human and animal health are linked to environmental health, and 2) the need to better understand the role of the environment in the spread of disease. Since 2020, EPA-ORD has led an interagency NARMS Environmental Working Group to define and implement this pilot effort. Surface water was selected as an initial environmental component for monitoring because of its integration of various anthropogenic impacts within a watershed. Following guidance from many international working groups on the environmental dimensions of AMR, a three-phase research plan was defined, involving 1) standardized sampling and analysis to facilitate comparison of these data to rapidly expanding analyses across the globe, 2) development of a statistically robust study at the watershed scale to serve as a template for further efforts across the country, and 3) national scale assessment to provide long term trends. Phase I focused on developing three major types of methods, including 1) culture based approaches for isolating antibiotic resistant bacteria (ARB) of interest (E. coli, Enterococcus, and Salmonella), 2) quantitative measures of dozens of antibiotic resistant genes (ARG), and 3) broader sequencing of the overall microbiome in water (i.e metagenomics). Phases I and II utilize existing EPA water quality monitoring efforts at the watershed (East Fork of the Little Miami River in Southeast Ohio, CY22-23) and national (National Rivers and Streams Assessment, CY23-24) scale.