NARMS Now: Human Data

Project Results: To view the PowerPoint presentation from CHIIC's November 2015 meeting, click here.

Media coverage: Several news articles were written about this project:

• Time magazine
• Discovery.com
• Tech Insider

Project Status: Completed

Point of Contact: Julian Grass

Center: NCEZID

Keywords: Antimicrobial Resistance, Visualization Tools, Graphical Displays, Data Download

Project Description: The National Antimicrobial Resistance Monitoring System (NARMS) is a US public health surveillance system that tracks antimicrobial resistance in foodborne and other enteric bacteria. NARMS is an interagency partnership among the US Centers for Diseases Control and Prevention (CDC), the US Food and Drug Administration (FDA), the US Department of Agriculture (USDA), and state and local health departments. CDC monitors foodborne and enteric bacterial isolates obtained from ill humans. Human surveillance began in fourteen sites in 1996 and became nationwide in 2003.
To date, the public has only been able to access summary data, and those summary data have been made available 2 or more years after isolate collection and testing. We have constructed interactive graphs manually by calculating summary data and typing them into spreadsheets for aggregate display by Crystal Dashboard software. The graphics have only depicted national data and do not allow visualization at the state or regional level. Isolate-level susceptibility results are also not readily available. Because of the increase of resistance to antimicrobial agents used to treat serious enteric bacterial infections, NARMS stakeholders, the public, academia, and Congress are demanding access to more timely data on emerging resistance. The community at large has expressed a desire to view and access data at an isolate-level and the NARMS team is interested in developing and ultimately deploying tools that will allow stakeholders and the public access to isolate-level susceptibility results. The tools developed will include a geographic and temporal data visualization dashboard and download capabilities for data retrieval on an isolate-level. Real time construction of interactive web graphics (from live data instead of manually constructed tables) is also planned.

1. Potential impact of project if successful
   As soon as susceptibility tests are conducted and confirmed by NARMS staff, the data will be put on the NARMS public facing website for download and for interactive graphical displays. This will allow users (e.g., states, stakeholders, the public, academia, and other government agencies) to explore and analyze resistance data online more easily and in a timely manner. This helps us achieve key steps in President Obama’s Open Government Directive and inform the public of the current state of antimicrobial resistance among enteric pathogens. Also, because of the evidence that antimicrobial resistance among foodborne pathogens (i.e., Salmonella) is predominantly a consequence of antimicrobial use in food animals, efforts are needed to promote antibiotic stewardship in that sector, especially of critically important agents. This project will aid in this effort by alerting policy makers in a timely fashion of the trends and emergence of resistance among these pathogens.
2. Scalability – applicability to wider audiences within CDC
   This project will be developed using responsive design so that the tools can be used among multiple platforms and devices. The project will provide a framework for building additional functionality and will incorporate data handling principles that can be applied to other surveillance systems across CDC.
3. Methodology – how your project will be carried out
   NARMS epidemiologists and microbiologists, along with a team of IT developers with extensive previous NARMS database development experience, will meet for a rapid series of requirement sessions to establish a set of core requirements for development. The designated group of NARMS subject matter experts and IT developers will use an iterative design method to build and beta-test each phase of development. This iterative and agile method allows for development and beta-testing to occur in parallel to build visualization and download capabilities. Usability experts will aid in designing an easy-to-use and intuitive graphical display that will have query and download capabilities.
4. Measure of success – your expected outcome
   Development and deployment of fully functional tools for both data visualization and download of NARMS resistance results that will allow any member of the public to access, query, and analyze the data. Because infection with antimicrobial-resistant Salmonella has been associated with increased risk of severe infection, hospitalization, and death, timely availability of information about resistance patterns is imperative to help alert clinicians and target prevention efforts. We expect the tools to be fully developed and submitted for NCEZID ISSO approval at the end of 4 months.

For more information about this project, please contact the CHIIC at chiic@cdc.gov or Brian Lee at brian.lee@cdc.hhs.gov.