Persistence of Multidrug-ResistantStaphylococcus haemolyticusin an Animal Veterinary Teaching Hospital Clinic

Virulence Factors in Coagulase-Negative Staphylococci

Coagulase-negative staphylococci (CoNS) have emerged as major pathogens in healthcare-associated facilities, being S. epidermidis, S. haemolyticus and, more recently, S. lugdunensis, the most clinically relevant species. Despite being less virulent than the well-studied pathogen S. aureus, the number of CoNS strains sequenced is constantly increasing and, with that, the number of virulence factors identified in those strains. In this regard, biofilm formation is considered the most important. Besides virulence factors, the presence of several antibiotic-resistance genes identified in CoNS is worrisome and makes treatment very challenging. In this review, we analyzed the different aspects involved in CoNS virulence and their impact on health and food.

Variability of resistance plasmids in coagulase-negative staphylococci and their importance as a reservoir of antimicrobial resistance

Coagulase-negative staphylococci (CoNS) are an important cause of human and animal diseases. Treatment of these diseases is complicated by their common antimicrobial resistance, caused by overuse of antibiotics in hospital and veterinary environment. Therefore, they are assumed to serve as a reservoir of resistance genes often located on plasmids. In this study, we analyzed plasmid content in 62 strains belonging to 10 CoNS species of human and veterinary origin. In 48 (77%) strains analyzed, 107 different plasmids were detected, and only some of them showed similarities with plasmids found previously. In total, seven different antimicrobial-resistance genes carried by plasmids were identified. Five of the CoNS staphylococci carried plasmids identical with either those of other CoNS species tested, or a well characterized Staphylococcus aureus strain COL, suggesting plasmid dissemination through horizontal transfer. To demonstrate the possibility of horizontal transfer, we performed electroporation of four resistance plasmids among Staphylococcus epidermidis, Staphylococcus petrasii, and coagulase-positive S. aureus strains. Plasmids were transferred unchanged, were stably maintained in recipient strains, and expressed resistance genes. Our work demonstrates a great variability of plasmids in human and veterinary staphylococcal strains and their ability to maintain and express resistance plasmids from other staphylococcal species.

Antimicrobial Resistance among Staphylococci of Animal Origin

Antimicrobial resistance among staphylococci of animal origin is based on a wide variety of resistance genes. These genes mediate resistance to many classes of antimicrobial agents approved for use in animals, such as penicillins, cephalosporins, tetracyclines, macrolides, lincosamides, phenicols, aminoglycosides, aminocyclitols, pleuromutilins, and diaminopyrimidines. In addition, numerous mutations have been identified that confer resistance to specific antimicrobial agents, such as ansamycins and fluoroquinolones. The gene products of some of these resistance genes confer resistance to only specific members of a class of antimicrobial agents, whereas others confer resistance to the entire class or even to members of different classes of antimicrobial agents, including agents approved solely for human use. The resistance genes code for all three major resistance mechanisms: enzymatic inactivation, active efflux, and protection/modification/replacement of the cellular target sites of the antimicrobial agents. Mobile genetic elements, in particular plasmids and transposons, play a major role as carriers of antimicrobial resistance genes in animal staphylococci. They facilitate not only the exchange of resistance genes among members of the same and/or different staphylococcal species, but also between staphylococci and other Gram-positive bacteria. The observation that plasmids of staphylococci often harbor more than one resistance gene points toward coselection and persistence of resistance genes even without direct selective pressure by a specific antimicrobial agent. This chapter provides an overview of the resistance genes and resistance-mediating mutations known to occur in staphylococci of animal origin.

Qac genes and biocide tolerance in clinical veterinary methicillin-resistant and methicillin-susceptible Staphylococcus aureus and Staphylococcus pseudintermedius

Qac genes are associated with increased tolerance to quaternary ammonium compounds and other cationic biocides such as chlorhexidine. This study aimed to determine whether qac genes and increased biocide tolerance were present in 125 clinical methicillin-resistant and susceptible veterinary staphylococci. A total of 125 methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant and -susceptible Staphylococcus pseudintermedius (MRSP and MSSP) from three archived Australian veterinary staphylococci collections underwent whole genome sequencing, multilocus sequence typing and qac gene screening. Two MRSA isolates (12%) harboured qacA/B genes; both isolates were ST8 from horses. QacJ, qacG and smr genes were identified in 28/90 (31%) MRSP and 1/18 (6%) MSSP isolates. ST71 MRSP was significantly more likely to harbour qac genes than other MRSP clones (p < 0.05). A random subset of 31 isolates underwent minimum bactericidal concentration (MBC) testing against F10SC^TM (benzalkonium chloride and biguanide), and Hexacon^TM (chlorhexidine gluconate), with and without the addition of bovine serum albumin (BSA) as an in vitro substitute for organic matter contamination. Qac genes were not associated with increased phenotypic biocide tolerance but biocide efficacy was significantly affected by the presence of BSA. In the absence of BSA, all MBC values were well below the recommended usage concentration. When BSA was present, regardless of qac gene presence, 50% of MRSA and 43% of MRSP had an F10SC^TM MBC above the recommended concentration for general disinfection. Qac genes did not confer increased in vitro biocide tolerance to veterinary staphylococci. Organic matter contamination must be minimized to ensure the efficacy of biocides against MRSA and MRSP.

Prevalence of methicillin-resistant Staphylococcus haemolyticus in companion animals: a cross-sectional study

Background

Among coagulase-negative staphylococci, Staphylococcus haemolyticus is the second most frequently isolated species from human blood cultures and has the highest level of antimicrobial resistance. This species has zoonotic character and is prevalent both in humans and animals. Recent studies have indicated that methicillin-resistant S. haemolyticus (MRSH) is one of the most frequent isolated Staphylococcus species among neonates in intensive care units. The aim of this study was to determine the presence of MRSH in different groups of companion animals and to characterize isolates according their antimicrobial resistance.

Methods

Samples (n = 754) were collected from healthy and diseased dogs and cats, female dogs in pure-breed kennels, healthy horses, and kennel owners. Classical microbiological tests along with molecular testing including PCR and 16S rRNA sequencing were performed to identify MRSH. Clonality of the isolates was assessed by Pulsed Field Gel Electrophoresis using the SmaI restriction enzyme. Antimicrobial susceptibility testing was performed using the broth micro-dilution method. Detection of genes encoding antimicrobial resistance was performed by PCR. Statistical analysis was performed using the R Project of Statistical Computing, “R 1.8.1” package.

Results

From a total of 754 samples tested, 12 MRSH isolates were obtained. No MRSH were found in horses and cats. Eleven isolates were obtained from dogs and one from a kennel owner. Ten of the dog isolates were detected in pure-breed kennels. The isolates demonstrated the same clonality only within separate kennels.

The most frequent resistances of MRSH isolates was demonstrated to benzylpenicillin (91.7%), erythromycin (91.7%), gentamicin (75.0%), tetracycline (66.7%), fluoroquinolones (41.7%) and co-trimoxazole (41.7%). One isolate was resistant to streptogramins. All isolates were susceptible to daptomycin, rifampin, linezolid and vancomycin. The clone isolated from the kennel owner and one of the dogs was resistant to beta-lactams, macrolides, gentamicin and tetracycline.

Conclusions

Pure-breed kennels keeping 6 or more females were determined to be a risk factor for the presence of MRSH strains. MRSH isolated from companion animals were frequently resistant to some classes of critically important antimicrobials, although they remain susceptible to antibiotics used exclusively in human medicine.

Effectiveness of a steam cleaning unit for disinfection in a veterinary hospital

OBJECTIVE

To evaluate whether the application of steam to a variety of surface types in a veterinary hospital would effectively reduce the number of bacteria.

SAMPLE

5 surface types.

PROCEDURES

Steam was applied as a surface treatment for disinfection to 18 test sites of 5 surface types in a veterinary hospital. A pretreatment sample was obtained by collection of a swab specimen from the left side of each defined test surface. Steam disinfection was performed on the right side of each test surface, and a posttreatment sample was then collected in the same manner from the treated (right) side of each test surface. Total bacteria for pretreatment and posttreatment samples were quantified by heterotrophic plate counts and for Staphylococcus aureus, Pseudomonas spp, and total coliforms by counts on selective media.

RESULTS

Significant reductions were observed in heterotrophic plate counts after steam application to dog runs and dog kennel floors. A significant reduction in counts of Pseudomonas spp was observed after steam application to tub sinks. Bacterial counts were reduced, but not significantly, on most other test surfaces that had adequate pretreatment counts for quantification.

CONCLUSIONS AND CLINICAL RELEVANCE

Development of health-care-associated infections is of increasing concern in human and veterinary medicine. The application of steam significantly reduced bacterial numbers on a variety of surfaces within a veterinary facility. Steam disinfection may prove to be an alternative or adjunct to chemical disinfection within veterinary practices.

Prevalence of Enterotoxigenic Staphylococcus aureus Isolated From Chicken Nugget in Iran

Background:

The enterotoxigenic Staphylococcus aureus is considered as one of the most important cause of food poisoning that manifests with gastroenteritis, diarrhea, and vomiting. Its complications usually occur when bacterial virulence genes are produced. The most important virulence factors are cell-associated components, exoenzymes, exotoxins, enterotoxins, and enterotoxin-like toxins.

Objectives:

The present study aimed to study the presence of S. aureus and its virulence factors in chicken nuggets in Iran.

Materials and Methods:

Totally, 420 chicken nuggets from five brands were collected from Isfahan and Chaharmahal-va-Bakhtiari provinces, Iran. Samples were cultured and the positive results were studied using ELISA and PCR for detection of classical staphylococcal enterotoxins and sea-sej virulence genes, respectively.

Results:

Results showed that 27 (6.42%) of 420 samples were contaminated with S. aureus with bacteria concentration between 6.1 × 10³ to 8.4 × 10¹/mL. Totally, 33.33% of isolates produced SEA, 4.16% SEB, 12.50% SEC, 8.33% SED, 12.50% SEA + SEC, and 12.50% SEA + SED. The most commonly detected genes were sea (25%), sea + seg (8.33%), sec (12.50%), sea + sed (12.50%), and sea + sec + sej (12.50%).

Conclusions:

S. aureus can easily contaminate the chicken nugget and this contamination is usually associated with significant presences of virulence genes. Consumption of these nuggets certainly is associated with gastrointestinal diseases. Therefore, some food safety and quality standards should be applied and performed in most of the Iranian food units to control growth of S. aureus and its virulence factors.

Characterization of Staphylococcus xylosus isolated from broiler chicken barn bioaerosol

In this study we isolated and characterized Staphylococcus xylosus, a coagulase-negative staphylococcal species considered as commensal and one of the prevalent staphylococcal species found in poultry bioaerosol. Isolates were obtained using air samplers and selective phenylethyl alcohol agar for gram-positive bacteria during 35-d periods at different times of the day. A total of 200 colonies were recovered and after basic biochemical tests were performed, presumptive staphylococci were subsequently identified by API Staph strips. A total of 153 (76.5%) staphylococci were found, among which 84 were S. xylosus (46 and 38 isolated inside and outside, respectively). Biofilm formation was observed in 86.9% of S. xylosus isolates, whereas 79.8% of them showed hemolytic activity. There was a strong correlation (92.5%) between biofilm formation and hemolytic activity. All 84 S. xylosus isolates were susceptible to amikacin, ampicillin/sulbactam, chloramphenicol, ciprofloxacin, gentamycin, kanamycin, linezolid, trimethoprim/sulfamethoxazole, and vancomycin. Resistance to nalidixic acid (86.9%), novobiocin (85.7%), penicillin (70.2%), lincomycin (46.4%), oxacillin (42.9%), ampicillin (27.4%), tetracycline (21.4%), erythromycin (11.9%), bacitracin (10.7%), and streptomycin (2.4%) was observed among the isolates. Resistance to tetracycline, lincomycin, erythromycin, and β-lactam antibiotics was occasionally linked to the tetK, linA, ermB, and blaZ genes, respectively. Random amplification of polymorphic DNA results showed similarity of 15 to 99% between isolates collected outside and inside the barn, indicating genetic diversity of these isolates. Our study indicates that characterization of poultry bioaerosol coagulase-negative staphylococcal species such as S. xylosus is necessary for assessing their safety status for both poultry and humans.

Prevalence and antimicrobial resistance of Enterococcus spp and Staphylococcus spp isolated from surfaces in a veterinary teaching hospital

OBJECTIVE

To determine the prevalence and antimicrobial resistance of enterococci and staphylococci collected from environmental surfaces at a veterinary teaching hospital (VTH).

DESIGN

Longitudinal study.

SAMPLE

Samples collected from surfaces in 5 areas (emergency and critical care, soft tissue and internal medicine, and orthopedic wards; surgery preparation and recovery rooms; and surgery office and operating rooms) of a VTH.

PROCEDURES

Selected surfaces were swabbed every 3 months during the 3-year study period (2007 to 2009). Isolates of enterococci and staphylococci were identified via biochemical tests, and antimicrobial susceptibility was evaluated with a microbroth dilution technique. A subset of isolates was analyzed to assess clonality by use of pulsed-field gel electrophoresis.

RESULTS

430 samples were collected, and isolates of enterococci (n = 75) and staphylococci (110) were identified. Surfaces significantly associated with isolation of Enterococcus spp and Staphylococcus spp included cages and a weight scale. Fourteen Enterococcus spp isolates and 17 Staphylococcus spp isolates were resistant to ≥ 5 antimicrobials. Samples collected from the scale throughout the study suggested an overall increase in antimicrobial resistance of Enterococcus faecium over time. Clonality was detected for E faecium isolates collected from 2 different surfaces on the same day.

CONCLUSIONS AND CLINICAL RELEVANCE

Although not surprising, the apparent increase in antimicrobial resistance of E faecium was of concern because of the organism's ability to transmit antimicrobial resistance genes to other pathogens. Results reported here may aid in identification of critical control points to help prevent the spread of pathogens in VTHs.

Does the wide use of quaternary ammonium compounds enhance the selection and spread of antimicrobial resistance and thus threaten our health?

Quaternary ammonium compounds (QACs) are widely used biocides that possess antimicrobial effect against a broad range of microorganisms. These compounds are used for numerous industrial purposes, water treatment, antifungal treatment in horticulture, as well as in pharmaceutical and everyday consumer products as preserving agents, foam boosters, and detergents. Resistance toward QACs is widespread among a diverse range of microorganisms and is facilitated by several mechanisms such as modifications in the membrane composition, expression of stress response and repair systems, or expression of efflux pump genes. Development of resistance in both pathogenic and nonpathogenic bacteria has been related to application in human medicine and the food industry. QACs in cosmetic products will inevitably come into intimate contact with the skin or mucosal linings in the mouth and thus are likely to add to the selection pressure toward more QAC-resistant microorganisms among the skin or mouth flora. There is increasing evidence of coresistance and cross-resistance between QACs and a range of other clinically important antibiotics and disinfectants. Use of QACs may have driven the fixation and spread of certain resistance cassette collectors (class 1 integrons), currently responsible for a major part of antimicrobial resistance in gram-negative bacteria. More indiscriminate use of QACs such as in cosmetic products may drive the selection of further new genetic elements that will aid in the persistence and spread of antimicrobial resistance and thus in limiting our treatment options for microbial infections.

Antimicrobial resistance in Staphylococcus pseudintermedius in the Norwegian dog population

The occurrence of antimicrobial resistance in Staphylococcus pseudintermedius from skin and ear infections in a representative sample of dogs unexposed to antimicrobial treatment before sampling was examined. The obtained isolates were further examined for genetic polymorphism and genetic background of resistance. A total of 59 isolates of S. pseudintermedius originating from 96 samples of 91 dogs in five different regions in Norway were included in this study. Susceptibility testing was performed using a broth dilution method. Resistant isolates were subjected to polymerase chain reaction for detection of resistance genes. All isolates were subjected to pulsed-field gel electrophoresis to examine the genetic polymorphism. In total, 19% of the isolates were susceptible to all antimicrobial agents included. Resistance to penicillin was most prevalent (70%), followed by resistance to fusidic acid (49%) and oxytetracycline (42%). Resistance to quinolones or cephalosporins was not observed. Resistance to penicillin, tetracycline, and erythromycin was mediated by the blaZ beta-lactamase gene, the tetM gene, and the ermB gene, respectively. One of the fusidic acid-resistant isolates harbored a fusC gene, whereas the mechanisms involved in resistance in the other fusidic acid-resistant isolates remained unknown. Pulsed-field gel electrophoresis showed a high genetic polymorphism of S. pseudintermedius. This study indicates that the occurrence of antimicrobial resistance is common among S. pseudintermedius from dogs unexposed to antimicrobial treatment before sampling, and that there is a high genetic polymorphism among S. pseudintermedius.

Risk of colonization or gene transfer to owners of dogs with meticillin-resistant Staphylococcus pseudintermedius

To determine the zoonotic risk from meticillin-resistant staphylococcal species or transfer of resistance genes between dogs with pyoderma and their owners, 25 dog-owner pairs were studied. Cultures were obtained from the dog's lesions and the owner's nasal cavity on the initial visit. Staphylococcus isolates were identified and antimicrobial susceptibility tests were performed by the Kirby-Bauer disk diffusion method. Presence of the mecA gene was determined by PCR. Staphylococcal Cassette Chromosome (SCCmec) typing was performed by multiplex PCR. Eighteen dogs had a meticillin-resistant staphylococcal species, with meticillin-resistant S. pseudintermedius (MRSP) isolated from 15 dogs. MRSP was isolated from two owners of dogs with MRSP skin infections. Both organisms had the same susceptibility pattern and SCCmec type. MRSP was not isolated from the owners after treating both dogs for 1 month. At least one coagulase-negative Staphylococcus spp. (CoNS) was isolated from each owner, with meticillin resistance found in 16 (64%) of the isolates. The mecA gene was identified in all but two of the meticillin-resistant Staphylococcus spp. Multiplex PCR identified SCCmec type V in all MRSP. The mecA gene-possessing CoNS isolates from owners contained either SCCmec type IVa or IVc. In conclusion, MRSP colonization of owners appeared to be uncommon and transient. Human nasal carriage of meticillin-resistant CoNS was common, but the SCCmec types were different from those in the canine MRSP isolates. Owners do not appear to be at great risk of zoonotic transfer of organisms or antimicrobial resistance genes from dogs with MRSP infections, but the findings should be confirmed with a much larger cohort.

Clonal spread of methicillin-resistant coagulase-negative staphylococci among horses, personnel and environmental sites at equine facilities

A cross-sectional study was carried out to investigate species distribution and clonality of methicillin-resistant coagulase-negative staphylococci (MRCoNS) isolated from the nasal cavity of 39 horses and 32 veterinary or caretaker staff, and from 76 environmental surfaces at three equine facilities in Denmark. MRCoNS obtained by selective isolation were characterised by 16S rDNA sequencing, PCR detection of mecA, and pulsed-field gel electrophoresis (PFGE). MRCoNS were found in 32 (82%) horses, 20 (63%) humans and 50 (66%) environmental samples. The most common species was S. vitulinus (n=56), followed by S. sciuri (n=25), S. haemolyticus (n=14). Undistinguishable PFGE patterns were observed in MRCoNS of equine, human and environmental origin. A S. vitulinus clone and a S. haemolyticus clone were isolated from multiple horses, staff members and environmental sites within a farm and a veterinary hospital, respectively. The results indicated that methicillin-resistant strains of these two species can be shared by and possibly exchanged between horses and personnel, either directly or through contaminated environments.