Methicillin-resistantStaphylococcus aureuskeratitis in a dog

Antimicrobial susceptibility and minimal inhibitory concentration of bacteria isolated from the eyes of dogs with keratoconjunctivitis sicca

ABSTRACT: The objective of this study was to evaluate the antimicrobial susceptibility profile of bacteria isolated from the eyes of dogs with keratoconjunctivitis sicca (KCS). We evaluated 65 dogs diagnosed with KCS and 30 healthy dogs (Control Group). Conjunctival swab samples were collected after KCS was diagnosed. Microbiological examinations were performed, including aerobic culture, antimicrobial susceptibility testing and minimum inhibitory concentration (MIC) determination for chloramphenicol, tobramycin, ofloxacin and moxifloxacin. MICs of the fifteen most resistant strains of Staphylococcus pseudintermedius (Staphylococcus intermedius Group, SIG) and the fifteen most resistant strains of gram-negative bacteria were determined. By percentage, the microorganisms exhibited the highest susceptibility to polymyxin B, tobramycin and chloramphenicol and the lowest to tetracycline. Three multi-drug-resistant strains of SIG were detected: one displayed isolated susceptibility to cefazolin, another to vancomycin, and another to polymyxin B and amikacin. The species of bacteria isolated from the eyes of dogs with KCS presented variable susceptibility to the antibiotics tested. We found evidence of the emergence of quinolone-resistant strains of SIG and further evidence of increased ocular prevalence. These findings reinforce the need to identify the bacteria involved and their antimicrobial susceptibility profile, as secondary infections can serve as exacerbating and perpetuating factors in KCS.

Bacterial contamination of slit lamps in veterinary ophthalmology

PURPOSE

Healthcare-associated infection (HAI) is a well-known problem in human medicine. The contamination of medical devices with pathogenic organisms is less studied in veterinary medicine. The purpose of this multicenter study was to evaluate the bacterial contamination of slit lamps throughout Europe and part of the United States. The efficacy of standard cleaning was additionally investigated.

METHODS

Samples from adjustment wheels of slit lamps were taken by different veterinary ophthalmologists and submitted for culture (n = 29). The efficacy of cleaning protocols was evaluated by taking a second sample after routine cleaning (n = 29). Sensitivity testing was performed for pathogenic bacteria using the minimum inhibitory concentration (MIC) or disc diffusion (Kirby-Bauer) method. Statistical analysis was performed using Fisher's exact test.

RESULTS

Seventeen of 29 slit lamps were contaminated before cleaning. The most frequently cultured bacteria were Staphylococcus spp. and coliform bacteria. Twelve of 29 slit lamps showed no bacterial growth before and after cleaning. There was a significant difference before and after cleaning (P = 0.0008), with only 4/29 contaminated samples after cleaning.

CONCLUSION

Contamination with pathogenic bacterial species is frequent in slit lamps used by veterinary ophthalmologists. A risk of cross-contamination in clinical patients has to be considered. Routine cleaning reduces bacterial contamination significantly.

Identification and antimicrobial susceptibility of microorganisms isolated from severe corneal ulcers of dogs in Thailand

This study aims to determine the microbiological profile and risk factors associated with antimicrobial-resistant bacteria in canine severe corneal ulcers. Thirty-two corneal and conjunctival swabs were collected from dogs with diagnosed severe corneal ulcers that presented to Prasu-Arthorn veterinary teaching hospital in Nakhon Pathom, Thailand from June 2015 to June 2016. Microorganisms were identified by means of genotypic and phenotypic approaches. Of 32 ulcers sampled, 26 (81.3%) yielded culturable microorganisms with 24 bacterial isolates and 7 fungal isolates. The most commonly isolated bacteria were Staphylococcus spp. (45.8%, 11/24) and Pseudomonas aeruginosa (20.8%, 5/24). Out of 11 staphylococcal isolates identified, 10 carried the mecA gene providing methicillin resistance. The extended-spectrum β-lactamase (ESBL) encoding genes blaCTX-M and blaVEB-1 were found in an Acinetobacter lwoffii isolate, and blaSHV was found in a P. aeruginosa isolate. Based on the Clinical Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoint criteria, minimum inhibitory concentrations values showed that all bacteria, except for staphylococci, were susceptible to current ophthalmic antibiotics. More than 50% of staphylococci were resistant to all generations of fluoroquinolones and fusidic acid. Chloramphenicol was highly active against staphylococci (81.3% susceptible). The width (P=0.02) and the depth (P=0.04) of ulcers predicted greater risk of yielding resistant bacteria. The identification of antimicrobial-resistant bacteria prompts practitioners to be prudent when choosing ophthalmic antibiotics for severe corneal ulcers.

Methicillin-resistant Staphylococcus aureus ulcerative keratitis in a Thoroughbred racehorse

We report the first case of methicillin-resistant Staphylococcus aureus (MRSA) keratitis in a racehorse. A 5-year-old mare developed punctate keratitis after racing. The corneal ulcer continued to expand despite ophthalmic antimicrobial therapy. On day 6, a conjunctival graft surgery was performed. The mare was euthanized, following colitis and laminitis development on day 10. MRSA was isolated from the corneal swab taken at the time of euthanasia. Immunohistochemical analysis demonstrated gram-positive and anti-S. aureus monoclonal antibody-positive cocci infiltration of the corneal stroma; and a diagnosis of MRSA ulcerative keratitis was made. An ophthalmic antimicrobial against the isolated MRSA did not improve the ocular lesion. The MRSA strain was found to be staphylococcal cassette chromosome mec type II, a strain frequently isolated from humans in Japan.

Two Different Concentrations of Topical Levofloxacin for the Treatment of Multidrug-Resistant Pseudomonas aeruginosa Keratitis

PURPOSE

To compare the efficacy of topical 1.5% and 0.5% levofloxacin (LVFX) for the treatment of multidrug-resistant Pseudomonas aeruginosa (MDRP) keratitis in rabbits.

METHODS

In a rabbit eye, we produced an MDRP keratitis model by excising a 2-mm circular disc of the cornea up to a depth of one-half of the stromal layer and inoculated an MDRP strain into the corneal concavity. Nine hours after inoculation and after confirming that MDRP keratitis had developed, we treated the eyes topically with 0.5% levofloxacin, 1.5% levofloxacin, or phosphate-buffered saline (PBS) every 6 h until 57 h postinfection. The infected eyes were evaluated by clinical score, histopathological examination, and viable bacterial count (colony forming units).

RESULTS

In the MDRP keratitis model, clinical score was significantly lower in 0.5% and 1.5% levofloxacin-treated groups than in PBS-treated group and was the lowest in 1.5% levofloxacin-treated group. Histopathological examination showed maintenance of corneal translucency and little influx of polymorphonuclear neutrophils in 1.5% levofloxacin-treated group. Viable bacterial count in the infected cornea was significantly lower in 0.5% levofloxacin-treated group compared with PBS-treated group, while no viable bacteria were detected in 1.5% levofloxacin-treated group.

CONCLUSIONS

Using our MDRP keratitis model, we showed that topical 0.5% levofloxacin is not adequately effective, while 1.5% levofloxacin is efficacious in controlling MDRP keratitis.

Prevalence and risk factors for isolation of methicillin-resistant Staphylococcus in dogs with keratitis

OBJECTIVE

To determine the prevalence of, and risk factors for, methicillin-resistant Staphylococcus (MRS) isolation in dogs with naturally acquired bacterial keratitis.

PROCEDURES

All Staphylococcus spp. isolated from corneal samples of dogs with keratitis during a 2-year period were evaluated for methicillin resistance by bacteriologic methods. Each MRS isolate was subjected to in vitro susceptibility testing for systemic and ocular antimicrobials. Nasal swabs for culture were collected from all dogs with MRS corneal isolation to evaluate for nasal carrier status. Potential risk factors for MRS isolation were investigated by medical record review and administration of an epidemiological survey to dog owners. Collected information characterizing animal, client, and environmental variables was analyzed for association with MRS isolation.

RESULTS

Seventy-one Staphylococcus spp. were isolated from seventy individual dogs with keratitis during the study period. Seventeen of the Staphylococcus isolates (23.9%) were methicillin resistant. The MRS isolates included Staphylococcus epidermidis (n = 10), Staphylococcus pseudintermedius (n = 6), and Staphylococcus aureus (n = 1). The MRS corneal isolates displayed extensive antimicrobial resistance. Four dogs (23.5%) with MRS corneal isolates had positive nasal cultures for MRS. Client occupation was significantly (P = 0.01) associated with MRS isolation, and dogs belonging to owners employed in veterinary or human healthcare fields were four times more likely to have MRS keratitis than dogs owned by clients with different professions. There were no significant associations between the other evaluated animal, client, and environmental factors.

CONCLUSIONS

Methicillin resistance is relatively common in Staphylococcus isolates from dogs with corneal infections, particularly among dogs belonging to healthcare workers.