Antimicrobial Susceptibilities of Aerobic Isolates from Respiratory Samples of Young New Zealand Horses

Evaluation of the Bactericidal Effect of Nebulized Silver Nanoparticles on Common Respiratory Bacteria in Horses- In Vitro Studies

Antimicrobial resistance is increasing in both human and veterinary medicine. Bacteria can be part of the etiology of respiratory disorders in horses. Bactericidal activity of silver has been largely described and silver is currently used in veterinary therapeutic applications such as wound dressings. The aim of this study was to assess the in vitro bactericidal effects of nebulized silver nanoparticles (AgNP) on 2 common equine respiratory bacteria, Streptococcus equi subsp. zooepidemicus and Actinobacillus equuli subsp. equuli. Firstly, antimicrobial susceptibility of AgNP was determined over time by turbidity assessment in liquid broth. Secondly, bacterial growth inhibition was tested after instillation or after nebulization of low (100 ppm) and high (500, 1,000 and 2,000 ppm) concentrations of AgNP on agar plate. Both bacteria were susceptible to AgNP, even at dilution 1:4 for A. equuli and 1:8 for S. zooepidemicus after 8 hours of incubation, and 1:256 for both bacteria after 24 hours of incubation. The bacterial growth was partially inhibited at low concentration and completely inhibited at high concentrations of instilled AgNP. The bacterial growth was completely inhibited after nebulization of low concentrations of AgNP for A. equuli and high concentrations of AgNP for S. zooepidemicus. We concluded nebulized AgNP could be a candidate for innovative therapeutic way against bacterial respiratory disorders in horses. Nevertheless, further investigations are required to assess the in vivo potential and toxicity of nebulized AgNP.

Antimicrobial resistance in clinical bacterial isolates from horses in the UK

BACKGROUND

Surveillance of antimicrobial resistance (AMR) in horses is important to aid empirical treatment decisions and highlight emerging AMR threats.

OBJECTIVE

To describe the AMR patterns of common groups of bacteria from clinical submissions from horses in the UK during 2018, and to determine how this varies by sample site and type of submitting veterinary practice.

STUDY DESIGN

Prospective observational study.

METHODS

All data on bacterial culture and subsequent antimicrobial susceptibility testing (AST) collected in 2018 from six large equine diagnostic laboratories were included. Resistance patterns were analysed including resistance to 1 or 2 antimicrobial classes, multidrug resistance (MDR), extensively drug resistant (XDR), resistance to highest priority critically important antimicrobials and isolates where there was no readily available treatment for adult horses in the UK. Submitting practices were classified according to whether they treated referral cases or not (first opinion). Comparisons between proportions and resistance for each bacterial group and sample site was performed using Chi-squared (or Fisher's exact test).

RESULTS

A total of 6,018 bacterial isolates from 4,038 diagnostic submissions were included from respiratory (n = 1555), urogenital (n = 1,010), skin/hair/wound/abscess (n = 753), surgical site infection (SSI) /catheter-related-infection (CRI) /orthopaedic infections (n = 347) and unknown/'other' submissions (n = 373). There were 2,711 Gram-negative isolates and 3,307 Gram-positive isolates. Prevalence of MDR for E. coli was 31.7%, Staphylococcus spp. 25.3% and > 25% for the majority of bacterial isolates from SSI/CRI/orthopaedic submissions. For Enterococcus spp. there was no readily available treatment for adult horses in the UK in 30.2% of positive submissions. MDR was significantly higher from referral hospital than first opinion submissions for the majority of pathogens (except Actinobacillus spp. and Pasteurella spp. and β-haemolytic Streptococcus spp.).

MAIN LIMITATIONS

Since culture and susceptibility results are not systematic analyses based on harmonised methods, selection bias could impact the findings.

CONCLUSIONS

Ongoing surveillance is essential to understand emerging patterns of resistance. MDR is high in SSI/CRI/orthopaedic infections, which is important for hospital biosecurity and guiding treatment decisions. Harmonisation of diagnostic procedures and interpretation of results amongst veterinary laboratories will improve AMR surveillance and data comparison among laboratories.

Cumulative antibiogram and multidrug-resistant organisms in a regional equine referral hospital

Prudent use of antimicrobials is paramount to slow the development of resistance and for successful treatment. The use of cumulative antibiograms will allow evidence-based antimicrobial selection with consideration of local resistance patterns. We generated a "first-isolate-per-patient" cumulative antibiogram for a regional equine referral hospital. Bacterial organisms cultured from horses between 2011 and 2018, sample origin, antimicrobial susceptibilities, and multidrug-resistant (MDR) status were tabulated. Of 1,176 samples, 50% were culture positive. Overall, 93 of 374 (25%) were MDR. Of the MDR isolates, 11 (12%) were susceptible to high-importance antimicrobials only (as defined by the Australian Strategic and Technical Advisory Group on antimicrobial resistance). β-hemolytic streptococci were uniformly susceptible to penicillin (76 of 76); 17 of 20 (85%) non-β-hemolytic Streptococcus spp. were susceptible to penicillin. Despite veterinary-specific challenges in constructing an antibiogram, our study provides an exemplar of the clinical utility of regional-, farm-, or hospital-specific cumulative antibiograms for evidence-based empirical antimicrobial selection by veterinarians prior to susceptibility result availability.

Modification of empirical antimicrobial regimens in large animal medicine

BACKGROUND

Empirical antimicrobial regimens can be modified following new diagnostic information or when empirical treatment fails. Little is known about the frequency or clinical context in which these modifications occur. We characterised these modifications in a large animal hospital to identify when antimicrobial use could be optimised.

METHODS

Chart reviews were performed for all inpatients and outpatients administered antimicrobials at a large animal veterinary referral and teaching hospital in 2017-2018 (n=1163 visits) to determine when and why empirical regimens were modified. Multinomial logistic regression was performed to identify factors associated with reasons for modification.

RESULTS

Empirical antimicrobial regimens were modified in 17.3 per cent of visits. The main reasons were parenteral-oral conversions in horses and failure of disease prevention or treatment in ruminants. Empirical therapy for disease prevention was more likely to be modified because of complications in ruminants and in animals on the emergency/critical care service. Empirical therapy for disease treatment was more often modified for reasons other than de-escalation in ruminants and in animals with longer lengths of stay.

CONCLUSIONS

Empirical antimicrobial regimens were modified infrequently and mostly for purposes of parenteral-oral conversion in horses and lack of response in ruminants. De-escalation of antimicrobials administered for disease treatment, when guided by diagnostics, is a major tenet of judicious antimicrobial use. However, more research is needed to determine when and how antimicrobial regimens administered for disease prevention should be modified.

Use of aminoglycoside antibiotics in equine clinical practice; a questionnaire-based study of current use

Veterinary use of the aminoglycoside antibiotics is under increasing scrutiny. This questionnaire-based study aimed to document the use of aminoglycosides with a particular focus on gentamicin. An online questionnaire was delivered to generalist equine veterinary surgeons and specialists in internal medicine to determine the perceived importance, frequency of use and routes of administration of the aminoglycoside antibiotics. A series of hypothetical scenarios were also evaluated regarding gentamicin. Data were compared to evaluate the impact of the level of specialisation on prescribing practices for different antibiotics using Chi-squared and Fischer's exact tests. Data were analysed from 111 responses. Gentamicin was commonly used empirically without culture and susceptibility testing. Generalists were more likely to use gentamicin only after susceptibility testing than specialists in a variety of clinical presentations including respiratory diseases, septic peritonitis, acute febrile diarrhoea, cellulitis and contaminated limb wounds (p < 0.01). Intravenous administration of gentamicin was most common, although inhaled and regional administration of gentamicin and amikacin were also described. Amikacin was most commonly used by intra-articular administration. Gentamicin was more likely to be used in high-risk procedures or contaminated surgeries (86% and 74%, respectively) compared with clean surgery (32%; p < 0.0001). Gentamicin was often used perioperatively in horses undergoing exploratory celiotomy and more commonly used in horses undergoing an enterotomy (90%) than without and enterotomy (79%; p = 0.04). Most respondents (86%) used gentamicin at a dose of 6.6 mg/kg in adults, with few changing their dosing strategies based on the presence of sepsis, although higher doses were more reported in foals (7-15 mg/kg) irrespective of the presence of sepsis. Aminoglycosides are widely used in equine practice and use outside current EU marketing authorisations is common. Stewardship of the aminoglycoside antibiotics could be enhanced in both generalists and specialists through the more frequent use of susceptibility testing, regional administration and dose adjustment, especially in foals.

Isolates, antimicrobial susceptibility profiles and multidrug resistance of bacteria cultured from samples collected from sheep in New Zealand (2003-2016)

Aim: To describe the common species, antimicrobial susceptibility and multidrug resistance (MDR) of bacteria cultured from samples submitted to veterinary diagnostic laboratories from sheep in New Zealand between 2003 and 2016. Methods: Bacterial culture and antimicrobial susceptibility test data from June 2003 to March 2016 for animals identified as sheep were obtained from two commercial veterinary diagnostic laboratories in New Zealand. Submission information included animal signalment, geographic origin, specimen description, the organisms cultured, and where available, antimicrobial susceptibilities of the isolates. MDR was defined as any isolate with resistance to ≥3 antimicrobial classes. Results: There were 1,971 unique laboratory submissions, yielding 2,188 isolates. Of the 1,971 submissions, the most commonly represented breeds were Romney (933; 47.3%), Romney cross (264; 13.4%), and Coopworth (197; 10.0%), and there were more submissions from females (1,006; 51.0%) than males (184; 9.3%). Most submissions were from Canterbury (549; 27.9%), Southland (471; 23.9%), and Manawatu-Wanganui (272; 13.8%) regions. Other signalment data were inconsistently described. Submitted samples most commonly originated from the gastrointestinal tract (852; 43.2%), faeces (378; 12.1%), or liver (146; 7.4%). Of the 2,188 isolates, 1,771 (80.9%) were identified by species and 247 (11.4%) by genus, with the most common isolates being Salmonella spp. (880; 40.2%), Campylobacter spp. (408; 18.6%), Listeria spp. (140; 6.4%) and Yersinia spp. (113; 5.2%). Susceptibility results were available for 117/2,188 (5.3%) isolates from 51/1,971 (2.6%) submissions. No antimicrobial susceptibility data were available for Salmonella spp., Campylobacter spp., Listeria spp. or Yersinia spp. Overall for the isolates tested, susceptibility to the fluoroquinolones and tetracyclines was greatest, and MDR was found in 24/117 (20.5%) isolates. MDR was a more frequent finding for Enterococcus spp., Bacillus spp., and Proteus mirabilis, but was infrequent in isolates of Staphylococcus aureus, alpha-haemolytic streptococci, Escherichia coli or Enterobacter spp. Conclusions and clinical relevance: This is the first report on antimicrobial susceptibility and MDR for isolates from laboratory submissions from sheep in New Zealand. The low numbers of isolates submitted for antimicrobial susceptibility testing during the period studied mean that these findings provide limited insights into antimicrobial resistance in this population, and highlight the need to address significant gaps in our understanding of why veterinarians do not more frequently submit samples from sheep for bacterial culture and susceptibility testing. Abbreviation: AMR: Antimicrobial resistance; MDR: Multidrug resistance.

Antimicrobial susceptibility of bacterial isolates from 33 thoroughbred horses with arytenoid chondropathy (2005-2019)

OBJECTIVE

To describe the prevalence and antimicrobial susceptibility of bacterial isolates cultured from surgical specimens of infected arytenoid cartilage and granulomas.

STUDY DESIGN

Retrospective cohort study.

ANIMALS

Thirty-three thoroughbred horses.

METHODS

Hospital records were retrieved for all horses admitted to a referral hospital for arytenoid chondropathy surgery that had samples submitted for culture and sensitivity between 2005 and 2019. Descriptive analyses were performed.

RESULTS

In total, 56 bacterial isolates were obtained. Gram-positive bacteria (58%), Gram-negative bacteria (54%), and anaerobes (33%) were cultured from samples. Fifty-eight percent of horses had multiple bacteria isolated. Streptococcus spp were the most common (32%), followed by Enterobacteriaceae (13%). Bacterial isolates were sensitive to ceftiofur (83%), followed by ampicillin (64%), tetracycline (48%), enrofloxacin (45%), trimethoprim-sulfamethoxazole (41%), and gentamicin (18%). Multidrug resistance (MDR) was present in 44% of bacterial isolates.

CONCLUSION

A wide variety of bacteria was cultured, providing evidence that secondary opportunistic infection by common respiratory bacteria is likely a factor in arytenoid chondropathy. Multidrug resistance was higher than what has been previously reported in equine respiratory samples. Trimethoprim-sulfamethoxazole had low effectiveness.

CLINICAL SIGNIFICANCE

Because culture and sensitivity testing is not available in the diagnosis of mild to moderate arytenoid chondropathy, the information from this study may allow for more targeted broad-spectrum antimicrobial treatment to limit disease progression when the disease is first identified. The antimicrobial susceptibilities and MDR found in this study emphasize the importance of following current antimicrobial guidelines and highlight the requirement for surgical intervention rather than continued medical treatment in cases that do not resolve with initial antimicrobial therapy.

Bacterial isolates, antimicrobial susceptibility and multidrug resistance in cultures from samples collected from beef and pre-production dairy cattle in New Zealand (2003-2016)

Aims: To describe the common species and the antimicrobial susceptibility of bacteria cultured from samples submitted to commercial veterinary diagnostic laboratories from beef and pre-production dairy cattle between 2003-2016, and to describe the proportion of isolates with multidrug resistance (MDR). Methods: Bacterial culture and antimicrobial susceptibility data from July 2003 to March 2016 were obtained from commercial veterinary diagnostic laboratories in New Zealand. Results were included from samples from beef cattle, irrespective of age or sex, dairy-breed females aged <2 years and dairy-breed males of any age. Submission information provided included the specimen description, the organisms cultured, and the antimicrobial susceptibilities of isolates, if tested. Antimicrobial resistance (AMR) was defined as any isolate not showing susceptibility to an antimicrobial compound and MDR as any isolate showing AMR to ≥3 antimicrobial classes. Results: There were 1,858 unique laboratory submissions, yielding 2,739 isolates. Of these submissions, most were from the Canterbury (389; 21.9%), Manawatu (388; 21.9%) Waikato (231; 12.4%) and Hawke's Bay (136; 7.3%) regions. There were 163 unique species identifications for the 2,739 isolates; the most common were Yersinia pseudotuberculosis (452; 16.5%), Campylobacter jejuni (249; 9.1%), Escherichia coli (230; 8.4%) and Salmonella enterica serovar Typhimurium (143; 5.2%). Only 251/2,739 (9.2%) isolates from 122/1,858 (6.6%) submissions had antimicrobial susceptibility results. There were no sensitivity results for Yersinia spp., and only one each for Salmonella spp., and Campylobacter spp. Amongst the isolates tested, susceptibility to ampicillin was lowest (33/56; 58.9%). Overall, 57/251 (20.7%) isolates tested for antimicrobial susceptibility had MDR, and MDR was most common for Enterococcus spp. (12/17; 71%) and E. coli (13/30; 43%). Conclusions and Clinical Relevance: This is the first report on antimicrobial susceptibility and MDR in New Zealand beef and pre-production dairy cattle. Findings highlight the limited use of bacterial culture and sensitivity testing by veterinarians and deficits in the information accompanying submissions. A national antimicrobial resistance surveillance strategy that specifically includes this population is recommended.

An epidemiologic study of antimicrobial resistance of Staphylococcus species isolated from equine samples submitted to a diagnostic laboratory

Background

Antimicrobial resistance limits traditional treatment options and increases costs. It is therefore important to estimate the magnitude of the problem so as to provide empirical data to guide control efforts. The aim of this study was to investigate the burden and patterns of antimicrobial resistance (AMR) among equine Staphylococcus samples submitted to the University of Kentucky Veterinary Diagnostic Laboratory (UKVDL) from 1993 to 2009. Retrospective data of 1711 equine Staphylococcus samples submitted to the UKVDL during the time period 1993 to 2009 were included in the study. Antimicrobial susceptibility testing, that included 16 drugs, were performed using cultures followed by the Kirby-Bauer disk diffusion susceptibility test. The proportion of resistant isolates by animal breed, species of organism, sample source, and time period were computed. Chi-square and Cochran-Armitage trend tests were used to identify significant associations and temporal trends, respectively. Logistic regression models were used to investigate predictors of AMR and multidrug resistance (MDR).

Results

A total of 66.3% of the isolates were resistant to at least one antimicrobial, most of which were Staphylococcus aureus (77.1%), while 25.0% were MDR. The highest level of resistance was to penicillins (52.9%). Among drug classes, isolates had the highest rate of AMR to at least one type of β-lactams (49.2%), followed by aminoglycosides (30.2%). Significant (p < 0.05) associations were observed between odds of AMR and horse breed, species of organism and year. Similarly, significant (p < 0.05) associations were identified between odds of MDR and breed and age. While some isolates had resistance to up to 12 antimicrobials, AMR profiles featuring single antimicrobials such as penicillin were more common than those with multiple antimicrobials.

Conclusion

Demographic factors were significant predictors of AMR and MDR. The fact that some isolates had resistance to up to 12 of the 16 antimicrobials assessed is quite concerning. To address the high levels of AMR and MDR observed in this study, future studies will need to focus on antimicrobial prescription practices and education of both practitioners and animal owners on judicious use of antimicrobials to slow down the development of resistance.

Prevalence of antimicrobial resistance from bacterial culture and susceptibility records from horse samples in South Africa

The continuous increase in prevalence of antimicrobial resistant bacteria presents a significant public health problem and is an indicator that antimicrobial prudent usage guidelines are not being followed, especially in developing countries. Despite trends being available from numerous countries, there is little published for South Africa. This study was aimed at estimating the prevalence and trends of antimicrobial resistance from bacterial isolates from equine clinical samples submitted for culture and susceptibility testing to the veterinary bacteriology laboratory of the University of Pretoria. The study covered a period of seven years from 2007. A total of 1505 bacterial isolates were included in this study comprising isolates from 2007 (n=447); 2008 (n=285); 2009 (n=258); 2010 (n=102); 2011 (n=89); 2012 (n=248) and 2013 (n=76). For this study, multiple drug resistance was above 50% for all the isolates. The Cochran-Armitage test showed evidence of a significantly increasing trend in prevalence of resistance to several antimicrobial agents, including amikacin (E. coli, Staphylococcus), AMX/AMP (Corynebacteria, Lactobacillus and Salmonella), chloramphenicol (Enterococcus, E. coli, Pseudomonas, Streptococcus, Staphylococcus and Salmonella), enrofloxacin (E. coli, Staphylococcus, Salmonella and Pseudomonas) and gentamicin (Salmonella, Staphylococcus). The data obtained from this study is relevant to equine practitioners, as it helps enhance the body of veterinary knowledge pertaining to antimicrobial resistance in common equine pathogens in South Africa.