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Putriningsih PAS, Kampa J, Jittimanee S, Phuektes P. Characterization of Oxacillin-Resistant and Oxacillin-Susceptible mecA-Positive Staphylococcus pseudintermedius from Skin Lesions and Nasal Cavities of Dogs with Clinical Pyoderma. Animals (Basel) 2024; 14:2613. [PMID: 39272398 PMCID: PMC11394641 DOI: 10.3390/ani14172613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 09/02/2024] [Accepted: 09/04/2024] [Indexed: 09/15/2024] Open
Abstract
Understanding the epidemiology of mecA-positive Staphylococcus pseudintermedius strains, including those that are oxacillin-susceptible but potentially inducible to resistance, is crucial for developing effective treatment strategies and mitigating public health risks. This study characterized 87 mecA-positive S. pseudintermedius isolates obtained from skin lesions and nasal orifices of 46 dogs with pyoderma enrolled at a referral hospital in Thailand between 2019 and 2020. All isolates underwent antibiogram profiling, SCCmec typing, and pulsed-field gel electrophoresis (PFGE) for phenotypic and genetic analysis. Among the 87 isolates, 33 isolates (37.9%) recovered from 15 dogs were oxacillin-resistant (OR-MRSP), while 54 isolates (62.1%) from 31 dogs were oxacillin-susceptible (OS-MRSP). All OR-MRSP isolates exhibited multidrug resistance (MDR), and 44% of the OS-MRSP isolates also showed MDR. SCCmec typing revealed type V as predominant among OR-MRSP isolates (69.7%), while many oxacillin-susceptible isolates (70.4%) were non-typeable. The OR-MRSP isolates from the same dog showed consistent antibiogram and SCCmec types, while OS-MRSP isolates displayed both identical and diverse patterns. No dominant pulsotypes were observed among the OR-MRSP or OS-MRSP strains. Genetic diversity was also noted among the isolates within the same dogs and among the others, highlighting the complexity of S. pseudintermedius colonization and infection dynamics in pyoderma-affected dogs.
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Affiliation(s)
- Putu Ayu Sisyawati Putriningsih
- Graduate School, Faculty of Veterinary Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Medicine, Udayana University, Denpasar 80361, Indonesia
| | - Jaruwan Kampa
- Division of Pathobiology, Faculty of Veterinary Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Suphattra Jittimanee
- Division of Pathobiology, Faculty of Veterinary Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Patchara Phuektes
- Division of Pathobiology, Faculty of Veterinary Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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Roberts E, Nuttall TJ, Gkekas G, Mellanby RJ, Fitzgerald JR, Paterson GK. Not just in man's best friend: A review of Staphylococcus pseudintermedius host range and human zoonosis. Res Vet Sci 2024; 174:105305. [PMID: 38805894 DOI: 10.1016/j.rvsc.2024.105305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
Staphylococcus pseudintermedius is one species in the commensal staphylococcal population in dogs. While it is commonly carried on healthy companion dogs it is also an opportunistic pathogen associated with a range of skin, ear, wound and other infections. While adapted to dogs, it is not restricted to them, and we have reviewed its host range, including increasing reports of human colonisation and infections. Despite its association with pet dogs, S. pseudintermedius is found widely in animals, covering companion, livestock and free-living species of birds and mammals. Human infections, typically in immunocompromised individuals, are increasingly being recognised, in part due to improved diagnosis. Colonisation, infection, and antimicrobial resistance, including frequent multidrug resistance, among S. pseudintermedius isolates represent important One Health challenges.
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Affiliation(s)
- E Roberts
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - T J Nuttall
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - G Gkekas
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - R J Mellanby
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - J R Fitzgerald
- The Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - G K Paterson
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom.
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Santana JA, Paraguassu AO, Santana RST, Xavier RGC, Freitas PMC, Aburjaile FF, Azevedo VADC, Brenig B, Bojesen AM, Silva ROS. Risk Factors, Genetic Diversity, and Antimicrobial Resistance of Staphylococcus spp. Isolates in Dogs Admitted to an Intensive Care Unit of a Veterinary Hospital. Antibiotics (Basel) 2023; 12:antibiotics12030621. [PMID: 36978487 PMCID: PMC10045350 DOI: 10.3390/antibiotics12030621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Intensive Care Units (ICU) usually provide an excellent environment for the selection of pathogens associated with hospital-acquired infections (HAI), leading to increased mortality and hospitalization costs. Methicillin-resistant Staphylococcus pseudintermedius (MRSP) is a major cause of HAI in dogs worldwide, but the risk factors and dynamics of colonization by MRSP are largely unknown. This study aimed to evaluate the risk factors associated with the acquisition of MRSP in dogs admitted to an ICU, and to report the antimicrobial resistance profiles and genetic relatedness of MRSP isolates. Sterile swabs from the nostril, axilla, and rectum were collected daily during the hospitalization of 54 dogs. Samples were subjected to Mannitol Salt Agar, and colonies were identified by MALDI-ToF, polymerase chain reaction (PCR), and sequencing of the rpoB gene. Antimicrobial susceptibility testing and PCR detection of mecA were performed. Staphylococcus spp. was isolated from 94% of the dogs, and the most frequently isolated species was S. pseudintermedius (88.2%). Carriage of multidrug resistant (MDR) staphylococci was observed in 64.4% of the dogs, and approximately 39% had methicillin-resistant Staphylococcus sp. (MRS), of which 21.6% had MRSP and 1.9% had methicillin-resistant S. aureus (MRSA). The acquisition of MRSP during ICU hospitalization was associated with sex (female), age (>7 years), and dogs that had previously been treated with antimicrobials. Animals colonized by MRSP resistant to ≥9 antimicrobial classes had longer hospital stays than those colonized by other MRS strains. Among the 13 MRSP isolates that were subjected to whole-genome sequencing, ten were classified as ST71. A single nucleotide polymorphism (SNP) analysis revealed three clones, including one that was detected in infected dogs outside the ICU. This study indicates novel risk factors associated with colonization by MRSP. The detection of the same MRSP clone causing HAI outside the ICU reinforces the need for improved infection prevention and control practices at veterinary hospitals in general and at the ICU in particular.
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Affiliation(s)
- Jordana Almeida Santana
- Departamento de Medicina Veterinária Preventiva, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 30720440, Brazil
| | - Amanda Oliveira Paraguassu
- Departamento de Medicina Veterinária Preventiva, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 30720440, Brazil
| | | | - Rafael Gariglio Clark Xavier
- Departamento de Medicina Veterinária Preventiva, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 30720440, Brazil
| | - Patricia Maria Colleto Freitas
- Departamento de Medicina Veterinária Preventiva, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 30720440, Brazil
| | - Flavia Figueira Aburjaile
- Departamento de Medicina Veterinária Preventiva, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 30720440, Brazil
| | | | - Bertram Brenig
- Institute of Veterinary Medicine, University of Göttingen, 37077 Göttingen, Germany
| | - Anders Miki Bojesen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2820 Copenhagen, Denmark
| | - Rodrigo Otávio Silveira Silva
- Departamento de Medicina Veterinária Preventiva, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 30720440, Brazil
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Khairullah AR, Sudjarwo SA, Effendi MH, Ramandinianto SC, Gelolodo MA, Widodo A, Riwu KHP, Kurniawati DA. Pet animals as reservoirs for spreading methicillin-resistant Staphylococcus aureus to human health. J Adv Vet Anim Res 2023; 10:1-13. [PMID: 37155545 PMCID: PMC10122942 DOI: 10.5455/javar.2023.j641] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 11/08/2022] [Accepted: 11/15/2022] [Indexed: 05/10/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a strain of pathogenic bacteria that is a major problem in the world's health. Due to their frequent interaction with humans, pets are one of the main risk factors for the spread of MRSA. The possibility for zoonotic transmission exists since frequently kept dogs and cats are prone to contract MRSA and act as reservoirs for spreading MRSA. The mouth, nose, and perineum are the primary locations of MRSA colonization, according to the findings of MRSA identification tests conducted on pets. The types of MRSA clones identified in cats and dogs correlated with MRSA clones infecting humans living in the same geographic area. A significant risk factor for the colonization or transmission of MRSA is human-pet contact. An essential step in preventing the spread of MRSA from humans to animals and from animals to humans is to keep hands, clothing, and floor surfaces clean.
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Affiliation(s)
- Aswin Rafif Khairullah
- Doctoral Program in Veterinary Science, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Sri Agus Sudjarwo
- Department of Veterinary Pharmacology, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Mustofa Helmi Effendi
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Maria Aega Gelolodo
- Department of Animal Infectious Diseases and Veterinary Public Health, Faculty of Medicine and Veterinary Medicine, Universitas Nusa Cendana, Kupang, Indonesia
| | - Agus Widodo
- Doctoral Program in Veterinary Science, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
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Moses IB, Santos FF, Gales AC. Human Colonization and Infection by Staphylococcus pseudintermedius: An Emerging and Underestimated Zoonotic Pathogen. Microorganisms 2023; 11:microorganisms11030581. [PMID: 36985155 PMCID: PMC10057476 DOI: 10.3390/microorganisms11030581] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
S. pseudintermedius is a known resident of the skin and mucous membranes and a constituent of the normal microbiota of dogs. It has also been recognized as an opportunistic and zoonotic pathogen that is able to colonize humans and cause severe diseases, especially in immunocompromised hosts. Most importantly, methicillin-resistant S. pseudintermedius (MRSP), which is intrinsically multidrug-resistant, has emerged with serious public health consequences. The epidemiological situation is further exacerbated with reports of its zoonotic transmission and human infections which have been mostly attributed to the increasing frequency of dog ownership and close contact between dogs and humans. Evidence on the zoonotic transmission of MRSP from pet dogs to humans (such as dog owners, small-animal veterinarians, and other people in close proximity to dogs) is limited, especially due to the misidentification of S. pseudintermedius as S. aureus. Despite this fact, reports on the increasing emergence and spread of MRSP in humans have been increasing steadily over the years since its first documented report in 2006 in Belgium. The emergence of MRSP strains has further compromised treatment outcomes in both veterinary and human medicine as these strains are resistant to beta-lactam antimicrobials usually prescribed as first line treatment. Frustratingly, the limited awareness and surveillance of the zoonotic transmission of S. pseudintermedius have underestimated their extent of transmission, prevalence, epidemiology, and public health significance. In order to fill this gap of information, this review focused on detailed reports on zoonotic transmission, human colonization, and infections by S. pseudintermedius, their pathogenic features, antimicrobial resistance profiles, epidemiology, risk factors, and treatment. In writing this review, we searched Web of Science, PubMed, and SCOPUS databases using the keyword “Staphylococcus pseudintermedius AND humans”. A phylogenetic tree to determine the genetic relatedness/diversity of publicly available genomes of S. pseudintermedius was also constructed.
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Affiliation(s)
- Ikechukwu Benjamin Moses
- Department of Internal Medicine, Division of Infectious Diseases, Escola Paulista de Medicina/Universidade Federal de São Paulo, Universidade Federal de São Paulo–UNIFESP, São Paulo 04039-032, Brazil
- Department of Applied Microbiology, Faculty of Sciences, Ebonyi State University, Abakaliki PMB 053, Nigeria
| | - Fernanda Fernandes Santos
- Department of Internal Medicine, Division of Infectious Diseases, Escola Paulista de Medicina/Universidade Federal de São Paulo, Universidade Federal de São Paulo–UNIFESP, São Paulo 04039-032, Brazil
| | - Ana Cristina Gales
- Department of Internal Medicine, Division of Infectious Diseases, Escola Paulista de Medicina/Universidade Federal de São Paulo, Universidade Federal de São Paulo–UNIFESP, São Paulo 04039-032, Brazil
- Correspondence:
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Sebola DC, Oguttu JW, Kock MM, Qekwana DN. Hospital-acquired and zoonotic bacteria from a veterinary hospital and their associated antimicrobial-susceptibility profiles: A systematic review. Front Vet Sci 2023; 9:1087052. [PMID: 36699325 PMCID: PMC9868922 DOI: 10.3389/fvets.2022.1087052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Background Hospital-acquired infections (HAIs) are associated with increased mortality, morbidity, and an economic burden due to costs associated with extended hospital stays. Furthermore, most pathogens associated with HAIs in veterinary medicine are zoonotic. This study used published data to identify organisms associated with HAIs and zoonosis in veterinary medicine. Furthermore, the study also investigated the antimicrobial-susceptibility profile of these bacterial organisms. Methods A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Search terms and five electronic databases were used to identify studies published over 20 years (2000-2020). The risk of bias was assessed using the "Strengthening the Reporting of Observational Studies in Epidemiology-Vet" (STROBE-Vet) checklist. Results Out of the identified 628 papers, 27 met the inclusion criteria for this study. Most studies (63%, 17/27) included were either from small animal or companion animal clinics/hospitals, while 5% (4/27) were from large animal clinics/hospitals inclusive of bovine and equine hospitals. Hospital-acquired bacteria were reported from environmental surfaces (33%, 9/27), animal clinical cases (29.6%, 8/27), and fomites such as cell phones, clippers, stethoscopes, and computers (14.8%, 4/27). Staphylococcus spp. was the most (63%; 17/27) reported organism, followed by Escherichia coli (19%; 5/27), Enterococcus spp. (15%, 4/27), Salmonella spp. (15%; 4/27), Acinetobacter baumannii (15%, 4/27), Clostridioides difficile (4%, 1/27), and Pseudomonas aeruginosa (4%; 1/27). Multidrug-resistant (MDR) organisms were reported in 71% (12/17) of studies linked to Methicillin-resistant Staphylococcus aureus (MRSA), Methicillin-resistant Staphylococcus pseudintermedius (MRSP), Enterococcus spp., Salmonella Typhimurium, A. baumannii, and E. coli. The mecA gene was identified in both MRSA and MRSP, the blaCMY-2 gene in E. coli and Salmonella spp., and the vanA gene in E. faecium isolate. Six studies reported organisms from animals with similar clonal lineage to those reported in human isolates. Conclusion Organisms associated with hospital-acquired infections and zoonosis have been reported from clinical cases, environmental surfaces, and items used during patient treatment and care. Staphylococcus species is the most reported organism in cases of HAIs and some isolates shared similar clonal lineage to those reported in humans. Some organisms associated with HAIs exhibit a high level of resistance and contain genes associated with antibiotic resistance.
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Affiliation(s)
- Dikeledi C. Sebola
- Section Veterinary Public Health, Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - James W. Oguttu
- Department of Agriculture and Animal Health, College of Agriculture and Environmental Sciences, University of South Africa, Johannesburg, South Africa
| | - Marleen M. Kock
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa,Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
| | - Daniel N. Qekwana
- Section Veterinary Public Health, Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa,*Correspondence: Daniel N. Qekwana ✉
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Takeuchi H, Nakajima C, Konnai S, Maekawa N, Okagawa T, Usui M, Tamura Y, Suzuki Y, Murata S, Ohashi K. Characterization of SpsQ from Staphylococcus pseudintermedius as an affinity chromatography ligand for canine therapeutic antibodies. PLoS One 2023; 18:e0281171. [PMID: 36701408 PMCID: PMC9879442 DOI: 10.1371/journal.pone.0281171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
Coagulase-positive Staphylococci express protein A, which binds to host antibodies, to evade the immune system. Taking advantage of its specific binding to antibodies, protein A from Staphylococcus aureus, which is called SpA, is commonly used as an affinity chromatography ligand for human therapeutic antibodies. However, among four canine IgG subclasses (A, B, C, and D), only IgG-B binds to SpA strongly and establishing an efficient and robust purification scheme for canine therapeutic antibodies whose IgG subclass is A, C, or D remains difficult and depends on finding a suitable substitute to SpA. S. pseudintermedius, a major coagulase-positive Staphylococci found in dogs, expresses spsQ gene which is orthologous to S. aureus spa. We hypothesized that to serve S. pseudintermedius to better adapt to the dog immune system, SpsQ would bind to canine IgGs stronger than SpA, making it a better affinity chromatography ligand for canine therapeutic antibodies. To characterize SpsQ, we first determined the spsQ nucleotide sequence from S. pseudintermedius isolates. Based on the identified sequence, we prepared recombinant proteins containing the immunoglobulin-binding domains of SpA (r-SpA) and SpsQ (r-SpsQ) and determined their binding capacity for each canine IgG subclass. The binding capacity of r-SpsQ for IgG-B was almost as high as that of r-SpA. Interestingly, while both r-SpsQ and r-SpA showed no binding to IgG-C, the binding capacity of r-SpsQ for IgG-A and IgG-D was significantly higher than that of r-SpA. Finally, we performed affinity chromatography using r-SpsQ- or r-SpA-immobilized resin and revealed that the recovery rates of IgG-A and IgG-D using r-SpsQ were significantly higher than those using r-SpA. Our findings indicate that SpsQ has a strong potential to be used as an affinity chromatography ligand for canine therapeutic antibodies of subclass A, B, and D.
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Affiliation(s)
- Hiroto Takeuchi
- Faculty of Veterinary Medicine, Department of Disease Control, Hokkaido University, Sapporo, Japan
| | - Chie Nakajima
- Faculty of Veterinary Medicine, Department of Advanced Pharmaceutics, Hokkaido University, Sapporo, Japan
- Division of Bioresources, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
- Institute for Vaccine Research and Development (HU-IVReD), Hokkaido University, Sapporo, Japan
| | - Satoru Konnai
- Faculty of Veterinary Medicine, Department of Disease Control, Hokkaido University, Sapporo, Japan
- Faculty of Veterinary Medicine, Department of Advanced Pharmaceutics, Hokkaido University, Sapporo, Japan
- Institute for Vaccine Research and Development (HU-IVReD), Hokkaido University, Sapporo, Japan
| | - Naoya Maekawa
- Faculty of Veterinary Medicine, Department of Advanced Pharmaceutics, Hokkaido University, Sapporo, Japan
| | - Tomohiro Okagawa
- Faculty of Veterinary Medicine, Department of Advanced Pharmaceutics, Hokkaido University, Sapporo, Japan
| | - Masaru Usui
- Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Yutaka Tamura
- Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Yasuhiko Suzuki
- Faculty of Veterinary Medicine, Department of Advanced Pharmaceutics, Hokkaido University, Sapporo, Japan
- Division of Bioresources, International Institute for Zoonosis Control, Hokkaido University, Sapporo, Japan
- Institute for Vaccine Research and Development (HU-IVReD), Hokkaido University, Sapporo, Japan
| | - Shiro Murata
- Faculty of Veterinary Medicine, Department of Disease Control, Hokkaido University, Sapporo, Japan
- Faculty of Veterinary Medicine, Department of Advanced Pharmaceutics, Hokkaido University, Sapporo, Japan
| | - Kazuhiko Ohashi
- Faculty of Veterinary Medicine, Department of Disease Control, Hokkaido University, Sapporo, Japan
- Faculty of Veterinary Medicine, Department of Advanced Pharmaceutics, Hokkaido University, Sapporo, Japan
- Faculty of Veterinary Medicine, International Affairs Office, Hokkaido University, Sapporo, Japan
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Biological properties of Staphylococcus virus ΦSA012 for phage therapy. Sci Rep 2022; 12:21297. [PMID: 36494564 PMCID: PMC9734660 DOI: 10.1038/s41598-022-25352-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
Staphylococcus virus ΦSA012 has a wide host range and efficient lytic activity. Here, we assessed the biological stability of ΦSA012 against temperature, freeze-thawing, and pH to clinically apply the phage. In addition, inoculation of ΦSA012 through i.p. and i.v. injections into mice revealed that phages were reached the limit of detection in serum and accumulated notably spleens without inflammation at 48 h post-inoculation. Furthermore, inoculation of ΦSA012 through s.c. injections in mice significantly induced IgG, which possesses neutralizing activity against ΦSA012 and other Staphylococcus viruses, ΦSA039 and ΦMR003, but not Pseudomonas viruses ΦS12-3 and ΦR18 or Escherichia viruses T1, T4, and T7 in vitro. Immunoelectron microscopic analysis showed that purified anti-phage IgG recognizes the long-tail fiber of staphylococcus viruses. Although S. aureus inoculation resulted in a 25% survival rate in a mouse i.p. model, ΦSA012 inoculation (i.p.) improved the survival rate to 75%; however, the survival rate of ΦSA012-immunized mice decreased to less than non-immunized mice with phage i.v. injection at a MOI of 100. These results indicated that ΦSA012 possesses promise for use against staphylococcal infections but we should carefully address the appropriate dose and periods of phage administration. Our findings facilitate understandings of staphylococcus viruses for phage therapy.
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Glajzner P, Szewczyk EM, Szemraj M. Pathogenic potential and antimicrobial resistance of Staphylococcus pseudintermedius isolated from human and animals. Folia Microbiol (Praha) 2022; 68:231-243. [PMID: 36221001 PMCID: PMC10104922 DOI: 10.1007/s12223-022-01007-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/23/2022] [Indexed: 11/04/2022]
Abstract
Crossing of interspecies barriers by microorganisms is observed. In recent years, Staphylococcus pseudintermedius-a species formerly thought to be animal-has also been isolated from human clinical materials. Many virulence factors are responsible for the colonization, which is the first step an infection, of the new host organism. We analyzed the factors influencing this colonization as well as susceptibility to antibiotics in fourteen S. pseudintermedius strains isolated from clinical cases from humans and animals. The occurrence of genes responsible for binding elastin, fibronectin, and fibrinogen and some phenotypic features, although different between strains, is comparable in both groups. However, the animal isolates had more genes coding for virulence factors. All isolates tested had the exfoliating toxin gene and the leukotoxin determining genes, but only the human strains had enterotoxin genes. The assessment of antibiotic resistance of strains of both groups indicates their broad resistance to antibiotics commonly used in veterinary medicine. Antibiotic resistance was more common among animal isolates. The multilocus sequence typing analysis of the studied strains was performed. The results indicated a large diversity of the S. pseudintermedius population in both studied groups of strains. Equipped with important virulence factors, they showed the ability to infect animals and humans. The clonal differentiation of the methicillin-susceptible strains and the multidrug resistance of the strains of both studied groups should be emphasized. The considerable genetic diversity of strains from a limited geographical area indicates the processes of change taking place within this species. Thus, careful observation of the ongoing process of variation is necessary, as they may lead to the selection of S. pseudintermedius, which will pose a significant threat to humans.
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Affiliation(s)
- Paulina Glajzner
- Department of Pharmaceutical Microbiology and Microbiological Diagnostics, Medical University of Lodz, ul. Muszyńskiego 1, 90-001, Lodz, Poland
| | - Eligia M Szewczyk
- Department of Pharmaceutical Microbiology and Microbiological Diagnostics, Medical University of Lodz, ul. Muszyńskiego 1, 90-001, Lodz, Poland
| | - Magdalena Szemraj
- Department of Pharmaceutical Microbiology and Microbiological Diagnostics, Medical University of Lodz, ul. Muszyńskiego 1, 90-001, Lodz, Poland.
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Fungwithaya P, Sontigun N, Boonhoh W, Boonchuay K, Wongtawan T. Antimicrobial resistance in Staphylococcus pseudintermedius on the environmental surfaces of a recently constructed veterinary hospital in Southern Thailand. Vet World 2022; 15:1087-1096. [PMID: 35698521 PMCID: PMC9178593 DOI: 10.14202/vetworld.2022.1087-1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Aim: Staphylococcus pseudintermedius is a zoonotic bacterium commonly found in animals, especially dogs. These bacteria can survive on environmental surfaces for several months. The infection of S. pseudintermedius from the environment is possible, but properly cleaning surface objects can prevent it. This study aimed to investigate the prevalence of methicillin-resistant S. pseudintermedius (MRSP) in the environment of a recently constructed veterinary hospital in Southern Thailand, where we hypothesized that the prevalence of MRSP might be very low. Materials and Methods: At three different time points, 150 samples were collected from different environmental surfaces and wastewater across the veterinary hospital. The collection was done after the hospital’s cleaning. Bacteria were purified in the culture before being identified as species by biochemical tests and polymerase chain reaction (PCR). Next, the antimicrobial-resistant profile was performed using an automated system (Vitek 2). Finally, the antimicrobial resistance genes were identified using PCR. Results: Fifteen colonies of S. pseudintermedius were isolated from the surfaces of eight floors, four tables, two chairs, and one rebreathing tube. Fourteen colonies (93.3%) were multidrug-resistant (MDR) and carried the blaZ gene (93.3%). The majority of colonies were resistant to benzylpenicillin (93.3%), cefovecin (93.3%), ceftiofur (93.3%), kanamycin (93.3%), and neomycin (93.3%). Notably, only four colonies (26.7%) were methicillin-susceptible S. pseudintermedius, whereas 11 colonies (73.3%) were MRSP and carried both the mecA and blaZ genes. Five MRSP (45.5%) were resistant to at least 14 antimicrobial drugs, represented as extensively drug-resistant (XDR) bacteria. Ten of eleven MRSP (90.9%) were Staphylococcal chromosomal mec type V, while another displayed untypeable. Despite the routine and extensive cleaning with detergent and disinfectant, MRSP isolates were still detectable. Conclusion: Many isolates of MRSP were found in this veterinary hospital. Almost all of them were MDR, and nearly half were XDR, posing a threat to animals and humans. In addition, the current hospital cleaning procedure proved ineffective. Future research should be conducted to determine the bacterial biofilm properties and bacterial sensitivity to certain detergents and disinfectants.
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Affiliation(s)
- Punpichaya Fungwithaya
- Centre of Excellence Research for Melioidosis and other Microorganism, Walailak University, Nakhon Si Thammarat 80160, Thailand; Centre for One Health, Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Narin Sontigun
- Centre of Excellence Research for Melioidosis and other Microorganism; Walailak University, Nakhon Si Thammarat 80160, Thailand; Centre for One Health, Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Worakan Boonhoh
- Centre for One Health, Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Kanpapat Boonchuay
- Centre for One Health, Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Tuempong Wongtawan
- Centre of Excellence Research for Melioidosis and other Microorganism, Walailak University, Nakhon Si Thammarat 80160, Thailand; Centre for One Health, Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand
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11
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Marco-Fuertes A, Marin C, Lorenzo-Rebenaque L, Vega S, Montoro-Dasi L. Antimicrobial Resistance in Companion Animals: A New Challenge for the One Health Approach in the European Union. Vet Sci 2022; 9:208. [PMID: 35622736 PMCID: PMC9146952 DOI: 10.3390/vetsci9050208] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
Antimicrobial resistance (AMR) and the increase in multi-resistant bacteria are among the most important threats to public health worldwide, according to the World Health Organisation (WHO). Moreover, this issue is underpinned by the One Health perspective, due to the ability of AMR to be transmitted between animals and humans living in the same environment. Therefore, since 2014 different surveillance and control programmes have been established to control AMR in commensal and zoonotic bacteria in production animals. However, public health authorities' reports on AMR leave out companion animals, due to the lack of national programmes and data collection by countries. This missing information constitutes a serious public health concern due to the close contact between companion animals, humans and their surrounding environment. This absence of control and harmonisation between programmes in European countries leads to the ineffectiveness of antibiotics against common diseases. Thus, there is a pressing need to establish adequate surveillance and monitoring programmes for AMR in companion animals and further develop alternatives to antibiotic use in this sector, considering the impact this could have on the gut microbiota. In this context, the aim of this review is to evaluate the current control and epidemiological situations of AMR in companion animals in the European Union (EU), as well as the proposed alternatives to antibiotics.
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Affiliation(s)
| | | | | | - Santiago Vega
- Departamento de Producción y Sanidad Animal, Salud Pública Veterinaria y Ciencia y Tecnología de los Alimentos, Instituto de Ciencias Biomédicas, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, Avenida Seminario s/n, 46113 Moncada, Spain; (A.M.-F.); (C.M.); (L.L.-R.); (L.M.-D.)
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12
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Abusleme F, Galarce N, Quezada-Aguiluz M, Iragüen D, González-Rocha G. Characterization and antimicrobial susceptibility of coagulase-positive Staphylococcus isolated in a veterinary teaching hospital in Chile. Rev Argent Microbiol 2022; 54:192-202. [PMID: 35331576 DOI: 10.1016/j.ram.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/10/2021] [Accepted: 12/02/2021] [Indexed: 10/18/2022] Open
Abstract
There is limited information about the prevalence and antimicrobial susceptibility of coagulase-positive Staphylococcus (CoPS) strains in veterinary settings in Chile. The aim of this observational study was to identify and characterize CoPS strains from dogs, owners, veterinary professionals and surfaces in a veterinary teaching hospital at Universidad de Chile to determine the presence of methicillin-resistant strains and evaluate the genetic relationship among the strains. Veterinarians (n=24), surfaces (n=10), and healthy dogs (n=40) and their respective owners (n=40) were sampled for CoPS. Isolates were identified by PCR and antimicrobial susceptibility was assessed by the disk diffusion method and MIC. The presence of the mecA gene was evaluated by PCR, and the genetic relationship among the strains was established by PFGE. A total of 45 CoPS strains were obtained, eight from veterinary professionals, three from hospital surfaces, eight from owners and 26 from dogs. Nine of the strains were resistant to methicillin (20%), and all of them carried the mecA gene. A high percentage of the strains was resistant to clindamycin (33.3%). Additionally, the isolated CoPS showed high genetic diversity. This study suggests that veterinarians are in high risk of harboring methicillin-resistant CoPS (25% versus 2.5% from owners) and our results provide evidence that clindamycin could not be an empiric alternative for CoPS in the analyzed hospital. This is the first report of methicillin-resistant CoPS in veterinary settings in Chile, considering humans, pets and surfaces.
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Affiliation(s)
- Francisco Abusleme
- Departamento de Ciencias Clínicas, Facultad de Ciencias Veterinarias y Pecuarias, FAVET, Universidad de Chile, Santiago, Chile.
| | - Nicolás Galarce
- Departamento de Medicina Preventiva Animal, Facultad de Ciencias Veterinarias y Pecuarias, FAVET, Universidad de Chile, Santiago, Chile
| | - Mario Quezada-Aguiluz
- Laboratorio de Investigación en Agentes Antibacterianos, Departamento de Microbiología, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile; Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Santiago, Chile; Departamento de Medicina Interna, Facultad de Medicina, Universidad de Concepción, Chile
| | - Daniela Iragüen
- Departamento de Ciencias Clínicas, Facultad de Ciencias Veterinarias y Pecuarias, FAVET, Universidad de Chile, Santiago, Chile
| | - Gerardo González-Rocha
- Laboratorio de Investigación en Agentes Antibacterianos, Departamento de Microbiología, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile; Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Santiago, Chile.
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13
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Hardefeldt LY, Hur B, Richards S, Scarborough R, Browning GF, Billman-Jacobe H, Gilkerson JR, Ierardo J, Awad M, Chay R, Bailey KE. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac015. [PMID: 35233530 PMCID: PMC8874133 DOI: 10.1093/jacamr/dlac015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background Antimicrobial stewardship programmes (ASPs) have been widely implemented in medical practice to improve antimicrobial prescribing and reduce selection for multidrug-resistant pathogens. Objectives To implement different antimicrobial stewardship intervention packages in 135 veterinary practices and assess their impact on antimicrobial prescribing. Methods In October 2018, general veterinary clinics were assigned to one of three levels of ASP, education only (CON), intermediate (AMS1) or intensive (AMS2). De-identified prescribing data (1 October 2016 to 31 October 2020), sourced from VetCompass Australia, were analysed and a Poisson regression model fitted to identify the effect of the interventions on the incidence rates of antimicrobial prescribing. Results The overall incidence rate (IR) of antimicrobial prescribing for dogs and cats prior to the intervention was 3.7/100 consultations, which declined by 36% (2.4/100) in the implementation period, and by 50% (1.9/100) during the post-implementation period. Compared with CON, in AMS2 there was a 4% and 6% reduction in the overall IR of antimicrobial prescribing, and a 24% and 24% reduction in IR of high importance antimicrobial prescribing, attributable to the intervention in the implementation and post-implementation periods, respectively. A greater mean difference in the IR of antimicrobial prescribing was seen in high-prescribing clinics. Conclusions These AMS interventions had a positive impact in a large group of general veterinary practices, resulting in a decline in overall antimicrobial use and a shift towards use of antimicrobials rated as low importance, with the greatest impact in high-prescribing clinics.
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Affiliation(s)
- L. Y. Hardefeldt
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, Victoria, Australia
- Corresponding author. E-mail:
| | - B. Hur
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - S. Richards
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, Victoria, Australia
| | - R. Scarborough
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, Victoria, Australia
| | - G. F. Browning
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, Victoria, Australia
| | - H. Billman-Jacobe
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, Victoria, Australia
| | - J. R. Gilkerson
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, Victoria, Australia
| | - J. Ierardo
- Greencross Vets Pty Ltd, Brisbane, Queensland, Australia
| | - M. Awad
- Greencross Vets Pty Ltd, Brisbane, Queensland, Australia
| | - R. Chay
- Greencross Vets Pty Ltd, Brisbane, Queensland, Australia
| | - K. E. Bailey
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, Victoria, Australia
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14
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Rana EA, Islam MZ, Das T, Dutta A, Ahad A, Biswas PK, Barua H. Prevalence of coagulase-positive methicillin-resistant Staphylococcus aureus and Staphylococcus pseudintermedius in dogs in Bangladesh. Vet Med Sci 2021; 8:498-508. [PMID: 34941011 PMCID: PMC8959323 DOI: 10.1002/vms3.701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The emergence of methicillin‐resistant Staphylococcus aureus (MRSA) and methicillin‐resistant Staphylococcus pseudintermedius (MRSP) have a significant health impact on people with direct or supportive occupations in veterinary medicine including veterinarians, animal handlers, laboratory personnel and pet owners. Objectives This cross‐sectional survey was conducted to determine the prevalence of and risk factors for S. aureus, S. pseudintermedius, MRSA and MRSP in dogs in Bangladesh. Methods A total of 358 swab samples were collected from different body sites of 150 dogs attending a university teaching veterinary hospital between January and June 2018. Standard bacteriological procedures were followed to isolate Staphylococcus, and identification was confirmed to the species level by PCR to detect the nuc gene. MRSA and MRSP were confirmed by the presence of the mecA gene. Results The prevalence of coagulase‐positive S. aureus and S. pseudintermedius in dogs were 16% and 45.3%, respectively. S. aureus and S. pseudintermedius isolates displayed the highest resistance against nalidixic acid (95.2% and 91%, respectively) and erythromycin (89.3% and 84.7%, respectively). Notably, all the staphylococcal isolates showed resistance to ≥3 antimicrobial classes. The prevalence of MRSA and MRSP in dogs was 8.7% and 6%, respectively. Multivariable logistic regression analysis identified the following variables as risk factors for MRSA colonisation in dogs: dogs with dermatitis (odds ratio [OR], 12.24, 95% CI: 3.12–57.33; p < 0.001) and history of antibiotic use (OR 8.73, 95% CI: 2.23–43.10; p < 0.001). Presence of otitis (OR 14.22; 95% CI: 1.64–103.58; p = 0.008) and oral lesions (OR 9.48, 95% CI: 1.14–64.82; p = 0.002) were identified as the significant risk factors for the carriage of MRSP. Conclusions The circulation of multidrug‐resistant S. aureus and S. pseudintermedius is a serious concern to dogs and humans. To our knowledge, this is the first report of S. pseudintermedius and MRSP affecting dogs in Bangladesh.
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Affiliation(s)
- Eaftekhar Ahmed Rana
- Department of Microbiology and Veterinary Public Health, Chattogram Veterinary and Animal Sciences University, Khulshi, Chattogram, Bangladesh
| | - Md Zohorul Islam
- Department of Microbiology and Veterinary Public Health, Chattogram Veterinary and Animal Sciences University, Khulshi, Chattogram, Bangladesh
| | - Tridip Das
- Department of Microbiology and Veterinary Public Health, Chattogram Veterinary and Animal Sciences University, Khulshi, Chattogram, Bangladesh
| | - Avijit Dutta
- Department of Microbiology and Veterinary Public Health, Chattogram Veterinary and Animal Sciences University, Khulshi, Chattogram, Bangladesh
| | - Abdul Ahad
- Department of Microbiology and Veterinary Public Health, Chattogram Veterinary and Animal Sciences University, Khulshi, Chattogram, Bangladesh
| | - Paritosh Kumar Biswas
- Department of Microbiology and Veterinary Public Health, Chattogram Veterinary and Animal Sciences University, Khulshi, Chattogram, Bangladesh
| | - Himel Barua
- Department of Microbiology and Veterinary Public Health, Chattogram Veterinary and Animal Sciences University, Khulshi, Chattogram, Bangladesh
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15
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Crespo-Piazuelo D, Lawlor PG. Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) prevalence in humans in close contact with animals and measures to reduce on-farm colonisation. Ir Vet J 2021; 74:21. [PMID: 34362463 PMCID: PMC8348836 DOI: 10.1186/s13620-021-00200-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/13/2021] [Indexed: 12/14/2022] Open
Abstract
Since the 1940s, Staphylococcus aureus has adapted to the use of different antimicrobials to treat infections. Although S. aureus can act as a commensal bacterium, some strains are facultative pathogens and acquiring them can be fatal. In particular, treating infections caused by S. aureus with acquired antimicrobial resistance is problematic, as their treatment is more difficult. Some of these S. aureus variants are methicillin-resistant S. aureus (MRSA) with prevalence across the globe in health-care facilities, community settings and on livestock farms. Apart from humans, MRSA can colonise other animal species, and because of this, resistance to new antimicrobials can appear and jump between species. Livestock and companion animals are particularly important in this regard considering the relatively high usage of antimicrobials in these species. There is a risk to humans who come into direct contact with animals acquiring MRSA but there is also the risk of animals acquiring MRSA from colonised humans. In this review, we summarise studies conducted worldwide to characterise the prevalence of MRSA in veterinarians, farmers and other personnel who come into close contact with animals. Finally, alternative treatment, preventive measures and on-farm strategies to reduce MRSA introduction to a farm and carriage within a herd are discussed.
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Affiliation(s)
- Daniel Crespo-Piazuelo
- Teagasc, Pig Development Department, Animal & Grassland Research & Innovation Centre, Moorepark, Fermoy, Co. Cork, P61 C996, Ireland
| | - Peadar G Lawlor
- Teagasc, Pig Development Department, Animal & Grassland Research & Innovation Centre, Moorepark, Fermoy, Co. Cork, P61 C996, Ireland.
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16
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Gentile D, Allbaugh RA, Adiguzel MC, Kenne DE, Sahin O, Sebbag L. Bacterial Cross-Contamination in a Veterinary Ophthalmology Setting. Front Vet Sci 2020; 7:571503. [PMID: 33426013 PMCID: PMC7785980 DOI: 10.3389/fvets.2020.571503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/07/2020] [Indexed: 12/16/2022] Open
Abstract
The present study describes the prevalence of bacterial cross-contamination in a veterinary ophthalmology setting, a serious issue that can result in healthcare-associated (or nosocomial) infections among patients and staff. Retrospective (n = 5 patients) and prospective (n = 23 patients) studies evaluated bacterial isolates in companion animals presenting with ulcerative keratitis, sampling the patients' cornea and surrounding examination room, including the environment (exam table, countertop, floor) and ophthalmic equipment (slit lamp, transilluminator, direct ophthalmoscope, indirect headset, tonometer). Results of bacterial culture and antibiotic susceptibility testing were recorded, and degree of genetic relatedness was evaluated in six pairs of isolates (cornea + environment or equipment) using pulse-field gel electrophoresis (PFGE). Overall contamination rate of ophthalmic equipment, environment, and examination rooms (equipment + environment) was 42.9% (15/35 samples), 23.7% (9/38 samples) and 32.9% (24/73 samples), respectively. Methicillin-resistant Staphylococcus pseudintermedius (MRSP), a multi-drug resistant (MDR) pathogen with zoonotic potential, was isolated in 8.2% (6/73) of samples. The patient's cornea was likely the source of cross-contamination in 50% (3/6) of MRSP pairs as evaluated by PFGE; notably, two of the three similar bacterial strains did not have an exact match of their antibiotic susceptibility profiles, highlighting the importance of advanced diagnostics such as PFGE to assess cross-contamination in healthcare facilities. Future work could examine the contamination prevalence of specific equipment or the efficacy of cleaning protocols to mitigate cross-contamination in veterinary practice.
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Affiliation(s)
- Dominic Gentile
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Rachel A Allbaugh
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Mehmet C Adiguzel
- Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, United States.,Department of Microbiology, Faculty of Veterinary Medicine, Ataturk University, Erzurum, Turkey
| | - Danielle E Kenne
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Orhan Sahin
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Lionel Sebbag
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
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17
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Ochoa SA, Cruz-Córdova A, Mancilla-Rojano J, Escalona-Venegas G, Esteban-Kenel V, Franco-Hernández I, Parra-Ortega I, Arellano-Galindo J, Hernández-Castro R, Perez-López CF, De la Rosa-Zamboni D, Xicohtencatl-Cortes J. Control of Methicillin-Resistant Staphylococcus aureus Strains Associated With a Hospital Outbreak Involving Contamination From Anesthesia Equipment Using UV-C. Front Microbiol 2020; 11:600093. [PMID: 33381094 PMCID: PMC7767929 DOI: 10.3389/fmicb.2020.600093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/25/2020] [Indexed: 12/23/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is considered an opportunistic pathogen in humans and is mainly associated with healthcare-associated infections (HCAIs). This bacterium colonizes the skin and mucous membranes of healthy people and causes frequent hospital outbreaks. The aim of this study was to perform molecular typing of the staphylococcal cassette chromosome mec (SCCmec) and agr loci as wells as to establish the pulsotypes and clonal complexes (CCs) for MRSA and methicillin-sensitive S. aureus (MSSA) outbreaks associated with the operating room (OR) at a pediatric hospital. Twenty-five clinical strains of S. aureus (19 MRSA and 6 MSSA strains) were recovered from the outbreak (patients, anesthesia equipment, and nasopharyngeal exudates from external service anesthesia technicians). These clinical S. aureus strains were mainly resistant to benzylpenicillin (100%) and erythromycin (84%) and were susceptible to vancomycin and nitrofurantoin. The SCCmec type II was amplified in 84% of the S. aureus strains, and the most frequent type of the agr locus was agrII, which was amplified in 72% of the strains; however, the agrI and agrIII genes were mainly detected in MSSA strains. A pulsed-field gel electrophoresis (PFGE) analysis grouped the 25 strains into 16 pulsotypes (P), the most frequent of which was P1, including 10 MRSA strains related to the anesthesia equipment, external service anesthesia technicians, and hospitalized patients. Multilocus sequence typing (MLST) identified 15 sequence types (STs) distributed in nine CCs. The most prevalent ST was ST1011, belonging to CC5, which was associated with the SCCmec type II and agrII type. We postulate that the external service anesthesia technicians were MRSA carriers and that these strains were indirectly transmitted from the contaminated anesthesia equipment that was inappropriately disinfected. Finally, the MRSA outbreak was controlled when the anesthesia equipment disinfection was improved and hand hygiene was reinforced.
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Affiliation(s)
- Sara A Ochoa
- Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Ariadnna Cruz-Córdova
- Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Jetsi Mancilla-Rojano
- Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico.,Facultad de Medicina, Posgrado de Ciencias Biológicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Gerardo Escalona-Venegas
- Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Veronica Esteban-Kenel
- Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Isabel Franco-Hernández
- Laboratorio Central de Bacteriología, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Israel Parra-Ortega
- Laboratorio Central de Bacteriología, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - José Arellano-Galindo
- Departamento de Infectología, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Rigoberto Hernández-Castro
- Departamento de Ecología de Agentes Patógenos, Hospital General Dr. Manuel Gea González, Ciudad de México, Mexico
| | - Citlalli F Perez-López
- Departamento de Epidemiología Hospitalaria, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Daniela De la Rosa-Zamboni
- Departamento de Epidemiología Hospitalaria, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Juan Xicohtencatl-Cortes
- Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
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18
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Characterization of Staphylococcus aureus Strains Isolated from Veterinary Hospital. Int J Microbiol 2020; 2020:2893027. [PMID: 32802069 PMCID: PMC7416298 DOI: 10.1155/2020/2893027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/22/2020] [Indexed: 11/17/2022] Open
Abstract
This study aims to detect Staphylococcus aureus (S. aureus) resistance in the veterinary hospital environment. S. aureus are one of the components of the microbiota, and they may be present in patients in a veterinary hospital environment. Methicillin resistance is determined by a chromosomal gene (mecA), which codes for modifications in the beta-lactam antibiotic receptor, where the penicillin-binding protein will have a low affinity for the antibiotic. Samples were collected through swabs of materials and equipment at the hospital. S. aureus was identified in 7.6% (21/276) of the samples collected, and of the 21 strains isolated, 4 (19.0%) carried the mecA gene. MRSA are all strains of S. aureus that express the mecA gene. Four strains harbor the mecA gene; however, only two expressed the phenotypic resistance to cefoxitin and were characterized as MRSA. An isolate (strain 18) present on a patient care table was identified as methicillin-resistant S. aureus with intermediate sensitivity to vancomycin (VISA). Our observations suggest the need for containment measures (good antisepsis practices) to avoid the possible transmission of resistant bacterial agents for the veterinary hospital environment.
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19
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Schmidt JS, Kuster SP, Nigg A, Dazio V, Brilhante M, Rohrbach H, Bernasconi OJ, Büdel T, Campos-Madueno EI, Gobeli Brawand S, Schuller S, Endimiani A, Perreten V, Willi B. Poor infection prevention and control standards are associated with environmental contamination with carbapenemase-producing Enterobacterales and other multidrug-resistant bacteria in Swiss companion animal clinics. Antimicrob Resist Infect Control 2020; 9:93. [PMID: 32576281 PMCID: PMC7310346 DOI: 10.1186/s13756-020-00742-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/29/2020] [Indexed: 12/16/2022] Open
Abstract
Background Intensive medical care in companion animal clinics could pose a risk for the selection and dissemination of multidrug-resistant organisms (MDROs). Infection prevention and control (IPC) concepts are key measures to reduce the spread of MDROs, but data on IPC standards in companion animal clinics is sparse. The study assessed IPC standards in seven companion animal clinics and practices in Switzerland by structured IPC audits and combined results with environmental MDRO contamination and MDRO carriage of the personnel. Methods IPC audits were held between August 2018 and January 2019. The observations in 34 IPC areas were scored based on predefined criteria (not fulfilled/partially fulfilled/fulfilled = score 0/1/2). Environmental swabs and nasal and stool samples from veterinary personnel were tested for methicillin-resistant (MR) staphylococci and macrococci and for colistin-resistant, extended-spectrum β-lactamase- and carbapenemase-producing (CP) Enterobacterales (CPE). Species was identified by MALDI-TOF MS, antimicrobial resistance determined by microdilution and β-lactam resistance gene detection, and genetic relatedness assessed by REP−/ERIC-PCR and multilocus sequence typing. Results Of a maximum total IPC score of 68, the institutions reached a median (range) score of 33 (19–55). MDROs were detected in median (range) 8.2% (0–33.3%) of the sampling sites. Clinics with low IPC standards showed extensive environmental contamination, i.e. of intensive care units, consultation rooms and utensils. CPE were detected in two clinics; one of them showed extensive contamination with CP Klebsiella pneumoniae (ST11, blaOXA-48) and MR Staphylococcus pseudintermedius (ST551, mecA). Despite low IPC scores, environmental contamination with MDROs was low in primary opinion practices. Three employees were colonized with Escherichia coli ST131 (blaCTX-M-15, blaCTX-M-27, blaCTX-M-14). Two employees carried CP E. coli closely related to environmental (ST410, blaOXA-181) and patient-derived isolates (ST167, blaNDM-5). MR Staphylococcus aureus (ST225, mecA) and MR S. pseudintermedius (ST551, mecA) of the same sequence types and with similar resistance profiles were found in employees and the environment in two clinics. Conclusions The study indicates that IPC standards in companion animal clinics are variable and that insufficient IPC standards could contribute to the evolution of MDROs which can be transferred between the environment and working personnel. The implementation of IPC concepts in companion animal clinics should urgently be promoted.
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Affiliation(s)
- Janne S Schmidt
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Zurich, Zurich, Switzerland
| | - Aurélien Nigg
- Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Valentina Dazio
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Michael Brilhante
- Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland.,Graduate School of Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Helene Rohrbach
- Small Animal Clinic, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Odette J Bernasconi
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Thomas Büdel
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Edgar I Campos-Madueno
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Stefanie Gobeli Brawand
- Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Simone Schuller
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Andrea Endimiani
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Vincent Perreten
- Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Barbara Willi
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
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20
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Gould AP, Coyner KS, Trimmer AM, Weese JS, Budke CM. Recovery of meticillin-resistant Staphylococcus species from pet-grooming salons. Vet Dermatol 2020; 31:262-e60. [PMID: 31876006 DOI: 10.1111/vde.12839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Meticillin-resistant (MR) staphylococcal species have been cultured from veterinary hospital environments and veterinary instruments. Pet-grooming salon environments and grooming tools may pose a risk for dissemination of MR staphylococcal bacteria into the pet population. OBJECTIVE The objectives of this study were to investigate the frequency of MR staphylococcal colonization of pet-grooming salons and to collect information regarding cleaning procedures in grooming salons. METHODS AND MATERIALS A nonrandomized, observational study was performed in 2018. Locations inside 19 grooming salons near Tacoma, WA, USA, were sampled and selectively cultured for MR, coagulase-positive staphylococci. Sampled sites included clipper blades and handles, leashes, rims of bathtub drains, insides of shampoo caps, and bathtub spray hoses or faucet handles. Grooming salons were asked to complete surveys regarding their cleaning practices. RESULTS Meticillin-resistant coagulase-positive staphylococci were isolated from 12 of 19 grooming salons and 25 of 112 total samples. Meticillin-resistant S. pseudintermedius, S. aureus and S. schleiferi were isolated from multiple salons, most commonly from electric clipper blades, clipper handles and grooming leashes. No statistically significant correlations were identified between cleaning practices and the isolation of MR coagulase-positive staphylococci. CONCLUSIONS AND CLINICAL IMPORTANCE Clipper blades, clipper handles and leashes are potential fomites for MR staphylococci in a grooming salon; increased disinfection practices for these items are indicated. A prospective, controlled, large-scale study is warranted to examine the effect of grooming salon hygiene practices on the isolation of MR staphylococci in salons.
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Affiliation(s)
- Alexandra P Gould
- Dermatology Clinic for Animals, 8300 Quinault Drive NE, Suite A, Lacey, WA, 98516, USA.,Animal Allergy and Dermatology Specialists, 6032 S Durango Dr, Suite 100, Las Vegas, NV, 89113, USA
| | - Kimberly S Coyner
- Dermatology Clinic for Animals, 8300 Quinault Drive NE, Suite A, Lacey, WA, 98516, USA
| | - Ann M Trimmer
- Animal Allergy and Dermatology Specialists, 6032 S Durango Dr, Suite 100, Las Vegas, NV, 89113, USA
| | - J Scott Weese
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, 50 Stone Road E, Guelph, Ontario, Canada, N1G 2W1
| | - Christine M Budke
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, 77843, USA
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21
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Vrbovská V, Sedláček I, Zeman M, Švec P, Kovařovic V, Šedo O, Laichmanová M, Doškař J, Pantůček R. Characterization of Staphylococcus intermedius Group Isolates Associated with Animals from Antarctica and Emended Description of Staphylococcus delphini. Microorganisms 2020; 8:E204. [PMID: 32024111 PMCID: PMC7074773 DOI: 10.3390/microorganisms8020204] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 11/16/2022] Open
Abstract
Members of the genus Staphylococcus are widespread in nature and occupy a variety of niches, however, staphylococcal colonization of animals in the Antarctic environment has not been adequately studied. Here, we describe the first isolation and characterization of two Staphylococcus intermedius group (SIG) members, Staphylococcus delphini and Staphylococcus pseudintermedius, in Antarctic wildlife. Staphylococcus delphini were found exclusively in Adélie penguins. The report of S. pseudintermedius from Weddell seals confirmed its occurrence in all families of the suborder Caniformia. Partial RNA polymerase beta-subunit (rpoB) gene sequencing, repetitive PCR fingerprinting with the (GTG)5 primer, and matrix-assisted laser-desorption/ionization time-of-flight mass spectrometry gave consistent identification results and proved to be suitable for identifying SIG members. Comparative genomics of S. delphini isolates revealed variable genomic elements, including new prophages, a novel phage-inducible chromosomal island, and numerous putative virulence factors. Surface and extracellular protein distribution were compared between genomes and showed strain-specific profiles. The pathogenic potential of S. delphini was enhanced by a novel type of exfoliative toxin, trypsin-like serine protease cluster, and enterotoxin C. Detailed analysis of phenotypic characteristics performed on six Antarctic isolates of S. delphini and eight reference strains from different animal sources enabled us to emend the species description of S. delphini.
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Affiliation(s)
- Veronika Vrbovská
- Division of Genetics and Molecular Biology, Department of Experimental Biology, Faculty of Science, Masaryk University, Kotlářská 2, 611 37 Brno, Czech Republic; (V.V.); (M.Z.); (V.K.); (J.D.)
| | - Ivo Sedláček
- Czech Collection of Microorganisms, Department of Experimental Biology, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (I.S.); (P.Š.); (M.L.)
| | - Michal Zeman
- Division of Genetics and Molecular Biology, Department of Experimental Biology, Faculty of Science, Masaryk University, Kotlářská 2, 611 37 Brno, Czech Republic; (V.V.); (M.Z.); (V.K.); (J.D.)
- Czech Collection of Microorganisms, Department of Experimental Biology, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (I.S.); (P.Š.); (M.L.)
| | - Pavel Švec
- Czech Collection of Microorganisms, Department of Experimental Biology, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (I.S.); (P.Š.); (M.L.)
| | - Vojtěch Kovařovic
- Division of Genetics and Molecular Biology, Department of Experimental Biology, Faculty of Science, Masaryk University, Kotlářská 2, 611 37 Brno, Czech Republic; (V.V.); (M.Z.); (V.K.); (J.D.)
| | - Ondrej Šedo
- Central European Institute of Technology, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic;
| | - Monika Laichmanová
- Czech Collection of Microorganisms, Department of Experimental Biology, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (I.S.); (P.Š.); (M.L.)
| | - Jiří Doškař
- Division of Genetics and Molecular Biology, Department of Experimental Biology, Faculty of Science, Masaryk University, Kotlářská 2, 611 37 Brno, Czech Republic; (V.V.); (M.Z.); (V.K.); (J.D.)
| | - Roman Pantůček
- Division of Genetics and Molecular Biology, Department of Experimental Biology, Faculty of Science, Masaryk University, Kotlářská 2, 611 37 Brno, Czech Republic; (V.V.); (M.Z.); (V.K.); (J.D.)
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22
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Gagetti P, Wattam AR, Giacoboni G, De Paulis A, Bertona E, Corso A, Rosato AE. Identification and molecular epidemiology of methicillin resistant Staphylococcus pseudintermedius strains isolated from canine clinical samples in Argentina. BMC Vet Res 2019; 15:264. [PMID: 31351494 PMCID: PMC6660709 DOI: 10.1186/s12917-019-1990-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/02/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Staphylococcus pseudintermedius is the leading cause of pyoderma in dogs and the frequent use of antimicrobial treatment is associated to the development of resistance to nearly all classes of antibiotics. Despite S. pseudintermedius significance, our understanding of the molecular mechanism of β-lactam resistance and its genetic diversity remains limited. We aimed to: i) determine the phenotypic resistance profile of methicillin resistant Staphylococcus pseudintermedius (MRSP) isolated from infected dogs in three different veterinary hospitals in Buenos Aires, Argentina; ii) identify the SCCmec elements and resistance genes; and iii) analyze the clonal relationship between isolates and in regard of dominant lineages found in the world. RESULTS In addition to the differential levels of β-lactam resistance, MRSP isolates (n = 10) showed resistance to 5-6 families of antibiotics, and were therefore categorized as multidrug-resistant. All the isolates were variant of SCCmec V homologous to S. aureus; additional SCCmecFinder analysis classified five of the genomes as SCCmec type V (5C2&5) with mecA (encodes for PBP2a), mecRI and mecI and all the genes closely related to the reference SCCmec type V S. aureus TSGH17 strain. In the remaining five strains, mecA was present, although other genes associated with SCCmec V including mecR1 and mecI were missing. PBP2a was inducible in low level resistance strains (MRSP 8151), and constitutively expressed in MRSP 8150, suggesting different mecA regulatory mechanisms. MRSP isolates showed significant genetic diversity: eight PFGE clonal types and six multilocus-sequence typing (MLST) sequence types (STs) (339, 649, 919, 920, 921 and 922), including four new STs genetically distinct from STs reported in other geographic areas. Comparative genomics and phylogenetic analyses of the MRSP showed a correlation between the genetic content and the phenotypes, and established the genetic relationship between the isolates. CONCLUSIONS MRSP could be a threat to animal health due to it concerning level of antimicrobial resistance. Our study highlights genetic and epidemiological aspects of multidrug-resistant MRSP strains from Argentina showing high degree of correlation between the resistance genes and the phenotype of the isolates and, furthermore, they appeared evolutionary closer to major worldwide reported ST68 and ST71.
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Affiliation(s)
- Paula Gagetti
- Servicio Antimicrobianos INEI-ANLIS "Dr. Carlos G. Malbran" , CABA, Argentina.,Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Alice R Wattam
- Biocomplexity Institute, University of Virginia, Virginia, USA
| | - Gabriela Giacoboni
- Departamento de Microbiologia, Facultad de Ciencias Veterinarias-UNLP, La Plata, Argentina
| | - Adriana De Paulis
- Departamento Microbiología, Instituto de Investigaciones Médicas Alfredo Lanari-UBA, CABA, Argentina
| | - Eugenia Bertona
- Departamento Microbiología, Instituto de Investigaciones Médicas Alfredo Lanari-UBA, CABA, Argentina
| | - Alejandra Corso
- Servicio Antimicrobianos INEI-ANLIS "Dr. Carlos G. Malbran" , CABA, Argentina
| | - Adriana E Rosato
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, USA.
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23
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Egan JT. Infection Control Practices and Methicillin-Resistant Staphylococcus aureus Skin Infections: A Survey of Students in US Chiropractic Programs. J Chiropr Med 2018; 17:75-81. [PMID: 30166963 DOI: 10.1016/j.jcm.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The purpose of this study was to assess the incidence of self-reported history of physician-diagnosed methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI) among chiropractic students and any association with infection control behaviors (hand and table hygiene, sharing gowns, and sharing lotion) and initiation of patient care. METHODS Questionnaires were obtained from 312 students attending half (9/18) of US chiropractic campuses. The questionnaire was derived from earlier studies led by Bearman in 2010 and Evans in 2007. Associations were assessed with Fisher exact test. Crude odds ratios were calculated for each of the variables. Two logistic regression models were produced. RESULTS Attendance at 1 campus was associated with postmatriculation MRSA SSTI in univariate analysis (P = .010). The logistic regression model was significant (P < .05), but the composing variables were not. CONCLUSIONS Fewer than 5 cases of MRSA SSTI were detected overall, revealing a low rate of reported postmatriculation MRSA SSTI among these students. There was a univariate association with postmatriculation MRSA SSTI at 1 chiropractic college.
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Affiliation(s)
- Jonathon T Egan
- Los Angeles College of Chiropractic, Southern California University of Health Sciences, Whittier, California
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24
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Tabatabaei S, Najafifar A, Askari Badouei M, Zahraei Salehi T, Ashrafi Tamai I, Khaksar E, Abbassi MS, Ghazisaeedi F. Genetic characterisation of methicillin-resistant Staphylococcus aureus and Staphylococcus pseudintermedius in pets and veterinary personnel in Iran: new insights into emerging methicillin-resistant S. pseudintermedius (MRSP). J Glob Antimicrob Resist 2018; 16:6-10. [PMID: 30172831 DOI: 10.1016/j.jgar.2018.08.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/28/2018] [Accepted: 08/24/2018] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Methicillin-resistant staphylococci, including methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus pseudintermedius (MRSP), pose a threat to animal and human health worldwide. Veterinary staff and pets may play a role in the spread of resistant clones. METHODS A total of 125 samples from veterinary staff (n=50), dogs (n=49) and cats (n=26) were investigated. Obtained isolates were tested for the methicillin resistance gene mecA and were subjected to multiplex PCR to differentiate coagulase-positive species. Following SCCmec and spa typing, isolates were tested for the presence of various toxin and virulence genes and phenotypic resistance to common antimicrobials. RESULTS Overall, 4 MRSA were isolated from two veterinarians and two dogs and 19 MRSP were found in eleven dogs (12 isolates) and five cats (7 isolates). The MRSA isolates possessed sea (2) and eta (3) virulence genes and the MRSP isolates possessed sea (6), expA (15), expB (1) and siet (19) genes. SCCmec type II and three spa types (t186, t1816 and t10897) were identified in the MRSA isolates. Most of the MRSP isolates belonged to SCCmec types II (2 isolates) and V (10 isolates); however, the remaining 7 isolates were untypeable and contained class C1 mec. The majority of isolates were multidrug-resistant (MDR). CONCLUSION These findings show that pets and veterinarians could be potential sources of MDR-MRSA and MDR-MRSP in Iran. Taken together, these findings warrant future investigations on the epidemiology and public-health significance of MDR-MRSA and MDR-MRSP both in veterinarians and companion animals in Iran.
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Affiliation(s)
- Saeid Tabatabaei
- Department of Microbiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Arash Najafifar
- Department of Pathobiology, Faculty of Veterinary Medicine, Garmsar Branch, Islamic Azad University, Garmsar, Iran
| | - Mahdi Askari Badouei
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, P.O. Box 91779489741793, Mashhad, Iran.
| | - Taghi Zahraei Salehi
- Department of Microbiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Iradj Ashrafi Tamai
- Department of Microbiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Ehsan Khaksar
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Garmsar Branch, Islamic Azad University, Garmsar, Iran
| | - Mohamed Salah Abbassi
- Université de Tunis El Manar, Tunisian Institute of Veterinary Research, Tunis, Tunisia
| | - Fereshteh Ghazisaeedi
- Department of Clinical Pathology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
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Worthing KA, Brown J, Gerber L, Trott DJ, Abraham S, Norris JM. Methicillin-resistant staphylococci amongst veterinary personnel, personnel-owned pets, patients and the hospital environment of two small animal veterinary hospitals. Vet Microbiol 2018; 223:79-85. [PMID: 30173756 DOI: 10.1016/j.vetmic.2018.07.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 11/17/2022]
Abstract
This study investigated the transmission cycle of methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus pseudintermedius (MRSP) in small companion animal veterinary practice. Sampling was undertaken at two small animal veterinary hospitals in Sydney, Australia. Samples were collected from 46 veterinary personnel, 79 personnel-owned dogs and cats, 151 clinically normal canine hospital admissions and 25 environmental sites. Nasal swabs were collected from veterinary personnel. Nasal, oral and perineal swabs were collected from animals. Methicillin resistance was detected by growth on BrillianceTM MRSA 2 Agar and confirmed by cefoxitin and oxacillin broth microdilution for S. aureus and S. pseudintermedius, respectively. MRSA and MRSP isolates were characterised using whole genome sequencing including mecA gene screening and multilocus sequence typing. MRSA was isolated from four (8%) veterinary personnel but no animals. MRSP was isolated from 11/151 (7%) of canine hospital admissions and 4/53 (8%) of personnel-owned dogs but no veterinary personnel or cats. No MRSA or MRSP was isolated from the environment. MRSP isolates were resistant to significantly more antimicrobial classes than MRSA. The main MRSP clone carried by canine patients (ST496) was distinct to that carried by personnel-owned dogs (ST64). One veterinary nurse, who carried Panton Valentine leucocidin-positive ST338 MRSA, also owned a ST749 MRSP-positive dog. Besides MRSP-positive dogs from the same household sharing the same clone of MRSP, MRSA and MRSP were not shared between humans, animals or environment. Therefore, in the non-outbreak setting of this study, there was limited MRS transmission between veterinary personnel, their pets, patients or the veterinary environment.
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Affiliation(s)
- Kate A Worthing
- University of Sydney, School of Veterinary Science, NSW, Australia.
| | - James Brown
- Animal Referral Hospital, Sydney, NSW, Australia.
| | - Laura Gerber
- University of Sydney, School of Veterinary Science, NSW, Australia.
| | - Darren J Trott
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy, South Australia, Australia.
| | - Sam Abraham
- Antimicrobial Resistance and Infectious Diseases Laboratory, School of Veterinary Life Sciences, Murdoch University, Murdoch, Western Australia, Australia.
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26
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Sato T, Usui M, Maetani S, Tamura Y. Prevalence of methicillin-resistant Staphylococcus aureus among veterinary staff in small animal hospitals in Sapporo, Japan, between 2008 and 2016: A follow up study. J Infect Chemother 2018; 24:588-591. [DOI: 10.1016/j.jiac.2018.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/30/2017] [Accepted: 01/28/2018] [Indexed: 11/16/2022]
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27
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Feßler AT, Schuenemann R, Kadlec K, Hensel V, Brombach J, Murugaiyan J, Oechtering G, Burgener IA, Schwarz S. Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus pseudintermedius (MRSP) among employees and in the environment of a small animal hospital. Vet Microbiol 2018; 221:153-158. [PMID: 29981702 DOI: 10.1016/j.vetmic.2018.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/09/2018] [Accepted: 06/04/2018] [Indexed: 12/13/2022]
Abstract
The aim of the study was to investigate methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus pseudintermedius (MRSP) among employees of a small animal hospital and the hospital environment. In total, 96 swabs from employees and 73 swabs from the clinic environment were investigated. Cation-adjusted-Mueller-Hinton broth (CAMHB) + 6.5% NaCl was used for enrichment before plating on Mueller-Hinton (MH) agar with 2% NaCl and 0.25 mg/L oxacillin. The staphylococcal species was determined using MALDI-TOF MS. The isolates were subjected to mecA-PCR, macrorestriction analysis, and antimicrobial susceptibility testing. MRSA were present in five nasal swabs of the 55 employees tested and in six environmental samples, MRSP in two employees (nasal and hand swabs, each) and in three environmental samples. All isolates harboured mecA. Susceptibility testing revealed that all but one of the isolates were multiresistant. All isolates were resistant to β-lactams and fluoroquinolones. All but one of the isolates were resistant to macrolides and lincosamides. A single MRSA was resistant to gentamicin. All MRSP were resistant to trimethoprim/sulfamethoxazole and non-susceptible to gentamicin. One isolate was also resistant to tetracycline. Macrorestriction analysis revealed three main SmaI patterns for MRSA and two main SmaI patterns for MRSP. All environmental isolates were found in areas of high people and animal traffic, such as dog ward areas, waiting and triage rooms. The finding of indistinguishable MRSA or MRSP among employees and in the environment of the small animal hospital suggests the possibility of transfer of these bacteria between humans, animals, and the hospital environment.
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Affiliation(s)
- Andrea T Feßler
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut (FLI), Neustadt-Mariensee, Germany; Institute of Microbiology and Epizootics, Centre for Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany.
| | | | - Kristina Kadlec
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut (FLI), Neustadt-Mariensee, Germany
| | - Vivian Hensel
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut (FLI), Neustadt-Mariensee, Germany
| | - Julian Brombach
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut (FLI), Neustadt-Mariensee, Germany; Institute of Microbiology and Epizootics, Centre for Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Jayaseelan Murugaiyan
- Institute of Animal Hygiene and Environmental Health, Freie Universität Berlin, Berlin, Germany; Department of Biotechnology, SRM University AP, Amaravati - 522502, India
| | - Gerhard Oechtering
- Department of Small Animal Medicine, University of Leipzig, Leipzig, Germany
| | - Iwan A Burgener
- Department of Small Animals and Horses, Small Animal Clinic, VetMedUni Vienna, Vienna, Austria
| | - Stefan Schwarz
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut (FLI), Neustadt-Mariensee, Germany; Institute of Microbiology and Epizootics, Centre for Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
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28
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Ho KK, Conley AC, Kennis RA, Hathcock TL, Boothe DM, White AG. Minimum inhibitory concentration and killing properties of rifampicin against canine Staphylococcus pseudintermedius isolates from dogs in the southeast USA. Vet Dermatol 2018; 29:302. [PMID: 29845664 DOI: 10.1111/vde.12653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 02/28/2024]
Abstract
BACKGROUND Meticillin-resistant (MR) staphylococcal pyoderma in dogs has led to increased use of alternate antibiotics such as rifampicin (RFP). However, little information exists regarding its pharmacodynamics in MR Staphylococcus pseudintermedius. HYPOTHESIS/OBJECTIVES To determine the minimum inhibitory concentration (MIC) and killing properties of RFP for canine Staphylococcus pseudintermedius isolates. METHODS The MIC of RFP was determined using the ETEST® for 50 meticillin-susceptible (MS) and 50 MR S. pseudintermedius isolates collected from dogs. From these isolates, two MS isolates (RFP MIC of 0.003 and 0.008 μg/mL, respectively) and two MR isolates (RFP MIC of 0.003 and 0.012 μg/mL, respectively) were subjected to time-kill studies. Mueller-Hinton broth was supplemented with RFP at 0, 0.5, 1, 2, 4, 8, 16 and 32 times the MIC for 0, 2, 4, 10, 16 and 24 h. The number of viable colony forming units in each sample was determined using a commercial luciferase assay kit. RESULTS The MIC50 and MIC90 were the same for MS and MR isolates, at 0.004 μg/mL and 0.008 μg/mL, respectively. Rifampicin kill curves were not indicative of concentration-dependency, suggesting time-dependent activity. Two isolates (MS 0.003 and 0.008 μg/mL) exhibited bacteriostatic activity, whereas two others (MR 0.003 and 0.012 μg/mL) exhibited bactericidal activity. CONCLUSIONS AND CLINICAL IMPORTANCE This study demonstrated that MS and MR S. pseudintermedius isolates were equally susceptible to rifampicin and that dosing intervals should be designed for time-dependent efficacy. These data can support pharmacokinetic studies of RFP in dogs with susceptible infections caused by S. pseudintermedius.
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Affiliation(s)
- Karen K Ho
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, 1220 Wire Road, Auburn, AL, 36849, USA
| | - Austin C Conley
- Department of Anatomy, Physiology, and Pharmacology, College of Veterinary Medicine, Auburn University, 109 Greene Hall, Auburn, AL, 36849, USA
| | - Robert A Kennis
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, 1220 Wire Road, Auburn, AL, 36849, USA
| | - Terri L Hathcock
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, 264 Greene Hall, Auburn, AL, 36849, USA
| | - Dawn M Boothe
- Department of Anatomy, Physiology, and Pharmacology, College of Veterinary Medicine, Auburn University, 109 Greene Hall, Auburn, AL, 36849, USA
| | - Amelia G White
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, 1220 Wire Road, Auburn, AL, 36849, USA
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29
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Lubkowicz D, Ho CL, Hwang IY, Yew WS, Lee YS, Chang MW. Reprogramming Probiotic Lactobacillus reuteri as a Biosensor for Staphylococcus aureus Derived AIP-I Detection. ACS Synth Biol 2018; 7:1229-1237. [PMID: 29652493 DOI: 10.1021/acssynbio.8b00063] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gram-positive Staphylococcus aureus infection that results in pneumonia, urinary tract infection, and in severe cases, sepsis, has recently been classified as a serious threat to public health. Rapid and cost-effective detection of these infections are costly and time-consuming. Here, we present probiotic lactic acid bacteria engineered to detect autoinducer peptide-I (AIP-I), a quorum sensing molecule produced by Staphylococcus sp. during pathogenesis. We achieved this by adapting the well-characterized agr quorum sensing ( agrQS) from Staphylococcus aureus into Lactobacillus reuteri. The engineered biosensor is able to detect AIP-I levels in the nanomolar to micromolar range. We further investigated the function of the biosensor to detect real-time changes in AIP-I levels to understand the dynamics of Staphylococcus aureus under various strenuous conditions. The developed sensors would be useful for detection of Staphylococcus contamination in hospital settings and for high-throughput drug screening.
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Affiliation(s)
- David Lubkowicz
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 119077, Singapore
- NUS Synthetic Biology for Clinical and Technological Innovation (SynCTI), Centre for Life Sciences, National University of Singapore, 119077, Singapore
| | - Chun Loong Ho
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 119077, Singapore
- NUS Synthetic Biology for Clinical and Technological Innovation (SynCTI), Centre for Life Sciences, National University of Singapore, 119077, Singapore
| | - In Young Hwang
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 119077, Singapore
- NUS Synthetic Biology for Clinical and Technological Innovation (SynCTI), Centre for Life Sciences, National University of Singapore, 119077, Singapore
| | - Wen Shan Yew
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 119077, Singapore
- NUS Synthetic Biology for Clinical and Technological Innovation (SynCTI), Centre for Life Sciences, National University of Singapore, 119077, Singapore
| | - Yung Seng Lee
- NUS Synthetic Biology for Clinical and Technological Innovation (SynCTI), Centre for Life Sciences, National University of Singapore, 119077, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 119077, Singapore
| | - Matthew Wook Chang
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 119077, Singapore
- NUS Synthetic Biology for Clinical and Technological Innovation (SynCTI), Centre for Life Sciences, National University of Singapore, 119077, Singapore
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Draft Genome Sequences of 12 Clinical and Environmental Methicillin-Resistant Staphylococcus pseudintermedius Strains Isolated from a Veterinary Teaching Hospital in Washington State. GENOME ANNOUNCEMENTS 2018; 6:6/15/e00290-18. [PMID: 29650582 PMCID: PMC5897803 DOI: 10.1128/genomea.00290-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Methicillin-resistant Staphylococcus pseudintermedius (MRSP) is a globally emergent multidrug-resistant pathogen of dogs associated with nosocomial transmission in dogs and with potential zoonotic impacts. Here, we report the draft whole-genome sequences of 12 hospital-associated MRSP strains and their resistance genotypes and phenotypes.
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Fujiki J, Nakamura T, Furusawa T, Ohno H, Takahashi H, Kitana J, Usui M, Higuchi H, Tanji Y, Tamura Y, Iwano H. Characterization of the Lytic Capability of a LysK-Like Endolysin, Lys-phiSA012, Derived from a Polyvalent Staphylococcus aureus Bacteriophage. Pharmaceuticals (Basel) 2018; 11:ph11010025. [PMID: 29495305 PMCID: PMC5874721 DOI: 10.3390/ph11010025] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/17/2018] [Accepted: 02/19/2018] [Indexed: 12/19/2022] Open
Abstract
Antibiotic-resistant bacteria (ARB) have spread widely and rapidly, with their increased occurrence corresponding with the increased use of antibiotics. Infections caused by Staphylococcus aureus have a considerable negative impact on human and livestock health. Bacteriophages and their peptidoglycan hydrolytic enzymes (endolysins) have received significant attention as novel approaches against ARB, including S. aureus. In the present study, we purified an endolysin, Lys-phiSA012, which harbors a cysteine/histidine-dependent amidohydrolase/peptidase (CHAP) domain, an amidase domain, and a SH3b cell wall binding domain, derived from a polyvalent S. aureus bacteriophage which we reported previously. We demonstrate that Lys-phiSA012 exhibits high lytic activity towards staphylococcal strains, including methicillin-resistant S. aureus (MRSA). Analysis of deletion mutants showed that only mutants possessing the CHAP and SH3b domains could lyse S. aureus, indicating that lytic activity of the CHAP domain depended on the SH3b domain. The presence of at least 1 mM Ca2+ and 100 µM Zn2+ enhanced the lytic activity of Lys-phiSA012 in a turbidity reduction assay. Furthermore, a minimum inhibitory concentration (MIC) assay showed that the addition of Lys-phiSA012 decreased the MIC of oxacillin. Our results suggest that endolysins are a promising approach for replacing current antimicrobial agents and may contribute to the proper use of antibiotics, leading to the reduction of ARB.
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Affiliation(s)
- Jumpei Fujiki
- Laboratory of Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu 069-8501, Japan; (J.F.); tomohiro-tobi-@hotmail.co.jp (T.N.); (T.F.); (H.O.); (H.T.); (J.K.)
| | - Tomohiro Nakamura
- Laboratory of Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu 069-8501, Japan; (J.F.); tomohiro-tobi-@hotmail.co.jp (T.N.); (T.F.); (H.O.); (H.T.); (J.K.)
| | - Takaaki Furusawa
- Laboratory of Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu 069-8501, Japan; (J.F.); tomohiro-tobi-@hotmail.co.jp (T.N.); (T.F.); (H.O.); (H.T.); (J.K.)
| | - Hazuki Ohno
- Laboratory of Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu 069-8501, Japan; (J.F.); tomohiro-tobi-@hotmail.co.jp (T.N.); (T.F.); (H.O.); (H.T.); (J.K.)
| | - Hiromichi Takahashi
- Laboratory of Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu 069-8501, Japan; (J.F.); tomohiro-tobi-@hotmail.co.jp (T.N.); (T.F.); (H.O.); (H.T.); (J.K.)
| | - Junya Kitana
- Laboratory of Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu 069-8501, Japan; (J.F.); tomohiro-tobi-@hotmail.co.jp (T.N.); (T.F.); (H.O.); (H.T.); (J.K.)
| | - Masaru Usui
- Laboratory of Food Microbiology and Food Safety, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu 069-8501, Japan; (M.U.); (Y.T.)
| | - Hidetoshi Higuchi
- Laboratory of Veterinary Hygiene, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu 069-8501, Japan;
| | - Yasunori Tanji
- Department of Bioengineering, Tokyo Institute of Technology, Yokohama 226-8502, Japan;
| | - Yutaka Tamura
- Laboratory of Food Microbiology and Food Safety, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu 069-8501, Japan; (M.U.); (Y.T.)
- Center for Veterinary Drug Development, Rakuno Gakuen University, Ebetsu 069-8501, Japan
| | - Hidetomo Iwano
- Laboratory of Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu 069-8501, Japan; (J.F.); tomohiro-tobi-@hotmail.co.jp (T.N.); (T.F.); (H.O.); (H.T.); (J.K.)
- Correspondence: ; Fax: +81-11-388-4885
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Iwano H, Inoue Y, Takasago T, Kobayashi H, Furusawa T, Taniguchi K, Fujiki J, Yokota H, Usui M, Tanji Y, Hagiwara K, Higuchi H, Tamura Y. Bacteriophage ΦSA012 Has a Broad Host Range against Staphylococcus aureus and Effective Lytic Capacity in a Mouse Mastitis Model. BIOLOGY 2018; 7:biology7010008. [PMID: 29315249 PMCID: PMC5872034 DOI: 10.3390/biology7010008] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 12/18/2022]
Abstract
Bovine mastitis is an inflammation of the mammary gland caused by bacterial infection in dairy cattle. It is the most costly disease in the dairy industry because of the high use of antibiotics. Staphylococcus aureus is one of the major causative agents of bovine mastitis and antimicrobial resistance. Therefore, new strategies to control bacterial infection are required in the dairy industry. One potential strategy is bacteriophage (phage) therapy. In the present study, we examined the host range of previously isolated S. aureus phages ΦSA012 and ΦSA039 against S. aureus strains isolated from mastitic cows. These phages could kill all S. aureus (93 strains from 40 genotypes) and methicillin-resistant S. aureus (six strains from six genotypes) strains tested. Using a mouse mastitis model, we demonstrated that ΦSA012 reduced proliferation of S. aureus and inflammation in the mammary gland. Furthermore, intravenous or intraperitoneal phage administration reduced proliferation of S. aureus in the mammary glands. These results suggest that broad host range phages ΦSA012 is potential antibacterial agents for dairy production medicine.
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Affiliation(s)
- Hidetomo Iwano
- Laboratory of Veterinary Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan; (Y.I.); (T.T.); (H.K.); (T.F.); (K.T.); (J.F.); (H.Y.)
- Correspondence: ; Tel.: +81-11-388-4885
| | - Yusuke Inoue
- Laboratory of Veterinary Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan; (Y.I.); (T.T.); (H.K.); (T.F.); (K.T.); (J.F.); (H.Y.)
| | - Takuji Takasago
- Laboratory of Veterinary Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan; (Y.I.); (T.T.); (H.K.); (T.F.); (K.T.); (J.F.); (H.Y.)
| | - Hironori Kobayashi
- Laboratory of Veterinary Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan; (Y.I.); (T.T.); (H.K.); (T.F.); (K.T.); (J.F.); (H.Y.)
| | - Takaaki Furusawa
- Laboratory of Veterinary Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan; (Y.I.); (T.T.); (H.K.); (T.F.); (K.T.); (J.F.); (H.Y.)
| | - Kotomi Taniguchi
- Laboratory of Veterinary Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan; (Y.I.); (T.T.); (H.K.); (T.F.); (K.T.); (J.F.); (H.Y.)
| | - Jumpei Fujiki
- Laboratory of Veterinary Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan; (Y.I.); (T.T.); (H.K.); (T.F.); (K.T.); (J.F.); (H.Y.)
| | - Hiroshi Yokota
- Laboratory of Veterinary Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan; (Y.I.); (T.T.); (H.K.); (T.F.); (K.T.); (J.F.); (H.Y.)
| | - Masaru Usui
- Laboratory of Food Microbiology and Food Safety, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan; (M.U.); (Y.T.)
| | - Yasunori Tanji
- Department of Bioengineering, Tokyo Institute of Technology, Yokohama 226-8502, Japan;
| | - Katsuro Hagiwara
- Laboratory of Veterinary Virology, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan;
| | - Hidetoshi Higuchi
- Laboratory of Veterinary Hygiene, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan;
| | - Yutaka Tamura
- Laboratory of Food Microbiology and Food Safety, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan; (M.U.); (Y.T.)
- Center for Veterinary Drug Vevelopment, Rakuno Gakuen University, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan
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Rodrigues AC, Belas A, Marques C, Cruz L, Gama LT, Pomba C. Risk Factors for Nasal Colonization by Methicillin-Resistant Staphylococci in Healthy Humans in Professional Daily Contact with Companion Animals in Portugal. Microb Drug Resist 2017; 24:434-446. [PMID: 28922060 DOI: 10.1089/mdr.2017.0063] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Methicillin-resistant staphylococci (MRS), namely Staphylococcus aureus (MRSA) and Staphylococcus pseudintermedius (MRSP), are opportunistic agents of great importance in human and veterinary medicine. The aims of this study were to investigate the frequency, persistence, and risk factors associated with nasal colonization by MRS in people in daily contact with animals in Portugal. Seventy-nine out of 129 (61.2%) participants were found to be colonized by, at least, one methicillin-resistant (MR) staphylococci species (MR Staphylococcus epidermidis [n = 68], MRSA [n = 19], MR Staphylococcus haemolyticus [n = 7], MRSP [n = 2], and other coagulase-negative staphylococci [n = 4]). Three lineages were identified among the MRSA isolates (n = 7): the major human healthcare clone in Portugal (ST22-t032-IV, n = 3), the livestock-associated MRSA (ST398-t108-V, n = 3), and the New York-/Japan-related clone (ST105-t002-II, n = 1). MRSP isolates belonged to the European clone ST71-II-III. We identified two risk factors for nasal colonization by MRS in healthy humans: (i) being a veterinary professional (veterinarian and veterinary nurse) (p < 0.0001, odds ratio [OR] = 6.369, 95% confidence interval [CI, 2.683-15.122]) and (ii) have contacted with one MRSA- or MRSP-positive animal (p = 0.0361, OR = 2.742, 95% CI [1.067-7.045]). The follow-up study revealed that the majority (85%) remain colonized. This study shows that MRS in veterinary clinical practice is a professional hazard and highlights the need to implement preventive measures to minimize spread.
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Affiliation(s)
- Ana Catarina Rodrigues
- 1 Laboratory of Antimicrobial and Biocide Resistance, CIISA, Faculty of Veterinary Medicine, University of Lisbon (FMV-UL) , Lisbon, Portugal
| | - Adriana Belas
- 1 Laboratory of Antimicrobial and Biocide Resistance, CIISA, Faculty of Veterinary Medicine, University of Lisbon (FMV-UL) , Lisbon, Portugal
| | - Cátia Marques
- 1 Laboratory of Antimicrobial and Biocide Resistance, CIISA, Faculty of Veterinary Medicine, University of Lisbon (FMV-UL) , Lisbon, Portugal
| | - Luís Cruz
- 2 Hospital Veterinário das Laranjeiras , Lisbon, Portugal
| | - Luís T Gama
- 3 Animal Genetic Resources, CIISA, Faculty of Veterinary Medicine, University of Lisbon (FMV-UL) , Lisbon, Portugal
| | - Constança Pomba
- 1 Laboratory of Antimicrobial and Biocide Resistance, CIISA, Faculty of Veterinary Medicine, University of Lisbon (FMV-UL) , Lisbon, Portugal
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Pomba C, Rantala M, Greko C, Baptiste KE, Catry B, van Duijkeren E, Mateus A, Moreno MA, Pyörälä S, Ružauskas M, Sanders P, Teale C, Threlfall EJ, Kunsagi Z, Torren-Edo J, Jukes H, Törneke K. Public health risk of antimicrobial resistance transfer from companion animals. J Antimicrob Chemother 2017; 72:957-968. [PMID: 27999066 DOI: 10.1093/jac/dkw481] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Antimicrobials are important tools for the therapy of infectious bacterial diseases in companion animals. Loss of efficacy of antimicrobial substances can seriously compromise animal health and welfare. A need for the development of new antimicrobials for the therapy of multiresistant infections, particularly those caused by Gram-negative bacteria, has been acknowledged in human medicine and a future corresponding need in veterinary medicine is expected. A unique aspect related to antimicrobial resistance and risk of resistance transfer in companion animals is their close contact with humans. This creates opportunities for interspecies transmission of resistant bacteria. Yet, the current knowledge of this field is limited and no risk assessment is performed when approving new veterinary antimicrobials. The objective of this review is to summarize the current knowledge on the use and indications for antimicrobials in companion animals, drug-resistant bacteria of concern among companion animals, risk factors for colonization of companion animals with resistant bacteria and transmission of antimicrobial resistance (bacteria and/or resistance determinants) between animals and humans. The major antimicrobial resistance microbiological hazards originating from companion animals that directly or indirectly may cause adverse health effects in humans are MRSA, methicillin-resistant Staphylococcus pseudintermedius, VRE, ESBL- or carbapenemase-producing Enterobacteriaceae and Gram-negative bacteria. In the face of the previously recognized microbiological hazards, a risk assessment tool could be applied in applications for marketing authorization for medicinal products for companion animals. This would allow the approval of new veterinary medicinal antimicrobials for which risk levels are estimated as acceptable for public health.
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Affiliation(s)
- Constança Pomba
- Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
| | - Merja Rantala
- Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | | | | | | | | | - Ana Mateus
- Royal Veterinary College, University of London, London, UK
| | - Miguel A Moreno
- Faculty of Veterinary Medicine, Complutense University, Madrid, Spain
| | - Satu Pyörälä
- Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Modestas Ružauskas
- Veterinary Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Pascal Sanders
- Agence Nationale de Sécurité Sanitaire (ANSES), Fougères, France
| | | | | | | | - Jordi Torren-Edo
- European Medicines Agency, London, UK.,Facultat de Veterinària, UAB, Cerdanyola del Vallès, Spain
| | - Helen Jukes
- Veterinary Medicines Directorate, Addlestone, UK
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Hardefeldt LY, Browning GF, Thursky K, Gilkerson JR, Billman-Jacobe H, Stevenson MA, Bailey KE. Antimicrobials used for surgical prophylaxis by equine veterinary practitioners in Australia. Equine Vet J 2017; 50:65-72. [PMID: 28608525 DOI: 10.1111/evj.12709] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/02/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Antimicrobials are widely used in Australian veterinary practices, but no investigation into the classes of antimicrobials used, or the appropriateness of use in horses, has been conducted. OBJECTIVES The aim of the study was to describe antimicrobial use for surgical prophylaxis in equine practice in Australia. STUDY DESIGN Cross-sectional questionnaire survey. METHODS An online questionnaire was used to document antimicrobial usage patterns. Information solicited in the questionnaire included demographic details of the respondents, the frequency with which antimicrobials were used for specific surgical conditions (including the dose, timing and duration of therapy) and practice antimicrobial use policies and sources of information about antimicrobials and their uses. RESULTS A total of 337 members of the Australian veterinary profession completed the survey. Generally, the choice of antimicrobial was appropriate for the specified equine surgical condition, but the dose and duration of therapy varied greatly. While there was poor optimal compliance with British Equine Veterinary Association guidelines in all scenarios (range 1-15%), except removal of a nonulcerated dermal mass (42%), suboptimal compliance (compliant antimicrobial drug selection but inappropriate timing, dose or duration of therapy) was moderate for all scenarios (range 48-68%), except for an uninfected contaminated wound over the thorax, where both optimal and suboptimal compliance was very poor (1%). Veterinarians practicing at a university hospital had higher odds of compliance than general practice veterinarians (Odds ratio 3.2, 95% CI, 1.1-8.9, P = 0.03). MAIN LIMITATIONS Many survey responses were collected at conferences which may introduce selection bias, as veterinarians attending conferences may be more likely to have been exposed to contemporary antimicrobial prescribing recommendations. CONCLUSIONS Antimicrobial use guidelines need to be developed and promoted to improve the responsible use of antimicrobials in equine practice in Australia. An emphasis should be placed on antimicrobial therapy for wounds and appropriate dosing for procaine penicillin.
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Affiliation(s)
- L Y Hardefeldt
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Carlton, Victoria, Australia
| | - G F Browning
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Carlton, Victoria, Australia
| | - K Thursky
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Carlton, Victoria, Australia
| | - J R Gilkerson
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - H Billman-Jacobe
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Carlton, Victoria, Australia
| | - M A Stevenson
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - K E Bailey
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Carlton, Victoria, Australia
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Qekwana DN, Oguttu JW, Sithole F, Odoi A. Burden and predictors of Staphylococcus aureus and S. pseudintermedius infections among dogs presented at an academic veterinary hospital in South Africa (2007-2012). PeerJ 2017; 5:e3198. [PMID: 28417060 PMCID: PMC5392248 DOI: 10.7717/peerj.3198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 03/18/2017] [Indexed: 11/28/2022] Open
Abstract
Background Staphylococci are commensals of the mucosal surface and skin of humans and animals, but have been implicated in infections such as otitis externa, pyoderma, urinary tract infections and post-surgical complications. Laboratory records provide useful information to help investigate these infections. Therefore, the objective of this study was to investigate the burdens of these infections and use multinomial regression to examine the associations between various Staphylococcus infections and demographic and temporal factors among dogs admitted to an academic veterinary hospital in South Africa. Methods Records of 1,497 clinical canine samples submitted to the bacteriology laboratory at a veterinary academic hospital between 2007 and 2012 were included in this study. Proportions of staphylococcal positive samples were calculated, and a multinomial logistic regression model was used to identify predictors of staphylococcal infections. Results Twenty-seven percent of the samples tested positive for Staphylococcus spp. The species of Staphylococcus identified were S. pseudintermedius (19.0%), S. aureus (3.8%), S. epidermidis (0.7%) and S. felis (0.1%). The remaining 2.87% consisted of unspeciated Staphylococcus. Distribution of the species by age of dog showed that S. pseudintermedius was the most common (25.6%) in dogs aged 2–4 years while S. aureus was most frequent (6.3%) in dogs aged 5–6 years. S. pseudintermedius (34.1%) and S. aureus (35.1%) were the most frequently isolated species from skin samples. The results of the multivariable multinomial logistic regression model identified specimen, year and age of the dog as significant predictors of the risk of infection with Staphylococcus. There was a significant temporal increase (RRR = 1.17; 95% CI [1.06–1.29]) in the likelihood of a dog testing positive for S. pseudintermedius compared to testing negative. Dogs ≤ 8 years of age were significantly more likely to test positive for S. aureus than those >8 years of age. Similarly, dogs between 2–8 years of age were significantly more likely to test positive for S. pseudintermedius than those >8 years of age. In addition, dogs 2–4 years of age (RRR = 1.83; 1.09–3.06) were significantly more likely to test positive for S. pseudintermedius compared to those <2 years of age. The risk of infection with S. pseudintermedius or S. aureus was significantly higher in ear canal and skin specimens compared to other specimens. Conclusions The findings suggest that S. pseudintermedius and S. aureus were the most commonly isolated species from dogs presented at the study hospital. Age of the dog and the location of infection were significant predictors of infection with both Staphylococcus species investigated. Significant increasing temporal trend was observed for S. pseudintermedius but not S. aureus. This information is useful for guiding clinical decisions as well as future research.
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Affiliation(s)
- Daniel N Qekwana
- Department of Paraclinical Sciences, Faculty of Veterinary Science, Section Veterinary Public Health, University of Pretoria, Pretoria, Gauteng, South Africa
| | - James Wabwire Oguttu
- Department of Agriculture and Animal Health, College of Agriculture and Environmental Sciences, University of South Africa, Johannesburg, South Africa
| | - Fortune Sithole
- Department of Paraclinical Sciences, Faculty of Veterinary Science, Section Veterinary Public Health, University of Pretoria, Pretoria, Gauteng, South Africa.,Ross University School of Veterinary Medicine, Basseterre, St Kitts and Nevis
| | - Agricola Odoi
- Department of Paraclinical Sciences, Faculty of Veterinary Science, Section Veterinary Public Health, University of Pretoria, Pretoria, Gauteng, South Africa.,Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, United States of America
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Hardefeldt LY, Browning GF, Thursky K, Gilkerson JR, Billman-Jacobe H, Stevenson MA, Bailey KE. Antimicrobials used for surgical prophylaxis by companion animal veterinarians in Australia. Vet Microbiol 2017; 203:301-307. [PMID: 28619161 DOI: 10.1016/j.vetmic.2017.03.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 01/07/2023]
Abstract
Antimicrobials are widely used in veterinary practices, but there has been no investigation into the classes of antimicrobials used or the appropriateness of their use in surgical prophylaxis. Antimicrobial usage guidelines were published by the Australian Infectious Disease Advisory Panel (AIDAP) in 2013, but there has been no investigation of compliance with them. This study aimed to investigate antimicrobial use for surgical prophylaxis in companion animal practice and assess compliance with AIDAP guidelines for selected conditions by conducting a cross-sectional study of antimicrobial usage patterns of Australian veterinarians using an online questionnaire. Information solicited included: details of the respondent, the frequency with which antimicrobials were used for specific surgical conditions (including dose and duration) and practice antimicrobial use policies and sources of information about antimicrobial drugs and their uses. A total of 886 members of the Australian veterinary profession completed the survey. Few (22%) reported that their practice that had an antimicrobial use policy. Generally, the choice of antimicrobial drug was appropriate for the given surgical conditions. There was poor compliance with AIDAP guidelines for non-use of antimicrobials for routine neutering. Veterinarians caring solely for companion animals had higher odds of optimal compliance with guidelines than veterinarians in mixed species practices (OR 1.4, 95%CI 1.1-1.9). Recent graduates (>2011) had lower odds of compliance than older graduates (OR 0.8, 95%CI 0.6-0.9). The findings suggest that antimicrobial use guidelines need to be expanded and promoted to improve the responsible use of antimicrobials in small animal practice in Australia.
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Affiliation(s)
- Laura Y Hardefeldt
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.
| | - Glenn F Browning
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St., Parkville, Victoria Australia
| | - James R Gilkerson
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Helen Billman-Jacobe
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Mark A Stevenson
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Kirsten E Bailey
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
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38
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Walther B, Tedin K, Lübke-Becker A. Multidrug-resistant opportunistic pathogens challenging veterinary infection control. Vet Microbiol 2017; 200:71-78. [DOI: 10.1016/j.vetmic.2016.05.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 12/23/2022]
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Rossi G, Cerquetella M, Attili AR. Amphixenosic Aspects of Staphylococcus aureus Infection in Man and Animals. Curr Top Microbiol Immunol 2016; 409:297-323. [PMID: 27023699 DOI: 10.1007/82_2016_2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
According to the mode of transmission, Staphylococcus aureus infection between hosts is classified as "direct zoonoses," or infection that is transmitted from an infected vertebrate host to a susceptible host (man) by direct contact, by contact with a fomite or by a mechanical vector. The agent itself undergoes little or no propagative or developmental changes during transmission. According to the reservoir host, staphylococcosis is most precisely defined as "zooanthroponoses" or infections transmitted from man to lower vertebrate animals (e.g., streptococci, diphtheria, Enterobacteriaceae, human tuberculosis in cattle and parrots), but also "anthropozoonoses" or infections transmitted to man from lower vertebrate animals. In particular, actually, the correct definition of S. aureus infections between humans and animals is "amphixenoses" or infections maintained in both man and lower vertebrate animals and transmitted in either direction. S. aureus exhibits tropisms to many distinct animal hosts. While spillover events can occur wherever there is an interface between host species, changes in host tropism only occur with the establishment of sustained transmission in the new host species, leading to clonal expansion. Although the genomic variation underpinning adaptation in S. aureus genotypes infecting bovids and poultry has been well characterized, the frequency of switches from one host to another remains obscure. In this review, we sought to identify the sustained switches in host tropism in the S. aureus population, both anthroponotic and zoonotic, and their distribution over the species phylogeny. S. aureus is an organism with the capacity to switch into and adapt to novel hosts, even after long periods of isolation in a single host species. Based on this evidence, animal-adapted S. aureus lineages exhibiting resistance to antibiotics must be considered a major threat to public health, as they can adapt to the human population.
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Affiliation(s)
- Giacomo Rossi
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024, Matelica, MC, Italy.
| | - Matteo Cerquetella
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024, Matelica, MC, Italy
| | - Anna Rita Attili
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024, Matelica, MC, Italy
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Detection of methicillin-resistant Staphylococcus pseudintermedius ST169 and novel ST354 SCCmec II-III isolates related to the worldwide ST71 clone. Epidemiol Infect 2015; 144:434-42. [PMID: 26138564 DOI: 10.1017/s0950268815001545] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The recent appearance of methicillin-resistant Staphylococcus pseudintermedius (MRSP) is a concern for both veterinary and human healthcare. MRSP clonal lineages with sequence type (ST) 71-spa t02-staphylococcal cassette chromosome mec (SCCmec) II-III and ST68-spa t06-SCCmec V have spread throughout Europe and North America, respectively. The current study compared the molecular characteristics of 43 MRSP isolates from dogs in Japan with those of MRSP from previous reports using multilocus sequence typing based on seven housekeeping genes, SCCmec typing, and detection of antimicrobial resistance genes. Three related clonal lineages, ST71, ST169, and the newly registered ST354, were observed in SCCmec II-III isolates from Japan, despite MRSP SCCmec II-III isolates being thought to belong to a single clonal lineage. The majority of SCCmec II-III isolates belonging to ST169 (9/11) and ST354 (3/3), but not ST71 (0/11), harboured tetM. Four STs were observed for the SCCmec V isolates; however, neither ST68 nor related STs were found in the Japanese MRSP isolates. In conclusion, MRSP SCCmec II-III isolates from Japan belonged to ST71 and related STs (ST169 and ST354). A variety of MRSP SCCmec V clones, including some novel clones, were identified.
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41
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Vigo GB, Giacoboni GI, Gagetti PS, Pasterán FG, Corso AC. Resistencia antimicrobiana y epidemiología molecular de aislamientos de Staphylococcus pseudintermedius de muestras clínicas de caninos. Rev Argent Microbiol 2015; 47:206-11. [DOI: 10.1016/j.ram.2015.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/23/2015] [Accepted: 06/26/2015] [Indexed: 11/16/2022] Open
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Damborg P, Broens EM, Chomel BB, Guenther S, Pasmans F, Wagenaar JA, Weese JS, Wieler LH, Windahl U, Vanrompay D, Guardabassi L. Bacterial Zoonoses Transmitted by Household Pets: State-of-the-Art and Future Perspectives for Targeted Research and Policy Actions. J Comp Pathol 2015; 155:S27-40. [PMID: 25958184 DOI: 10.1016/j.jcpa.2015.03.004] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/17/2015] [Accepted: 03/29/2015] [Indexed: 11/17/2022]
Abstract
The close contact between household pets and people offers favourable conditions for bacterial transmission. In this article, the aetiology, prevalence, transmission, impact on human health and preventative measures are summarized for selected bacterial zoonoses transmissible by household pets. Six zoonoses representing distinct transmission routes were selected arbitrarily based on the available information on incidence and severity of pet-associated disease caused by zoonotic bacteria: bite infections and cat scratch disease (physical injuries), psittacosis (inhalation), leptospirosis (contact with urine), and campylobacteriosis and salmonellosis (faecal-oral ingestion). Antimicrobial resistance was also included due to the recent emergence of multidrug-resistant bacteria of zoonotic potential in dogs and cats. There is a general lack of data on pathogen prevalence in the relevant pet population and on the incidence of human infections attributable to pets. In order to address these gaps in knowledge, and to minimize the risk of human infection, actions at several levels are recommended, including: (1) coordinated surveillance of zoonotic pathogens and antimicrobial resistance in household pets, (2) studies to estimate the burden of human disease attributable to pets and to identify risk behaviours facilitating transmission, and (3) education of those in charge of pets, animal caretakers, veterinarians and human medical healthcare practitioners on the potential zoonotic risks associated with exposure to pets. Disease-specific recommendations include incentives to undertake research aimed at the development of new diagnostic tests, veterinary-specific antimicrobial products and vaccines, as well as initiatives to promote best practices in veterinary diagnostic laboratories and prudent antimicrobial usage.
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Affiliation(s)
- P Damborg
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.
| | - E M Broens
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - B B Chomel
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, USA
| | - S Guenther
- Institute of Microbiology and Epizootics, Freie Universität Berlin, Berlin, Germany
| | - F Pasmans
- Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - J A Wagenaar
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - J S Weese
- Department of Pathobiology, University of Guelph, Guelph, Canada
| | - L H Wieler
- Institute of Microbiology and Epizootics, Freie Universität Berlin, Berlin, Germany
| | - U Windahl
- Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute, Uppsala, Sweden
| | - D Vanrompay
- Department of Molecular Biotechnology, Faculty of Bioscience Engineering, University of Ghent, Ghent, Belgium
| | - L Guardabassi
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
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43
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Stull JW, Stevenson KB. Zoonotic disease risks for immunocompromised and other high-risk clients and staff: promoting safe pet ownership and contact. Vet Clin North Am Small Anim Pract 2014; 45:377-92, vii. [PMID: 25534535 DOI: 10.1016/j.cvsm.2014.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pets can be a source of disease (zoonoses) for humans. The disease risks associated with pet contact are highest among young children, the elderly, pregnant women, and immunocompromised hosts. These individuals and household members display limited knowledge of pet-associated disease, rarely recall receipt of pet-associated disease information, and report pet ownership practices that are often at odds with established disease prevention recommendations. Veterinary staff are in a key position to promote safe pet ownership and contact practices. Encouraging and safeguarding client disclosure of immunocompromising health conditions and promoting veterinarian-physician communications are critical for effectively providing this service.
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Affiliation(s)
- Jason W Stull
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, 1920 Coffey Road, Columbus, OH 43210, USA.
| | - Kurt B Stevenson
- Department of Internal Medicine, Wexner Medical Center, Colleges of Medicine and Public Health, The Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA
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Ishihara K, Saito M, Shimokubo N, Muramatsu Y, Maetani S, Tamura Y. Methicillin-resistant Staphylococcus aureus carriage among veterinary staff and dogs in private veterinary clinics in Hokkaido, Japan. Microbiol Immunol 2014; 58:149-54. [PMID: 24397564 DOI: 10.1111/1348-0421.12128] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/27/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
Abstract
To explore the prevalence and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) in veterinary medical practices, MRSA carriage was tested among 96 veterinarians (Vets), 70 veterinary technicians (VTs) and 292 dogs with which they had contact at 71 private veterinary clinics (VCs) in Hokkaido, Japan. MRSA isolates were obtained from 22 Vets [22.9%] and 7 VTs [10%]. The prevalence of MRSA among Vets was as high as that found in an academic veterinary hospital in our previous study. In contrast, only two blood donor dogs and one dog with liver disease (1.0%, 3/292) yielded MRSA. All MRSA-positive dogs were reared or treated in different VCs, in each of which at least one veterinary staff member carrying MRSA worked. Sequence types (ST) identified by multilocus sequence typing, spa types, and SCCmec types for canine MRSA isolates (ST5-spa t002-SCCmec II [from two dogs] or ST30-spa t021-SCCmec IV [from a dog]) were concordant with those from veterinary staff members in the same clinics as the MRSA-positive dogs, with which they had potentially had contact. Most MRSA isolates from veterinary staff were the same genotype (SCCmec type II and spa type t002) as a major hospital-acquired MRSA clone in Japan. The remaining MRSA was the same genotypes as domestic and foreign community-associated MRSA. Measures against MRSA infection should be provided in private VCs.
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Affiliation(s)
- Kanako Ishihara
- Department of Veterinary Medicine, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, 183-8509, Japan; School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, 069-8501, Japan
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45
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Ishihara K, Saito M, Shimokubo N, Muramatsu Y, Maetani S, Tamura Y. Epidemiological analysis of methicillin-resistant Staphylococcus aureus carriage among veterinary staff of companion animals in Japan. J Vet Med Sci 2014; 76:1627-9. [PMID: 25649946 PMCID: PMC4300379 DOI: 10.1292/jvms.14-0119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Veterinary staff carrying
methicillin-resistant Staphylococcus aureus(MRSA) can be a source of MRSA
infection in animals. To identify risk factors of MRSA carriage among veterinary staff,
MRSA carriage and epidemiological information (sex, career, contact with MRSA-identified
animal patients and others) were analyzed from 96 veterinarians and 70 veterinary
technicians working at 71 private veterinary clinics in Japan. Univariate analysis
determined sex (percentage of MRSA carriage, male (29.2%) vs. female (10%);
P=0.002) and career (veterinarians (22.9%) vs. veterinary technicians
(10%); P=0.030) as risk factors. Multivariable analysis revealed that sex
was independently associated with MRSA carriage (adjusted odds ratio, 3.717; 95%
confidence interval, 1.555–8.889; P=0.003). Therefore, male veterinary
staff had a higher risk of MRSA carriage than female staff.
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Affiliation(s)
- Kanako Ishihara
- School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan
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46
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LoPinto AJ, Mohammed HO, Ledbetter EC. Prevalence and risk factors for isolation of methicillin-resistant Staphylococcus in dogs with keratitis. Vet Ophthalmol 2014; 18:297-303. [PMID: 25130050 DOI: 10.1111/vop.12200] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Alexander J LoPinto
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA
| | - Hussni O Mohammed
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA
| | - Eric C Ledbetter
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA
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47
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Vincze S, Brandenburg AG, Espelage W, Stamm I, Wieler LH, Kopp PA, Lübke-Becker A, Walther B. Risk factors for MRSA infection in companion animals: results from a case-control study within Germany. Int J Med Microbiol 2014; 304:787-93. [PMID: 25130703 DOI: 10.1016/j.ijmm.2014.07.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Increasing numbers of companion animals suffering from infections with methicillin-resistant Staphylococcus aureus (MRSA) have been reported in the recent past. These infections are of particular concern because of the limited treatment options for MRSA and their transferability to humans. Since MRSA lineages isolated from infected companion animals often mirror typical human epidemic strains circulating in the same region, successful strategies to combat MRSA need strong and coordinated efforts from both, the human and the veterinary field according to the "One Health" concept. Hence, to identify potential risk factors related to MRSA infections in dogs, cats and horses, a case-control study was conducted, including data on 106 MRSA-infected animal patients as cases and 102 MSSA-infected animals as controls, originating from 155 different veterinary settings within Germany. Demographic data on animal patients, patient history and administration of antibiotics as well as practice/clinic specific parameters were assessed as putative risk factors. Multivariable logistic regression identified the following variables as risk factors for MRSA infection compared to MSSA infection: number of employees working at the veterinary setting (n>10; p<0.001), antibiotic treatment prior to sampling (systemic: p=0.002; local: p=0.049, both: p=0.011) and surgical site infection (p<0.001). Spa typing revealed predominantly clonal complexes well-known for hospital-associated lineages spreading in human health-care settings in Germany (CC5 and CC22) for isolates of dog and cat origin. CC398-MRSA dominated among equine isolates, a CC that was described as a nosocomial pathogen in equine clinical settings before. The identified risk factors and genotyping results are in accordance with numerous study outcomes from the field of human medicine and point towards reasonable problems with nosocomial spread of MRSA, especially within companion animal veterinary clinics. To define targeted infection control strategies against nosocomial pathogens, it is important to accomplish intervention studies addressing routes of transmission in companion animal veterinary settings.
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Affiliation(s)
- Szilvia Vincze
- Centre for Infection Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, Berlin, Germany.
| | - Anja G Brandenburg
- Vet Med Labor GmbH, Division of IDEXX Laboratories, Ludwigsburg, Germany
| | - Werner Espelage
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - Ivonne Stamm
- Vet Med Labor GmbH, Division of IDEXX Laboratories, Ludwigsburg, Germany
| | - Lothar H Wieler
- Centre for Infection Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, Berlin, Germany
| | - Peter A Kopp
- Vet Med Labor GmbH, Division of IDEXX Laboratories, Ludwigsburg, Germany
| | - Antina Lübke-Becker
- Centre for Infection Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, Berlin, Germany
| | - Birgit Walther
- Centre for Infection Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, Berlin, Germany
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48
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Gold RM, Patterson AP, Lawhon SD. Understanding methicillin resistance in staphylococci isolated from dogs with pyoderma. J Am Vet Med Assoc 2013; 243:817-24. [DOI: 10.2460/javma.243.6.817] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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49
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Novel pseudo-staphylococcal cassette chromosome mec element (ψSCCmec57395) in methicillin-resistant Staphylococcus pseudintermedius CC45. Antimicrob Agents Chemother 2013; 57:5509-15. [PMID: 23979735 DOI: 10.1128/aac.00738-13] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Genetic characterization of methicillin-resistant Staphylococcus pseudintermedius (MRSP) from Thailand and Israel revealed the presence of a predominant atypical clonal lineage which was not typeable by SmaI-PFGE and SCCmec typing. All the atypical isolates (n = 34) belonged to CC45 (30 ST45 and 2 ST179 isolates, 1 ST57 isolate, and 1 ST85 isolate). The isolates originated from healthy and diseased dogs and cats, as well as from the environment of one clinic. Cfr9I-pulsed-field gel electrophoresis (Cfr9I-PFGE) and dru typing permitted the further distinction of CC45 isolates from the two different countries. Microarray analysis identified genes that confer resistance to β-lactams (mecA; blaZ), aminoglycosides [aac(6')-Ie-aph(2')-Ia; aph(3')-III; ant(6)-Ia], macrolides and lincosamides [erm(B)], tetracyclines [tet(M)], trimethoprim [dfr(G)], streptothricin (sat4), and chloramphenicol (catpC221). Fluoroquinolone resistance was attributed to specific amino acid substitutions, i.e., Ser84Leu in GyrA and Ser80Ile and Asp84Asn in GrlA. A novel pseudo-staphylococcal cassette chromosome (ΨSCCmec57395) element was identified in MRSP strain 57395 (sequence type ST45) by whole-genome sequencing. The 12,282-bp ΨSCCmec57395 element contained a class C1 mec gene complex but no ccr genes. In addition to the methicillin resistance gene mecA, ΨSCCmec57395 also carried determinants of resistance to heavy metals, such as arsenic, cadmium, and copper. Bsu36I restriction analysis of the ΨSCCmec57395 element amplified by long-range PCR revealed the presence of ΨSCCmec57395 in the 33 additional isolates of MRSP CC45. The ΨSCCmec57395 element represents a new class of SCCmec and has been identified in MRSP of CC45, which is a predominant clonal lineage in Israel and Thailand.
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50
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Davis MF, Cain CL, Brazil AM, Rankin SC. Two coagulase-negative staphylococci emerging as potential zoonotic pathogens: wolves in sheep's clothing? Front Microbiol 2013; 4:123. [PMID: 23720657 PMCID: PMC3654208 DOI: 10.3389/fmicb.2013.00123] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 04/30/2013] [Indexed: 11/13/2022] Open
Affiliation(s)
- Meghan F Davis
- Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, USA
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