Abstract
Simple summaryThis prospective study investigated the prevalence, molecular characteristics and risk factors of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) shedding in three equine cohorts: (i) farm horses (13 farms, n = 192); (ii) on admission to a hospital (n = 168) and; (iii) horses hospitalized for ≥72 h re-sampled from cohort (ii) (n = 86). Bacteria were isolated from rectal swabs, identified, antibiotic susceptibility patterns were determined, and medical records and owners’ questionnaires were analyzed for risk factor analysis. ESBL shedding rates significantly increased during hospitalization (77.9%, n = 67/86), compared to farms (20.8%, n = 40/192), and horses on admission (19.6%, n = 33/168). High bacterial species diversity was identified, mainly in cohorts (ii) and (iii), with high resistance rates to commonly used antimicrobials. Risk factors for shedding in farms included horses’ breed (Arabian), sex (stallion), and antibiotic treatment. Older age was identified as a protective factor. We demonstrated a reservoir for antibiotic-resistant bacteria in an equine hospital and farms, with a significant ESBL-E acquisition. In light of our findings, in order to control ESBL spread, we recommend conducting active ESBL surveillance programs alongside antibiotic stewardship programs in equine facilities.We aimed to investigate the prevalence, molecular characteristics and risk factors of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) shedding in horses. A prospective study included three cohorts: (i) farm horses (13 farms, n = 192); (ii) on hospital admission (n = 168) and; (iii) horses hospitalized for ≥72 h re-sampled from cohort (ii) (n = 86). Enriched rectal swabs were plated, ESBL-production was confirmed (Clinical and Laboratory Standards Institute (CLSI)) and genes were identified (polymerase chain reaction (PCR)). Identification and antibiotic susceptibility were determined (Vitek-2). Medical records and owners’ questionnaires were analyzed. Shedding rates increased from 19.6% (n = 33/168) on admission to 77.9% (n = 67/86) during hospitalization (p < 0.0001, odds ratio (OR) = 12.12). Shedding rate in farms was 20.8% (n = 40/192), significantly lower compared to hospitalized horses (p < 0.0001). The main ESBL-E species (n = 192 isolates) were E. coli (59.9%, 115/192), Enterobacter sp. (17.7%, 34/192) and Klebsiella pneumoniae (13.0%, 25/192). The main gene group was CTX-M-1 (56.8%). A significant increase in resistance rates to chloramphenicol, enrofloxacin, gentamicin, nitrofurantoin, and trimethoprim-sulpha was identified during hospitalization. Risk factors for shedding in farms included breed (Arabian, OR = 3.9), sex (stallion, OR = 3.4), and antibiotic treatment (OR = 9.8). Older age was identified as a protective factor (OR = 0.88). We demonstrated an ESBL-E reservoir in equine cohorts, with a significant ESBL-E acquisition, which increases the necessity to implement active surveillance and antibiotic stewardship programs.
Highlights
Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) poses a clinical challenge to both human and veterinary clinicians
Risk factor analysis in the level of the farm revealed that the odds of being an ESBL/AmpC-producing E. coli premises were higher among riding schools than breeding premises, if premises housed a horse that had been medically treated with antibiotics within the last three months, and in premises where the staff consisted of more than five persons [13]
We aimed to investigate and compare ESBL-E shedding in different equine cohorts, including farm horses, horses on admission to an equine hospital and during hospitalization, as well as to determine risk factors for shedding
Summary
Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) poses a clinical challenge to both human and veterinary clinicians. Risk factors for colonization and infection in humans include severe illness with prolonged hospital stays, the presence of invasive medical devices for a prolonged duration and antibiotic use [2]. Horses were described as carriers, as well as infected by ESBL-E, in equine clinics and in farm settings [9,10]. In equine community settings, being stabled in the same yard with a recently hospitalized horse was identified as a risk factor for ESBL-producing E. coli carriage [14]. Risk factor analysis in the level of the farm revealed that the odds of being an ESBL/AmpC-producing E. coli premises were higher among riding schools than breeding premises, if premises housed a horse that had been medically treated with antibiotics within the last three months, and in premises where the staff consisted of more than five persons [13]
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