Abstract
Previous research identified veterinary clinics as hotspots with respect to accumulation and spread of multidrug resistant extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (EC). Therefore, promoting the prudent use of antibiotics to decrease selective pressure in that particular clinical environment is preferable to enhance biosecurity for animal patients and hospital staff. Accordingly, this study comparatively investigated the impact of two distinct perioperative antibiotic prophylaxis (PAP) regimens (short-term versus prolonged) on ESBL-EC carriage of horses subjected to colic surgery. While all horses received a combination of penicillin/gentamicin (P/G) as PAP, they were assigned to either the “single-shot group” (SSG) or the conventional “5-day group” (5DG). Fecal samples collected on arrival (t0), on the 3rd (t1) and on the 10th day after surgery (t2) were screened for ESBL-EC. All isolates were further investigated using whole genome sequences. In total, 81 of 98 horses met the inclusion criteria for this study. ESBL-EC identified in samples available at t0, t1 and t2 were 4.8% (SSG) and 9.7% (5DG), 37% (SSG) and 47.2% (5DG) as well as 55.6% (SSG) and 56.8% (5DG), respectively. Regardless of the P/G PAP regimen, horses were 9.12 times (95% CI 2.79–29.7) more likely to carry ESBL-EC at t1 compared to t0 (p < 0.001) and 15.64 times (95% CI 4.57–53.55) more likely to carry ESBL-EC at t2 compared to t0 (p < 0.001). ESBL-EC belonging to sequence type (ST) 10, ST86, ST641, and ST410 were the most prevalent lineages, with blaCTX–M–1 (60%) being the dominant ESBL gene. A close spatio-temporal relationship between isolates sharing a particular ST was revealed by genome analysis, strongly indicating local spread. Consequently, hospitalization itself has a strong impact on ESBL-EC isolation rates in horses, possibly masking differences between distinct PAP regimens. The results of this study reveal accumulation and spread of multi-drug resistant ESBL-EC among horses subjected to colic surgery with different P/G PAP regimens, challenging the local hygiene management system and work-place safety of veterinary staff. Moreover, the predominance of particular ESBL-EC lineages in clinics providing health care for horses needs further investigation.
Highlights
MATERIALS AND METHODSThe occurrence of zoonotic and multidrug resistant (MDR) pathogens, such as methicillin resistant Staphylococcus aureus (MRSA), Acinetobacter spp. and extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, are an ongoing challenge to both, biosecurity and hygiene in veterinary clinics (Walther et al, 2017, 2018a; Royden et al, 2019)
Previous studies reported the constant admission of equine patients carrying ESBL-producing Escherichia coli (ESBL-EC) to horse clinics (Apostolakos et al, 2017; Walther et al, 2018b)
A total of 98 horses subjected to abdominal surgery due to acute abdomen from January 2018 to February 2020 have been considered as study participants
Summary
MATERIALS AND METHODSThe occurrence of zoonotic and multidrug resistant (MDR) pathogens, such as methicillin resistant Staphylococcus aureus (MRSA), Acinetobacter spp. and extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, are an ongoing challenge to both, biosecurity and hygiene in veterinary clinics (Walther et al, 2017, 2018a; Royden et al, 2019). Previous studies reported the constant admission of equine patients carrying ESBL-producing Escherichia coli (ESBL-EC) to horse clinics (Apostolakos et al, 2017; Walther et al, 2018b). Hospital associated infections (HAI) have been linked to local spread of the abovementioned MDR pathogens in horse clinics (Walther et al, 2014b; van Spijk et al, 2019). These infections are often difficult to handle due to a multitude of additional antimicrobial resistances (AMR) commonly associated with ESBL-EC (Wieler et al, 2011). For instance, as well as antibiotic courses have only recently been identified as important risk factors for ESBL-EC colonization of equine patients (Schoster et al, 2020)
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