Characterisation of and risk factors for extended-spectrum β-lactamase producing Enterobacterales (ESBL-E) in an equine hospital with a special reference to an outbreak caused by Klebsiella pneumoniae ST307:CTX-M-1.
Abstract: Extended-spectrum β-lactamase producing Enterobacterales (ESBL-E) are important causative agents for infections in humans and animals. At the Equine Veterinary Teaching Hospital of the University of Helsinki, the first infections caused by ESBL-E were observed at the end of 2011 leading to enhanced infection surveillance. Contact patients were screened for ESBL-E by culturing infection sites and rectal screening. This study was focused on describing the epidemiology and microbiological characteristics of ESBL-E from equine patients of the EVTH during 2011-2014, and analysing putative risk factors for being positive for ESBL-E during an outbreak of Klebsiella pneumoniae ST307. Results: The number of ESBL-E isolations increased through 2012-2013 culminating in an outbreak of multi-drug resistant K. pneumoniae ST307:bla:bla:bla during 04-08/2013. During 10/2011-05/2014, altogether 139 ESBL-E isolates were found from 96 horses. Of these, 26 were from infection-site specimens and 113 from rectal-screening swabs. A total of 118 ESBL-E isolates from horses were available for further study, the most numerous being K. pneumoniae (n = 44), Escherichia coli (n = 31) and Enterobacter cloacae (n = 31). Hospital environmental specimens (N = 47) yielded six isolates of ESBL-E. Two identical E. cloacae isolates originating from an operating theatre and a recovery room had identical or highly similar PFGE fingerprint profiles as five horse isolates. In the multivariable analysis, mare-foal pairs (OR 4.71, 95% CI 1.57-14.19, P = 0.006), length of hospitalisation (OR 1.62, 95% CI 1.28-2.06, P < 0.001) and passing of a nasogastric tube (OR 2.86, 95% CI 1.03-7.95, P = 0.044) were associated with being positive for ESBL-E during the K. pneumoniae outbreak. Conclusions: The occurrence of an outbreak caused by a pathogenic ESBL-producing K. pneumoniae ST307 strain highlights the importance of epidemiological surveillance of ESBL-E in veterinary hospitals. Limiting the length of hospitalisation for equine patients may reduce the risk of spread of ESBL-E. It is also important to acknowledge the importance of nasogastric tubing as a potential source of acquiring ESBL-E. As ESBL-E were also found in stomach drench pumps used with nasogastric tubes, veterinary practices should pay close attention to appropriate equipment cleaning procedures and disinfection practices.
© 2022. The Author(s).
Publication Date: 2022-02-09 PubMed ID: 35139865PubMed Central: PMC8827190DOI: 10.1186/s13028-022-00621-6Google Scholar: Lookup
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- Journal Article
Summary
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The research studied the factors and characteristics of an Extended-spectrum β-lactamase producing Enterobacterales (ESBL-E) outbreak in an equine hospital, highlighting the role of prolonged hospitalization, nasogastric tubing, and horse-mother-and-foal pairs in the proliferation of these antibiotic-resistant bacteria.
Overview
- The research was driven by an increased identification of ESBL-E infections in the Equine Veterinary Teaching Hospital at the University of Helsinki around 2011. This triggered in-depth surveillance, screening, and subsequent research to understand the reasons behind the outbreak.
Epidemiology and Microbiological Characteristics
- The study identified an increase in the number of ESBL-E isolations ranging from 2012-2013, with a major outbreak identified between April to August 2013, led by a multi-drug resistant strain of K. pneumoniae ST307.
- Between October 2011 to May 2014, 139 ESBL-E isolates were identified from 96 horses. The most common of these were K. pneumoniae, E.coli and Enterobacter cloacae.
Risk Factors & Hospital Environment
- The study identified mare-foal pairs, length of hospitalization and the insertion of a nasogastric tube as significant risk factors for horses to contract ESBL-E.
- Environmental inspections revealed six isolates of ESBL-E. Importantly, two identical E. cloacae isolates were found in both an operating theatre and a recovery room, sharing similar genetic markers as five horse isolates.
Concluding Thoughts
- The outbreak at the equine hospital emphasized the significance of monitoring ESBL-E in veterinary hospitals for the prevention of major outbreaks.
- The length of hospitalization for equine patients could be a key contributor to the spread of ESBL-E, suggesting that reducing this could mitigate risk.
- The study also underscored the role of certain clinical procedures, such as nasogastric tubing, in the proliferation of ESBL-E. In particular, ESBL-E was found in stomach drench pumps used with nasogaic tubes, suggesting a need for better cleaning and disinfection processes.
Cite This Article
APA
Thomson K, Eskola K, Eklund M, Suominen K, Määttä M, Junnila J, Nykäsenoja S, Niinistö K, Grönthal T, Rantala M.
(2022).
Characterisation of and risk factors for extended-spectrum β-lactamase producing Enterobacterales (ESBL-E) in an equine hospital with a special reference to an outbreak caused by Klebsiella pneumoniae ST307:CTX-M-1.
Acta Vet Scand, 64(1), 4.
https://doi.org/10.1186/s13028-022-00621-6 Publication
Researcher Affiliations
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, PO Box 57, 00014, Helsinki, Finland. katariina.thomson@helsinki.fi.
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, PO Box 57, 00014, Helsinki, Finland.
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, PO Box 57, 00014, Helsinki, Finland.
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, PO Box 66, 00014, Helsinki, Finland.
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, PO Box 57, 00014, Helsinki, Finland.
- Oy 4Pharma Ltd, Arkadiankatu 7, 00100, Helsinki, Finland.
- Finnish Food Authority, PO Box 100, 00027, Helsinki, Finland.
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Helsinki, PO Box 57, 00014, Helsinki, Finland.
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, PO Box 57, 00014, Helsinki, Finland.
- Finnish Food Authority, PO Box 100, 00027, Helsinki, Finland.
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, PO Box 57, 00014, Helsinki, Finland.
MeSH Terms
- Animals
- Anti-Bacterial Agents / therapeutic use
- Disease Outbreaks / veterinary
- Female
- Horse Diseases / drug therapy
- Horse Diseases / epidemiology
- Horses
- Hospitals, Animal
- Hospitals, Teaching
- Humans
- Klebsiella Infections / drug therapy
- Klebsiella Infections / epidemiology
- Klebsiella Infections / veterinary
- Klebsiella pneumoniae
- Microbial Sensitivity Tests / veterinary
- Risk Factors
- beta-Lactamases
Conflict of Interest Statement
The authors declare that they have no competing interests.
References
This article includes 58 references
Citations
This article has been cited 1 times.- Wen X, Luo S, Lv D, Jia C, Zhou X, Zhai Q, Xi L, Yang C. Variations in the fecal microbiota and their functions of Thoroughbred, Mongolian, and Hybrid horses.. Front Vet Sci 2022;9:920080.
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