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The Journal of antimicrobial chemotherapy2014; 69(10); 2676-2680; doi: 10.1093/jac/dku217

Clonal spread of highly successful ST15-CTX-M-15 Klebsiella pneumoniae in companion animals and horses.

Abstract: To investigate the clinical relevance and molecular epidemiology of extended-spectrum β-lactamase (ESBL)-producing Klebsiella species in animals. Methods: Antimicrobial susceptibilities and presence of ESBLs were examined among Klebsiella spp. (n = 1519) from clinical samples (>1200 senders from Germany and other European countries) mainly from companion animals and horses from October 2008 to March 2010. Multilocus sequence typing (MLST) and PFGE were performed including human isolates for comparative purposes. Results: The overall ESBL rate was 8% for Klebsiella pneumoniae subsp. pneumoniae. Most K. pneumoniae subsp. pneumoniae ESBL producers were isolated from soft tissue infections (29.3%) and urinary tract infections (14.9%). The major ESBL type was CTX-M-15 (85.4%), located on different plasmid scaffolds (HI2, I1, FIA, FIB, FII, A/C, R and N). Other ESBL genes, such as bla(CTX-M-1) (5.6%), bla(CTX-M-3), bla(CTX-M-9), bla(SHV-2) and bla(SHV-12) (1.1% each), were also detected. Additional resistances, e.g. to fluoroquinolones (89.9%), were frequently present. ST15-CTX-M-15, a clonal group that recently emerged in humans, accounted for 75.8% of the strains analysed by MLST and there was evidence for nosocomial events in five veterinary clinics. Human ST15-CTX-M-15 strains shared PFGE clusters with animal isolates, suggesting the dissemination of this clonal group between both populations. Conclusions: Our data indicate a wide spread of ST15-CTX-M-15 K. pneumoniae subsp. pneumoniae, which should be considered as a zoonotic agent of high clinical relevance for humans and animals. Further research should be undertaken to unravel both microevolutionary and biological aspects probably contributing to this global success.
Publication Date: 2014-06-27 PubMed ID: 24974381DOI: 10.1093/jac/dku217Google Scholar: Lookup
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  • Journal Article
  • Research Support
  • Non-U.S. Gov't

Summary

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This study investigates the clinical importance and molecular characteristics of the extended-spectrum β-lactamase (ESBL)-producing Klebsiella species in animals, with a focus on ESBL-producing Klebsiella pneumoniae. The research highlights the spread of a specific clonal group, ST15-CTX-M-15, in both humans and animals, suggesting it as a potentially significant zoonotic agent.

Research Objectives and Methods

  • The purpose of this study was to understand the clinical significance and molecular epidemiology of ESBL-producing Klebsiella species in animals, primarily pets and horses.
  • Klebsiella samples were collected and tested for antimicrobial susceptibilities and presence of ESBLs.
  • Methods involved multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE), including testing isolates from humans for comparison.

Findings and Results

  • The overall ESBL rate was 8% for Klebsiella pneumoniae. Most of the time, these ESBL-producing bacteria were found in soft tissue infections and urinary tract infections.
  • The predominant ESBL type was CTX-M-15, found in 85.4% of the cases. This type was located on various plasmid scaffolds. Other ESBL genes were also detected, though at much lower rates.
  • In addition to ESBL, the Klebsiella pneumoniae showed resistance to other antibiotics, such as fluoroquinolones, in a significant majority of cases (89.9%).
  • ST15-CTX-M-15, a clonal group that recently emerged in humans, accounted for 75.8% of the strains analyzed. Clusters of human ST15-CTX-M-15 shared similarities with animal isolates, suggesting a possible cross-transmission between humans and animals.

Conclusion and Implications

  • The research concludes that the wide spread of ST15-CTX-M-15 K. pneumoniae is a critical concern both in human and veterinary medicine. It suggests that this strain is a zoonotic agent, meaning it can pass between animals and humans.
  • The dissemination of the ST15-CTX-M-15 clonal group calls for further research to understand the microevolutionary and biological aspects that contribute to its success. This research could lead to better control and prevention strategies for ESBL-producing Klebsiella infections across both human and animal health.

Cite This Article

APA
Ewers C, Stamm I, Pfeifer Y, Wieler LH, Kopp PA, Schønning K, Prenger-Berninghoff E, Scheufen S, Stolle I, Günther S, Bethe A. (2014). Clonal spread of highly successful ST15-CTX-M-15 Klebsiella pneumoniae in companion animals and horses. J Antimicrob Chemother, 69(10), 2676-2680. https://doi.org/10.1093/jac/dku217

Publication

ISSN: 1460-2091
NlmUniqueID: 7513617
Country: England
Language: English
Volume: 69
Issue: 10
Pages: 2676-2680

Researcher Affiliations

Ewers, Christa
  • Institute of Hygiene and Infectious Diseases of Animals, Justus-Liebig-Universität Giessen, Giessen, Germany christa.ewers@vetmed.uni-giessen.de.
Stamm, Ivonne
  • Vet Med Labor GmbH, Division of IDEXX Laboratories, Ludwigsburg, Germany.
Pfeifer, Yvonne
  • Robert Koch Institute, FG13 Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany.
Wieler, Lothar H
  • Institute of Microbiology and Epizootics, Centre for Infection Medicine, Freie Universität Berlin, Berlin, Germany.
Kopp, Peter A
  • Vet Med Labor GmbH, Division of IDEXX Laboratories, Ludwigsburg, Germany.
Schønning, K
  • Department of Clinical Microbiology 445, Hvidovre Hospital, Hvidovre, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Prenger-Berninghoff, Ellen
  • Institute of Hygiene and Infectious Diseases of Animals, Justus-Liebig-Universität Giessen, Giessen, Germany.
Scheufen, Sandra
  • Institute of Hygiene and Infectious Diseases of Animals, Justus-Liebig-Universität Giessen, Giessen, Germany.
Stolle, Inka
  • Institute of Hygiene and Infectious Diseases of Animals, Justus-Liebig-Universität Giessen, Giessen, Germany.
Günther, Sebastian
  • Institute of Microbiology and Epizootics, Centre for Infection Medicine, Freie Universität Berlin, Berlin, Germany.
Bethe, Astrid
  • Institute of Microbiology and Epizootics, Centre for Infection Medicine, Freie Universität Berlin, Berlin, Germany.

MeSH Terms

  • Animal Diseases / microbiology
  • Animals
  • Anti-Bacterial Agents / pharmacology
  • Conjugation, Genetic
  • Genotype
  • Horse Diseases / microbiology
  • Horses
  • Klebsiella Infections / veterinary
  • Klebsiella pneumoniae / classification
  • Klebsiella pneumoniae / drug effects
  • Klebsiella pneumoniae / genetics
  • Microbial Sensitivity Tests
  • Multilocus Sequence Typing
  • Phenotype
  • Phylogeny
  • beta-Lactam Resistance / genetics
  • beta-Lactamases / genetics

Citations

This article has been cited 45 times.
  1. Dabos L, Raczynska JE, Bogaerts P, Zavala A, Girlich D, Bonnin RA, Dortet L, Peyrat A, Retailleau P, Iorga BI, Jaskólski M, Glupczynski Y, Naas T. Structural and Biochemical Features of OXA-517: a Carbapenem and Expanded-Spectrum Cephalosporin Hydrolyzing OXA-48 Variant.. Antimicrob Agents Chemother 2023 Feb 16;67(2):e0109522.
    doi: 10.1128/aac.01095-22pubmed: 36648230google scholar: lookup
  2. Tietgen M, Sedlaczek L, Higgins PG, Kaspar H, Ewers C, Göttig S. Colistin Resistance Mechanisms in Human and Veterinary Klebsiella pneumoniae Isolates.. Antibiotics (Basel) 2022 Nov 21;11(11).
    doi: 10.3390/antibiotics11111672pubmed: 36421315google scholar: lookup
  3. de Sousa ATHI, Costa MTDS, Cândido SL, Makino H, Morgado TO, Pavelegini LAD, Colodel EM, Nakazato L, Dutra V. Determination of multidrug-resistant populations and molecular characterization of complex Klebsiella spp. in wild animals by multilocus sequence typing.. Vet World 2022 Jul;15(7):1691-1698.
  4. Muñoz-Ibarra E, Molina-López RA, Durán I, Garcias B, Martín M, Darwich L. Antimicrobial Resistance in Bacteria Isolated from Exotic Pets: The Situation in the Iberian Peninsula.. Animals (Basel) 2022 Jul 27;12(15).
    doi: 10.3390/ani12151912pubmed: 35953901google scholar: lookup
  5. Davies YM, Cunha MPV, Dropa M, Lincopan N, Gomes VTM, Moreno LZ, Sato MIZ, Moreno AM, Knöbl T. Pandemic Clones of CTX-M-15 Producing Klebsiella pneumoniae ST15, ST147, and ST307 in Companion Parrots.. Microorganisms 2022 Jul 13;10(7).
  6. Stair MI, Carrasco SE, Annamalai D, Jordan EB, Mannion A, Feng Y, Fabian N, Ge Z, Muthupalani S, Dzink-Fox J, Krzisch MA, Fox JG. The Epidemiology of Invasive, Multipleantibiotic-resistant Klebsiella pneumoniae Infection in a Breeding Colony of Immunocompromised NSG Mice.. Comp Med 2022 Aug 1;72(4):220-229.
    doi: 10.30802/AALAS-CM-21-000088pubmed: 35882504google scholar: lookup
  7. Arafa AA, Hedia RH, Dorgham SM, Ibrahim ES, Bakry MA, Abdalhamed AM, Abuelnaga ASM. Determination of extended-spectrum β-lactamase-producing Klebsiella pneumoniae isolated from horses with respiratory manifestation.. Vet World 2022 Apr;15(4):827-833.
  8. Zhang Z, Zhang L, Dai H, Zhang H, Song Y, An Q, Wang J, Xia Z. Multidrug-Resistant Klebsiella pneumoniae Complex From Clinical Dogs and Cats in China: Molecular Characteristics, Phylogroups, and Hypervirulence-Associated Determinants.. Front Vet Sci 2022;9:816415.
    doi: 10.3389/fvets.2022.816415pubmed: 35359688google scholar: lookup
  9. Wareth G, Linde J, Hammer P, Pletz MW, Neubauer H, Sprague LD. WGS-Based Phenotyping and Molecular Characterization of the Resistome, Virulome and Plasmid Replicons in Klebsiella pneumoniae Isolates from Powdered Milk Produced in Germany.. Microorganisms 2022 Mar 5;10(3).
  10. Garcia-Fierro R, Drapeau A, Dazas M, Saras E, Rodrigues C, Brisse S, Madec JY, Haenni M. Comparative phylogenomics of ESBL-, AmpC- and carbapenemase-producing Klebsiella pneumoniae originating from companion animals and humans.. J Antimicrob Chemother 2022 Apr 27;77(5):1263-1271.
    doi: 10.1093/jac/dkac041pubmed: 35224624google scholar: lookup
  11. Nielsen SS, Bicout DJ, Calistri P, Canali E, Drewe JA, Garin-Bastuji B, Gonzales Rojas JL, Gortazar Schmidt C, Herskin M, Michel V, Miranda Chueca MA, Padalino B, Pasquali P, Roberts HC, Sihvonen LH, Spoolder H, Stahl K, Velarde A, Viltrop A, Winckler C, Dewulf J, Guardabassi L, Hilbert F, Mader R, Baldinelli F, Alvarez J. Assessment of animal diseases caused by bacteria resistant to antimicrobials: Horses.. EFSA J 2021 Dec;19(12):e07112.
    doi: 10.2903/j.efsa.2021.7112pubmed: 34987627google scholar: lookup
  12. Hassan B, Ijaz M, Khan A, Sands K, Serfas GI, Clayfield L, El-Bouseary MM, Lai G, Portal E, Khan A, Watkins WJ, Parkhill J, Walsh TR. A role for arthropods as vectors of multidrug-resistant Enterobacterales in surgical site infections from South Asia.. Nat Microbiol 2021 Oct;6(10):1259-1270.
    doi: 10.1038/s41564-021-00965-1pubmed: 34580444google scholar: lookup
  13. Carvalho I, Chenouf NS, Carvalho JA, Castro AP, Silva V, Capita R, Alonso-Calleja C, Enes Dapkevicius MLN, Igrejas G, Torres C, Poeta P. Multidrug-resistant Klebsiella pneumoniae harboring extended spectrum β-lactamase encoding genes isolated from human septicemias.. PLoS One 2021;16(5):e0250525.
    doi: 10.1371/journal.pone.0250525pubmed: 33945553google scholar: lookup
  14. Nesporova K, Valcek A, Papagiannitsis C, Kutilova I, Jamborova I, Davidova-Gerzova L, Bitar I, Hrabak J, Literak I, Dolejska M. Multi-Drug Resistant Plasmids with ESBL/AmpC and mcr-5.1 in Paraguayan Poultry Farms: The Linkage of Antibiotic Resistance and Hatcheries.. Microorganisms 2021 Apr 17;9(4).
    doi: 10.3390/microorganisms9040866pubmed: 33920558google scholar: lookup
  15. Lee D, Oh JY, Sum S, Park HM. Prevalence and antimicrobial resistance of Klebsiella species isolated from clinically ill companion animals.. J Vet Sci 2021 Mar;22(2):e17.
    doi: 10.4142/jvs.2021.22.e17pubmed: 33774933google scholar: lookup
  16. Zhang Z, Lei L, Zhang H, Dai H, Song Y, Li L, Wang Y, Xia Z. Molecular Investigation of Klebsiella pneumoniae from Clinical Companion Animals in Beijing, China, 2017-2019.. Pathogens 2021 Feb 27;10(3).
    doi: 10.3390/pathogens10030271pubmed: 33673656google scholar: lookup
  17. Wareth G, Neubauer H. The Animal-foods-environment interface of Klebsiella pneumoniae in Germany: an observational study on pathogenicity, resistance development and the current situation.. Vet Res 2021 Feb 8;52(1):16.
    doi: 10.1186/s13567-020-00875-wpubmed: 33557913google scholar: lookup
  18. Khdary HN, Almalki A, Alkhdiri MH Jr, Alhamoudi S, Alfaleh A, Alghoribi MF, Uz Zaman T. Investigation on the Genetic Signatures of Antibiotic Resistance in Multi-Drug-Resistant Klebsiella Pneumoniae Isolates From National Guard Hospital, Riyadh.. Cureus 2020 Nov 1;12(11):e11288.
    doi: 10.7759/cureus.11288pubmed: 33154861google scholar: lookup
  19. Khalifa HO, Oreiby AF, Abd El-Hafeez AA, Okanda T, Haque A, Anwar KS, Tanaka M, Miyako K, Tsuji S, Kato Y, Matsumoto T. First Report of Multidrug-Resistant Carbapenemase-Producing Bacteria Coharboring mcr-9 Associated with Respiratory Disease Complex in Pets: Potential of Animal-Human Transmission.. Antimicrob Agents Chemother 2020 Dec 16;65(1).
    doi: 10.1128/AAC.01890-20pubmed: 33139280google scholar: lookup
  20. De Oliveira DMP, Forde BM, Kidd TJ, Harris PNA, Schembri MA, Beatson SA, Paterson DL, Walker MJ. Antimicrobial Resistance in ESKAPE Pathogens.. Clin Microbiol Rev 2020 Jun 17;33(3).
    doi: 10.1128/CMR.00181-19pubmed: 32404435google scholar: lookup
  21. Horváth M, Kovács T, Koderivalappil S, Ábrahám H, Rákhely G, Schneider G. Identification of a newly isolated lytic bacteriophage against K24 capsular type, carbapenem resistant Klebsiella pneumoniae isolates.. Sci Rep 2020 Apr 3;10(1):5891.
    doi: 10.1038/s41598-020-62691-8pubmed: 32246126google scholar: lookup
  22. Sukmawinata E, Uemura R, Sato W, Thu Htun M, Sueyoshi M. Multidrug-Resistant ESBL/AmpC-Producing Klebsiella pneumoniae Isolated from Healthy Thoroughbred Racehorses in Japan.. Animals (Basel) 2020 Feb 25;10(3).
    doi: 10.3390/ani10030369pubmed: 32106501google scholar: lookup
  23. Loncaric I, Cabal Rosel A, Szostak MP, Licka T, Allerberger F, Ruppitsch W, Spergser J. Broad-Spectrum Cephalosporin-Resistant Klebsiella spp. Isolated from Diseased Horses in Austria.. Animals (Basel) 2020 Feb 20;10(2).
    doi: 10.3390/ani10020332pubmed: 32093201google scholar: lookup
  24. Shnaiderman-Torban A, Navon-Venezia S, Dor Z, Paitan Y, Arielly H, Ahmad WA, Kelmer G, Fulde M, Steinman A. Extended-Spectrum β-lactamase-Producing Enterobacteriaceae Shedding in Farm Horses Versus Hospitalized Horses: Prevalence and Risk Factors.. Animals (Basel) 2020 Feb 11;10(2).
    doi: 10.3390/ani10020282pubmed: 32054111google scholar: lookup
  25. Hordijk J, Farmakioti E, Smit LAM, Duim B, Graveland H, Theelen MJP, Wagenaar JA. Fecal Carriage of Extended-Spectrum-β-Lactamase/AmpC-Producing Escherichia coli in Horses.. Appl Environ Microbiol 2020 Apr 1;86(8).
    doi: 10.1128/AEM.02590-19pubmed: 32033947google scholar: lookup
  26. Sahoo RK, Das A, Sahoo S, Gaur M, Rao EV, Subudhi E. The first report of colistin-carbapenem resistance in Klebsiella pneumoniae ST70 isolated from the pediatric unit in India.. Braz J Microbiol 2020 Mar;51(1):1-3.
    doi: 10.1007/s42770-019-00181-4pubmed: 31707716google scholar: lookup
  27. Bourély C, Cazeau G, Jarrige N, Jouy E, Haenni M, Lupo A, Madec JY, Leblond A, Gay E. Co-resistance to Amoxicillin and Tetracycline as an Indicator of Multidrug Resistance in Escherichia coli Isolates From Animals.. Front Microbiol 2019;10:2288.
    doi: 10.3389/fmicb.2019.02288pubmed: 31649635google scholar: lookup
  28. Zhang W, Zhu Y, Wang C, Liu W, Li R, Chen F, Luan T, Zhang Y, Schwarz S, Liu S. Characterization of a Multidrug-Resistant Porcine Klebsiella pneumoniae Sequence Type 11 Strain Coharboring bla(KPC-2) and fosA3 on Two Novel Hybrid Plasmids.. mSphere 2019 Sep 11;4(5).
    doi: 10.1128/mSphere.00590-19pubmed: 31511369google scholar: lookup
  29. Trigo da Roza F, Couto N, Carneiro C, Cunha E, Rosa T, Magalhães M, Tavares L, Novais Â, Peixe L, Rossen JW, Lamas LP, Oliveira M. Commonality of Multidrug-Resistant Klebsiella pneumoniae ST348 Isolates in Horses and Humans in Portugal.. Front Microbiol 2019;10:1657.
    doi: 10.3389/fmicb.2019.01657pubmed: 31379799google scholar: lookup
  30. Hong JS, Song W, Park HM, Oh JY, Chae JC, Shin S, Jeong SH. Clonal Spread of Extended-Spectrum Cephalosporin-Resistant Enterobacteriaceae Between Companion Animals and Humans in South Korea.. Front Microbiol 2019;10:1371.
    doi: 10.3389/fmicb.2019.01371pubmed: 31275286google scholar: lookup
  31. Bortolami A, Zendri F, Maciuca EI, Wattret A, Ellis C, Schmidt V, Pinchbeck G, Timofte D. Diversity, Virulence, and Clinical Significance of Extended-Spectrum β-Lactamase- and pAmpC-Producing Escherichia coli From Companion Animals.. Front Microbiol 2019;10:1260.
    doi: 10.3389/fmicb.2019.01260pubmed: 31231344google scholar: lookup
  32. Marques C, Belas A, Aboim C, Cavaco-Silva P, Trigueiro G, Gama LT, Pomba C. Evidence of Sharing of Klebsiella pneumoniae Strains between Healthy Companion Animals and Cohabiting Humans.. J Clin Microbiol 2019 Jun;57(6).
    doi: 10.1128/JCM.01537-18pubmed: 30944193google scholar: lookup
  33. Harada K, Shimizu T, Ozaki H, Kimura Y, Miyamoto T, Tsuyuki Y. Characterization of Antimicrobial Resistance in Serratia spp. and Citrobacter spp. Isolates from Companion Animals in Japan: Nosocomial Dissemination of Extended-Spectrum Cephalosporin-Resistant Citrobacter freundii.. Microorganisms 2019 Feb 28;7(3).
    doi: 10.3390/microorganisms7030064pubmed: 30823419google scholar: lookup
  34. Daehre K, Projahn M, Friese A, Semmler T, Guenther S, Roesler UH. ESBL-Producing Klebsiella pneumoniae in the Broiler Production Chain and the First Description of ST3128.. Front Microbiol 2018;9:2302.
    doi: 10.3389/fmicb.2018.02302pubmed: 30337912google scholar: lookup
  35. Pulss S, Stolle I, Stamm I, Leidner U, Heydel C, Semmler T, Prenger-Berninghoff E, Ewers C. Multispecies and Clonal Dissemination of OXA-48 Carbapenemase in Enterobacteriaceae From Companion Animals in Germany, 2009-2016.. Front Microbiol 2018;9:1265.
    doi: 10.3389/fmicb.2018.01265pubmed: 29963026google scholar: lookup
  36. Dabos L, Bogaerts P, Bonnin RA, Zavala A, Sacré P, Iorga BI, Huang DT, Glupczynski Y, Naas T. Genetic and Biochemical Characterization of OXA-519, a Novel OXA-48-Like β-Lactamase.. Antimicrob Agents Chemother 2018 Aug;62(8).
    doi: 10.1128/AAC.00469-18pubmed: 29866857google scholar: lookup
  37. Zaman TU, Alrodayyan M, Albladi M, Aldrees M, Siddique MI, Aljohani S, Balkhy HH. Clonal diversity and genetic profiling of antibiotic resistance among multidrug/carbapenem-resistant Klebsiella pneumoniae isolates from a tertiary care hospital in Saudi Arabia.. BMC Infect Dis 2018 May 3;18(1):205.
    doi: 10.1186/s12879-018-3114-9pubmed: 29724185google scholar: lookup
  38. Zogg AL, Simmen S, Zurfluh K, Stephan R, Schmitt SN, Nüesch-Inderbinen M. High Prevalence of Extended-Spectrum β-Lactamase Producing Enterobacteriaceae Among Clinical Isolates From Cats and Dogs Admitted to a Veterinary Hospital in Switzerland.. Front Vet Sci 2018;5:62.
    doi: 10.3389/fvets.2018.00062pubmed: 29662886google scholar: lookup
  39. Klotz P, Jacobmeyer L, Leidner U, Stamm I, Semmler T, Ewers C. Acinetobacter pittii from Companion Animals Coharboring bla(OXA-58), the tet(39) Region, and Other Resistance Genes on a Single Plasmid.. Antimicrob Agents Chemother 2018 Jan;62(1).
    doi: 10.1128/AAC.01993-17pubmed: 29109166google scholar: lookup
  40. Skaradzińska A, Śliwka P, Kuźmińska-Bajor M, Skaradziński G, Rząsa A, Friese A, Roschanski N, Murugaiyan J, Roesler UH. The Efficacy of Isolated Bacteriophages from Pig Farms against ESBL/AmpC-Producing Escherichia coli from Pig and Turkey Farms.. Front Microbiol 2017;8:530.
    doi: 10.3389/fmicb.2017.00530pubmed: 28405193google scholar: lookup
  41. Harada K, Shimizu T, Mukai Y, Kuwajima K, Sato T, Usui M, Tamura Y, Kimura Y, Miyamoto T, Tsuyuki Y, Ohki A, Kataoka Y. Phenotypic and Molecular Characterization of Antimicrobial Resistance in Klebsiella spp. Isolates from Companion Animals in Japan: Clonal Dissemination of Multidrug-Resistant Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae.. Front Microbiol 2016;7:1021.
    doi: 10.3389/fmicb.2016.01021pubmed: 27446056google scholar: lookup
  42. Timofte D, Maciuca IE, Williams NJ, Wattret A, Schmidt V. Veterinary Hospital Dissemination of CTX-M-15 Extended-Spectrum Beta-Lactamase-Producing Escherichia coli ST410 in the United Kingdom.. Microb Drug Resist 2016 Oct;22(7):609-615.
    doi: 10.1089/mdr.2016.0036pubmed: 27314838google scholar: lookup
  43. Davis GS, Waits K, Nordstrom L, Weaver B, Aziz M, Gauld L, Grande H, Bigler R, Horwinski J, Porter S, Stegger M, Johnson JR, Liu CM, Price LB. Intermingled Klebsiella pneumoniae Populations Between Retail Meats and Human Urinary Tract Infections.. Clin Infect Dis 2015 Sep 15;61(6):892-9.
    doi: 10.1093/cid/civ428pubmed: 26206847google scholar: lookup
  44. Gao L, Tan Y, Zhang X, Hu J, Miao Z, Wei L, Chai T. Emissions of Escherichia coli carrying extended-spectrum β-lactamase resistance from pig farms to the surrounding environment.. Int J Environ Res Public Health 2015 Apr 16;12(4):4203-13.
    doi: 10.3390/ijerph120404203pubmed: 25893997google scholar: lookup
  45. Wohlwend N, Endimiani A, Francey T, Perreten V. Third-generation-cephalosporin-resistant Klebsiella pneumoniae isolates from humans and companion animals in Switzerland: spread of a DHA-producing sequence type 11 clone in a veterinary setting.. Antimicrob Agents Chemother 2015 May;59(5):2949-55.
    doi: 10.1128/AAC.04408-14pubmed: 25733505google scholar: lookup