Monitoring the Prevalence of Antimicrobial Resistance in Companion Animals: Results from Clinical Isolates in an Italian University Veterinary Hospital

The role of companion animals in the spread of antimicrobial resistance (AMR) is still not well known. As part of a wider surveillance system, this study aimed to provide data about AMR in bacterial isolates from infections in companion animals referred to an Italian University Veterinary Hospital (VUH) from November 2020 to September 2022. A total of 940 isolates were identified with MALDI-TOF MS and subsequently the antimicrobial susceptibility test (AST) for 12 antimicrobials was performed. Urine was the most commonly submitted specimen (54.92%) and Escherichia coli was the most common bacterial species isolated (36.06%). Out of the 940 isolates, 747 (79.47%) were nonsusceptible to at least one drug (AMR), while 420 (44.68%) were considered multidrug resistant (MDR). The highest nonsusceptibility percentages were recorded for clindamycin (59.65 %), erythromycin (58.96 %), ampicillin (52.85%), and enrofloxacin (48.19%). Alarming percentages were recorded also for ceftiofur (25.51%), amoxicillin–clavulanate (22.99%), and piperacillin–tazobactam (15.85%). In multivariable risk factors analysis, previous use of invasive devices ( in both cases) and previous use of antimicrobials ( in both cases) were statistically related with higher AMR and MDR percentages. Apart from a general evaluation, the study focused on specific bacterial species (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) and specimens (blood cultures, urine from suspected healthcare-associated urinary tract infections, and surgical site infections), showing in both cases higher AMR and MDR percentages compared to average. These data highlight the urgency to further investigate AMR spread in pets and how passive surveillance systems can be effective tools to monitor AMR and to optimize antimicrobial use

High Risk of Secondary Infections Following Thrombotic Complications in Patients With COVID-19

Background. This study’s primary aim was to evaluate the impact of thrombotic complications on the development of secondary infections. The secondary aim was to compare the etiology of secondary infections in patients with and without thrombotic complications. Methods. This was a cohort study (NCT04318366) of coronavirus disease 2019 (COVID-19) patients hospitalized at IRCCS San Raffaele Hospital between February 25 and June 30, 2020. Incidence rates (IRs) were calculated by univariable Poisson regression as the number of cases per 1000 person-days of follow-up (PDFU) with 95% confidence intervals. The cumulative incidence functions of secondary infections according to thrombotic complications were compared with Gray’s method accounting for competing risk of death. A multivariable Fine-Gray model was applied to assess factors associated with risk of secondary infections. Results. Overall, 109/904 patients had 176 secondary infections (IR, 10.0; 95% CI, 8.8–11.5; per 1000-PDFU). The IRs of secondary infections among patients with or without thrombotic complications were 15.0 (95% CI, 10.7–21.0) and 9.3 (95% CI, 7.9–11.0) per 1000-PDFU, respectively (P = .017). At multivariable analysis, thrombotic complications were associated with the development of secondary infections (subdistribution hazard ratio, 1.788; 95% CI, 1.018–3.140; P = .043). The etiology of secondary infections was similar in patients with and without thrombotic complications. Conclusions. In patients with COVID-19, thrombotic complications were associated with a high risk of secondary infections

Case report: First isolation of Yersinia pseudotuberculosis from the blood of a cat

: A 14-year-old female domestic short-haired cat with a diagnosed diabetes mellitus and acromegaly was presented for lethargy and dysorexia. On clinical presentation, the patient showed hyperglycemia, hyperthermia, dull mentation, and dehydration. With the suspicion of an inflammatory or infectious complication of diabetes, she was hospitalized with constant rate infusion of insulin, and empirical ampicillin sulbactam was started. Blood culture revealed positivity for Yersinia pseudotuberculosis and the septic picture was confirmed by blood analysis, with leukocytosis, neutrophilia, and an increased serum amyloid A concentration. The isolated Y. pseudotuberculosis strain showed susceptibility to every antimicrobial tested. During the second day of hospitalization, the onset of hypoglycemia and hypotension was treated with norepinephrine and glucose in fluid therapy. The cat recovered well and was discharged with insulin and amoxicillin-clavulanate. This is the first case of septicemia associated with Y. pseudotuberculosis in a cat, suspected of developing the infection after contact with natural reservoirs such as rodents or birds. This route of transmission should be highlighted especially in relation to the zoonotic potential of the bacteria

Prevalence and Patterns of Antimicrobial Resistance among <i>Escherichia coli</i> and <i>Staphylococcus</i> spp. in a Veterinary University Hospital

The occurrence of antimicrobial resistance in commensal strains of Escherichia coli and Staphylococcus spp. was investigated in 320 samples collected from patients and the environment of a veterinary university hospital—specifically, the consultation area (CA) and intensive care unit (ICU). E. coli was isolated in 70/160 samples (44%), while Staphylococcus spp. were isolated in 110/160 (69%) samples. The occurrence of multidrug-resistant (MDR) isolates from CA and ICU admission were similar for E. coli (1/12 (8%) versus 4/27 (15%), respectively) and Staphylococcus spp. (10/19 (53%) versus 26/50 (52%), respectively). MDR E. coli isolates increased significantly at hospital discharge (18/31; 58%; p = 0.008). Antimicrobial treatment administered during hospitalization was a risk factor for carriage of MDR E. coli (OR, 23.9; 95% CI: 1.18–484.19; p = 0.04) and MDR Staphylococcus spp. (OR, 19.5; 95% CI 1.30–292.76; p = 0.02), respectively. The odds ratio for MDR E. coli was 41.4 (95% CI 2.13–806.03; p = 0.01), if the administration of fluoroquinolones was evaluated. The mecA gene was detected in 19/24 (79%) coagulase-positive Staphylococcus spp. isolates resistant to oxacillin. High rates of MDR Staphylococcus spp. were reported. Hospitalization in the ICU and antimicrobial treatment were risk factors for colonization by MDR commensal bacteria

PULSED ACTIVE SURVEILLANCE FOR THE EVALUATION OF COMMENSAL ANTIMICROBIC RESISTANT BACTERIA IN A SMALL ANIMAL VETERINARY UNIVERSITY HOSPITAL: PRELIMINARY RESULTS

Emergence of multidrug-resistant (MDR) bacteria is a massive threat to both human and animal health. Veterinary University Hospitals (VUHs) are considered high-risk environments for the selection and transmission of MDR agents (1) due to the high-density of referred patients and the presence of students. Some of the most frequently isolated MDR bacteria in veterinary medicine are extended-spectrum betalactamase (ESBL) and carbapenemase (CPE)-producing Enterobacteriaceae and methicillin-resistant Staphylococci (MRS). Those MDR bacteria are frequently involved in healthcare-associated infections (HAIs) and outbreaks (2). Like in human settings, a microbiological surveillance system is an important tool to estimate MDR bacteria rates, as well as to prevent HAIs and to serve as a database for infection control. Since November 2020, a surveillance plan has started at the Small Animal Clinic of the Bologna VUH. This plan includes a pulsed active surveillance with periodic sessions of one month, performed every four-months, that aimed at monitoring asymptomatic MDR bacteria carriers rate at the time of hospital admission and at discharge, MDR bacteria-associated risk factors, the % of MDR bacteria acquisition and its trend over time. For every session, 25 patients, hospitalized for at least 48 hours, were sampled at the time of hospital admission and before discharge. Rectal and oral swabs were respectively cultured into selective media for ESBL and CPE-producing Enterobacteriaceae, and for MRS. Owners of included pets were asked to fill a consent form, as well as to fill a survey to investigate potential risk factors for MDR exposure (e.g., comorbidities, previous antimicrobial treatments, ...). Preliminary results obtained from 3 sessions of pulsed active surveillance and a total of 75 investigated patients indicated a % of MDR bacteria carriage of 45,3% (95% CI, 34- 56,6) at the admission and of 65,3% (95% CI, 54,5-76,1) at discharge, with a % of MDR acquisition of 38,3% (95% CI, 27,3-49,3). Risk factors for acquisition were &gt;6 days of hospitalization (p=0.017844) and antimicrobial treatment during hospital stay (p=0.01357). ESBL-producing Escherichia coli was the most frequently isolated species. Those preliminary results need to be extended in terms of number of patients and further analyzed by genotypic and phenotypic characterizations of isolates to better define resistance patterns and perform an epidemiologic evaluation

Active surveillance of antimicrobial resistance in companion animals: A pilot study in a Spanish Veterinary Teaching Hospital

Abbreviations: AMR, antimicrobial resistance; AMRO, antimicrobial-resistant organisms; AST, antimicrobial susceptibility testing; CDT, combination disc test; CRGNB, carbapenem-resistant gram-negative bacteria; ESBL-E, extended spectrum beta-lactamases producing Enterobacterales; ESCMID, European Society of Clinical Microbiology and Infectious Diseases; EUCAST, European Committee of Antimicrobial Suceptibility Testing; HCAI, healthcare-associated infections; MALDI-TOF, matrix-assisted laser desorption/ionization time of flight; MRS, methicillin-resistant Staphylococci; MRSA, methicillin-resistant Staphylococcus aureus; MRSP, methicillin-resistant Staphylococcus pseudintermedius; 3GCR-GNB, 3rd generation cephalosporins-resistant gram-negative bacteria; VTH, veterinary teaching hospital. Authorship contribution statement: Marta Perez Sancho: Writing – review & editing, Visualization, Validation, Project administration, Methodology, Formal analysis, Data curation. Miriam Portero Fuentes: Visualization, Resources, investigation. Jose Luis Blanco: Writing – review & editing, Visualization, Validation, Supervision, Resources, Project administration, Formal analysis, Conceptualization. Marta Eulalia Garcia: Writing – review & editing, Supervision, Resources, Project administration, Conceptualization. Laura Leal Velez De Mendizabal: ´ Writing – review & editing, Methodology, Investigation. Sergio Quevedo Caraballo: Investigation. Silvia Piva: Writing – review & editing, Validation, Supervision, Resources, Funding acquisition. Raffaele Scarpellini: Writing – review & editing, Writing – original draft, Project administration, Methodology, Investigation, Data curation, Conceptualization. Erika Esposito: Data curation, Conceptualization. Elisabetta Mondo: Visualization. Silvia Penelo: Resources, Investigation.The role of small animal veterinary hospitals in the onset and dissemination of antimicrobial-resistant organisms (AMROs) is still not clear, and the implementation of an internal surveillance systems is a cost-effective tool to better understand their impact. The aim of this study was to describe a pilot program of active surveillance in a Spanish Veterinary Teaching Hospital, developed to estimate the detection frequency of AMROs in the commensal flora of patients and in the environment. Surveillance was focused on Methicillin-resistant Staphylococci (MRS), third generation cephalosporins resistant gram-negative bacteria (3GCR-GNB), and carbapenems-resistant gram-negative bacteria (CR-GNB). Oral and perirectal swabs were collected in the same dogs and cats hospitalized > 48 h, at their admission and before their discharge. Out of 50 patients sampled, 24% (12/50) were carriers at admission of at least one of the three investigated AMROs. Twenty-eight percent of patients (14/50) acquired at least one AMRO during the hospital stay. MRS detection frequency at admission was 12% (6/50), while acquisition was 6% (3/50). 3GCR-GNB detection frequency was 14% at admission (7/50) and acquisition 22% (11/50), while CR-GNB detection frequency was 2% at admission (1/50) and acquisition 2% (1/50). Environmental surveillance (98 samples) showed a total detection frequency of 22.4% for MRS (22/98), 2% for 3GCR-GNB and CR-GNB (2/98). Clinical staff’ shoe soles showed high detection frequency for MRS (50%). 3GCR Escherichia coli was the most isolated species in patients (n = 17). The results show how active surveillance can be used as a tool to assess the impact of AMROs in veterinary hospitals to subsequently build up tailored control plans based on specific issues.Depto. de Sanidad AnimalFac. de VeterinariaTRUEpu