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

Background 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:blaCTX-M-1:blaTEM:blaSHV 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.

Variations in the fecal microbiota and their functions of Thoroughbred, Mongolian, and Hybrid horses

“…Enterobacteriaceae are widely distributed in nature; have a broad host range; and are parasitic or symbiotic in humans, animals, and plants. Some genera in the family Enterobacteriaceae, such as Escherichia ( 51 ), Salmonella ( 52 ), Shigella ( 53 ), and Klebsiella ( 54 ), belong to the common opportunistic pathogens. Ruminococcaceae are the main microorganisms that convert primary bile acids into secondary bile acids and are also involved in polysaccharide degradation ( 55 ).…”

Antimicrobial Resistance and Extended-Spectrum Beta-Lactamase Genes in Enterobacterales, Pseudomonas and Acinetobacter Isolates from the Uterus of Healthy Mares

“…were reported in mares with fertility problems [ 62 ] in chronic endometritis and in those without response to antibiotic treatments [ 63 , 64 ]. On the other hand, Klebsiella pneumoniae has been frequently found in respiratory and digestive conditions in horses [ 65 , 66 ]. Enterococcus spp.…”

Genomic characterization of ESBL/AmpC-producing and high-risk clonal lineages of Escherichia coli and Klebsiella pneumoniae in imported dogs with shelter and stray background

“…Another MDR high-risk clonal lineage, K. pneumoniae ST307, which was detected in one of the studied dogs, has been emerging recently around the globe [37] . In Finland, a specific outbreak of K. pneumoniae ST307 was detected in a human patient previously hospitalized in Russia, as well as in an equine hospital [38,39] . In other countries, K. pneumoniae ST307 has been detected amongst healthy and sick dogs [40,41] .…”