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Published Date: 2019-04-17 22:36:00
Subject: PRO/AH/EDR> MDR bacteria - UK, Israel: pets
Archive Number: 20190417.6427456
MULTIDRUG RESISTANT BACTERIA - UK, ISRAEL: PETS
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In this post:
[1] UK
[2] Israel: MDR Gram-negative bacteria, petting zoos

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[1] UK
Date: Tue 16 Apr 2019
Source: Medical Xpress, European Society of Clinical Microbiology and Infectious Diseases, press release [edited]
https://medicalxpress.com/news/2019-04-antibiotic-resistance-gene-transmitted-pets.html


A gene that enables bacteria to be highly resistant to linezolid, an antibiotic that is used as a last resort for treating infections in humans, has been found in bacterial samples from cats and a dog at a small-animal hospital in the UK for the 1st time. The new research is being presented at this year's European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam, Netherlands (13-16 Apr 2019).

Linezolid is licensed for the treatment of certain bacterial infections in humans including streptococci and methicillin-resistant staphylococci (MRSA), but it is not used in animals in the UK. However, samples from companion animals in a small-animal hospital in the UK indicated that pets could carry bacteria which are resistant to linezolid.

The new research suggests that there is potential for the gene (optrA) that plays a key role in bacterial resistance to linezolid to spread between different bacterial populations in animals and humans.

"We believe this is the 1st report of optrA-positive enterococci isolated from companion animals in the UK", says Dr Katie Hopkins from Public Health England who led the research. "This is concerning as transmission of this organism to owners carries the potential for spread to other bacteria, including _Staphylococcus aureus_. This may lead to difficult-to-treat infections. In order to minimise transmission of resistant bacteria between companion animals and people veterinary surgeries need to ensure adequate cleaning takes place and pet owners should wash their hands after handling pets."

"Whilst linezolid is not licensed for veterinary use in the UK, optrA also is involved in resistance to florfenicol, which is used in animals. However, standard protocols for the management of colonised or infected animals should prevent transmission to veterinary staff, and therapeutic options (such as, ampicillin or glycopeptides) are available should an infection occur."

Linezolid resistance is still rare in enterococci (less than one percent of bacterial isolates), but has been detected in isolates from both humans and animals, and is most commonly within chromosomal genes making the resistance mechanism stable and incapable of spreading to other bacteria. However, in recent years genes causing resistance to linezolid, such as optrA, have been identified on mobile bits of DNA caused plasmids, meaning that these gene can spread to other bacterial populations.

During routine testing for antibiotic resistance, an _Enterococcus faecalis_ isolate from a cat wound swab was referred by the veterinary diagnostic laboratory to Public Health England's Antimicrobial Resistance and Healthcare Associated Infections Reference Unit. Subsequently, 3 further _E. faecalis_ isolates from other 2 cats and one dog from the same small-animal hospital (but different households) were analysed.

Four isolates from 3 wound swabs (2 cats, one dog), and a 3rd cat rectal swab were confirmed to be resistant to linezolid and gentamicin, but susceptible to the antibiotics teicoplanin, vancomycin, and daptomycin.

Concerningly, all 4 isolates were positive for optrA and there was evidence that there was transmission between animals.

"Our findings further the 'One Health' view that antibiotic-resistant bacteria can be shared by animals and humans, although the direction of transfer is often difficult to prove. We currently do not know the prevalence of linezolid-resistant enterococci in companion animals and therefore a joint approach to monitoring emergence and dissemination of resistance mechanisms of public health importance is needed", says Dr Hopkins. "In this instance, further transmission was stopped by cleaning and decontamination and we have no evidence that any people acquired an infection from these animals."

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[2] Israel: MDR Gram-negative bacteria, petting zoos
Date: Sun 14 Apr 2019
Source: Medical Xpress, European Society of Clinical Microbiology and Infectious Diseases, press release [edited]
https://medicalxpress.com/news/2019-04-petting-zoos-potentially-transmit-highly.html


New research presented at this year's European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam, Netherlands (13-16 Apr 2019) shows that petting zoos can create a diverse reservoir of multidrug resistant (MDR) bacteria, which could lead to highly virulent drug-resistant pathogens being passed on to visitors.

The study is by Professor Shiri Navon-Venezia of Ariel University, Ariel, Israel and colleagues, and aimed to explore the prevalence, molecular epidemiology, and risk factors for animals in petting zoos becoming colonised by MDR bacteria. Petting zoos are a popular attraction around the world, allowing direct and indirect exposure of both children and adults to a diverse range of animal species. They are different from regular zoos because rather than visitors just looking at the animals, petting zoos are interactive with children visiting, holding and petting the animals.

Extended spectrum beta-lactamase (ESBL) and AmpC-producing Enterobacteriaceae (AmpC-E), which are resistant to a number of commonly used antibiotics, have become a matter of great concern in both human and veterinary medicine, so understanding the likelihood of them colonising the animals is critical to evaluating the risk that may be posed to visitors.

The researchers did a study across 8 randomly chosen petting zoos geographically distributed throughout Israel, taking samples of faecal matter as well as from the body surface (skin, fur, or feathers) from 228 animals belonging to 42 different species. Genetic sequencing was used to identify both the species of bacteria in each sample, and the presence of ESBL and AmpC drug resistance genes. Zoo owners were given questionnaires about the ages and medical histories of their animals which were analysed to determine additional risk factors.

In total, 382 samples were collected from 228 animals, and 12 percent of the animals were found to be colonised with at least one ESBL/AmpC-producing bacterial strain, with 35 different recovered species of bacteria. The majority (77 percent) of the MDR bacteria were obtained from faeces, with the remaining 23 percent coming from skin, fur, or feathers. A quarter of those animals which tested positive for drug-resistant bacteria were colonised by more than one bacterial strain. Among the bacterial strains identified, were the highly virulent _E. coli_ ST656, which causes travellers' diarrhoea, and _E. coli_ ST127; a frequent cause of urinary tract infections in humans.

Analysis of the data revealed that if an animal was treated with antibiotics it was 7 times more likely to shed MDR bacteria. The study found that petting zoos provide a reservoir for a diverse range of ESBL/AmpC-E species, and are a potential source for shedding these highly virulent pathogens that may be transmitted to humans -- mostly children -- that occasionally visit these facilities.

Professor Navon-Venezia concludes: "Our findings demonstrate that animals in petting zoos can result in shedding and transmission of MDR pathogens that may cause illness for human visitors, even when the animals appear healthy. We recognise the high educational and emotional value of petting zoos for children, therefore, we strongly recommend that petting zoo management teams implement a strict hygiene and infection control policy, together with rationalised antibiotic policy, in order to reduce the risk of transmission between animals and visitors."

She adds: "Immediate actions by zoo operators should include installation of handwashing stations to ensure proper handwashing before and after petting animals, prohibiting food and drinking near animals, and also not allowing petting of animals receiving antibiotic treatment."

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[The first news article above reports that the optrA gene, a plasmid encoded gene that confers resistance to the oxazolidinones, linezolid and tedizolid, has been found for the 1st time in _Enterococcus faecalis_ isolated from companion animals (namely, 3 cats and a dog from different households) at the same small-animal hospital in the UK. The news report above says that there was evidence for transmission of the optrA gene between animals, but does not say what this evidence was.

Plasmids are mobile genetic elements that allow genes carried by a plasmid to move between bacteria of the same and even different species. Plasmids are also known to carry linked antibiotic resistance genes and selection for resistance to one antibiotic may result in resistance to multiple antibiotics. The 4 enterococcal isolates were resistant to gentamicin as well as the oxazolidinones, but susceptible to the antibiotics teicoplanin, vancomycin, and daptomycin.

In addition to the oxazolidinones, the optrA gene also confers resistance to chloramphenicol and florfenicol. Florfenicol is a fluorinated synthetic analog of chloramphenicol that has been used in veterinary medicine in the U.S. and Europe. Thus, although the oxazolidinones are not used in veterinary medicine, veterinary use of florfenicol could select for resistance to both the oxazolidinones, florfenicol and chloramphenicol. - Mod.ML

The lack of formal or adequate infection control programs in many veterinary facilities combined with space limitations that prevent adequate disinfectant contact time and/or use pose an under-recognized risk when it comes to MDR organisms. Combine that with veterinary facilities and equipment that are rarely designed with disinfection in mind, re-use of single use or difficult to sterilize supplies/equipment, limited or inadequate quarantine spaces, and it all creates a perfect scenario for the spread of these organisms once introduced.

Petting zoos are on the same end of the risk spectrum for zoonotic disease transmission as agricultural fairs and live animal markets with the main question being do the animals infect the people more often than the people infect the animals? - Mod.JH]

See Also

Salmonellosis, st Heidelberg - USA: MDR, cattle contact 20170803.5225307
E. coli EHEC - Israel (02): (HD) 1st rep, kibbutz nursery, petting zoo susp 20160505.4201599
E. coli EHEC - Israel: petting zoo, RFI 20160502.4196559
E. coli EHEC - USA (16): (ME) petting zoo 20151007.3697939
E. coli EHEC - USA (07): (WA) petting zoo, O157 20150516.3365125
E. coli EHEC - USA (02): (WA) petting zoo 20150429.3330419
E. coli EHEC - UK (05): (England) lamb petting zoo, O157 20140506.2454180
E. coli EHEC - Australia (06): (QL) petting zoo, O157 20130908.1930665
E. coli EHEC - Australia: (QL) petting zoo 20130823.1897832
E. coli EHEC - USA (33): (NC, SC) O157, county fair petting zoo 20121018.1350553
E. coli EHEC - UK (06) : (Wales) O157, petting zoo 20120922.1304308
Cryptosporidiosis, petting zoo - USA (02): (MN) 20120422.1109883
E. coli O157 - Canada (02): (BC), petting zoo 20090917.3268
E. coli O157, petting zoos 2004-2005 - USA (multistate) 20051223.3666
Hemolytic uremic syndrome, petting zoo - USA (FL)(08) 20050408.1021
Hemolytic uremia syndrome, petting zoo - USA (FL) 20050324.0852
E. coli 0157, petting zoo - USA (NC) (04) 20041219.3348
E. coli O157, petting zoo - USA (NC) 20041103.2982
E. coli O157, petting zoo - USA (PA): confirmed 20030823.2128
E. coli O157, petting zoo - New Zealand 20020724.4849
E. coli O157, petting zoo - USA (Pennsylvania) 20001105.1929
E. coli, VTEC, cattle, petting zoo - Canada (Ont.) (03) 19991016.1840
E. coli, VTEC, cattle, petting zoo - Canada (Ontario) 19991012.1821
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