Poor infection prevention and control standards are associated with environmental contamination with carbapenemase-producing Enterobacterales and other multidrug-resistant bacteria in Swiss companion animal clinics

Janne S Schmidt; Stefan P Kuster; Aurélien Nigg; Valentina Dazio; Michael Brilhante; Helene Rohrbach; Odette J Bernasconi; Thomas Büdel; Edgar I Campos-Madueno; Stefanie Gobeli Brawand; Simone Schuller; Andrea Endimiani; Vincent Perreten; Barbara Willi

doi:10.1186/s13756-020-00742-5

Poor infection prevention and control standards are associated with environmental contamination with carbapenemase-producing Enterobacterales and other multidrug-resistant bacteria in Swiss companion animal clinics

Antimicrob Resist Infect Control. 2020 Jun 23;9(1):93. doi: 10.1186/s13756-020-00742-5.

Authors

Affiliations

¹ Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
² Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Zurich, Zurich, Switzerland.
³ Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
⁴ Division of Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
⁵ Graduate School of Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland.
⁶ Small Animal Clinic, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
⁷ Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland.
⁸ Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland. bwilli@vetclinics.uzh.ch.

Abstract

Background: Intensive medical care in companion animal clinics could pose a risk for the selection and dissemination of multidrug-resistant organisms (MDROs). Infection prevention and control (IPC) concepts are key measures to reduce the spread of MDROs, but data on IPC standards in companion animal clinics is sparse. The study assessed IPC standards in seven companion animal clinics and practices in Switzerland by structured IPC audits and combined results with environmental MDRO contamination and MDRO carriage of the personnel.

Methods: IPC audits were held between August 2018 and January 2019. The observations in 34 IPC areas were scored based on predefined criteria (not fulfilled/partially fulfilled/fulfilled = score 0/1/2). Environmental swabs and nasal and stool samples from veterinary personnel were tested for methicillin-resistant (MR) staphylococci and macrococci and for colistin-resistant, extended-spectrum β-lactamase- and carbapenemase-producing (CP) Enterobacterales (CPE). Species was identified by MALDI-TOF MS, antimicrobial resistance determined by microdilution and β-lactam resistance gene detection, and genetic relatedness assessed by REP-/ERIC-PCR and multilocus sequence typing.

Results: Of a maximum total IPC score of 68, the institutions reached a median (range) score of 33 (19-55). MDROs were detected in median (range) 8.2% (0-33.3%) of the sampling sites. Clinics with low IPC standards showed extensive environmental contamination, i.e. of intensive care units, consultation rooms and utensils. CPE were detected in two clinics; one of them showed extensive contamination with CP Klebsiella pneumoniae (ST11, bla_OXA-48) and MR Staphylococcus pseudintermedius (ST551, mecA). Despite low IPC scores, environmental contamination with MDROs was low in primary opinion practices. Three employees were colonized with Escherichia coli ST131 (bla_CTX-M-15, bla_CTX-M-27, bla_CTX-M-14). Two employees carried CP E. coli closely related to environmental (ST410, bla_OXA-181) and patient-derived isolates (ST167, bla_NDM-5). MR Staphylococcus aureus (ST225, mecA) and MR S. pseudintermedius (ST551, mecA) of the same sequence types and with similar resistance profiles were found in employees and the environment in two clinics.

Conclusions: The study indicates that IPC standards in companion animal clinics are variable and that insufficient IPC standards could contribute to the evolution of MDROs which can be transferred between the environment and working personnel. The implementation of IPC concepts in companion animal clinics should urgently be promoted.

Keywords: Antimicrobial resistant pathogens; Colonization; Enterobacteriaceae; Infection prevention and control; Multidrug-resistant pathogens; Small animal clinic; Zoonosis.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Animal Technicians
Animals
Carbapenem-Resistant Enterobacteriaceae / isolation & purification*
Commission on Professional and Hospital Activities
Drug Resistance, Multiple, Bacterial
Equipment Contamination
Equipment and Supplies / microbiology*
Feces / microbiology*
Hospitals, Animal
Humans
Infection Control / standards*
Nose / microbiology*
Pets / microbiology*
Prospective Studies
Switzerland
Veterinarians