Search

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 Animal, Fac. de Veterinaria, TRUE, pub

The role of small animal veterinary hospitals in the onset and dissemination of antimicrobial-resistant organisms (AMROs) is an emerging research field, and the implementation of internal surveillance programs is a cost-effective tool to better understand their impact. The aim of this PhD project was to develop a surveillance program in the Veterinary Teaching Hospital (VTH) of the Department of Veterinary Medical Sciences, University of Bologna, to obtain, analyze and compare data on AMROs and healthcare-associated infections (HAIs). The program was composed by passive surveillance, active surveillance on patients, active surveillance on the environment, outbreak surveillance and the communication system. Results from passive surveillance on 1342 clinical isolates highlighted a multi-drug resistance (MDR) percentage of 41.6%, with worrying non-susceptibility percentages detected for clindamycin (58.4%), amoxicillin-clavulanate (20.3%), piperacillin-tazobactam (15%) and enrofloxacin (45.8%). Whole genome sequencing on some selected MDR Enterobacterales isolates revealed the presence of multiple worrisome resistance genes, including the carbapenemase-encoding gene blaNDM-5. Considering only isolates from suspected HAIs (13.9% of the total), MDR percentage was considerably higher (71.7%). Active surveillance on patients showed a high in-hospital acquisition rate (25.6%) of commensal carbapenem-resistant gram-negative bacteria (CR-GNB) with multiple resistance genes, including blaNDM. Active surveillance on the environment detected high prevalence of methicillin- resistant Staphylococci (MRS, 19.5%). Active surveillance was also executed in a Spanish VTH, showing a lower AMROs frequency of detection at admission and in-hospital acquisition. Outbreak surveillance allowed to early detect and manage two outbreaks both caused by the Enterobacter cloacae complex. The communication system involved professionals from different fields and assisted the redaction of a new depart