Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Zurich, Zurich, Switzerland.
Antimicrob Resist Infect Control. 2020 Jun 23;9(1):93. doi: 10.1186/s13756-020-00742-5.
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.
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.
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) 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, bla, bla). Two employees carried CP E. coli closely related to environmental (ST410, bla) and patient-derived isolates (ST167, bla). 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.
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.
在伴侣动物诊所进行强化医疗可能会对多药耐药菌（MDRO）的选择和传播构成风险。感染预防和控制（IPC）概念是减少 MDRO 传播的关键措施，但有关伴侣动物诊所 IPC 标准的数据很少。本研究通过结构化的 IPC 审计评估了瑞士七家伴侣动物诊所和实践中的 IPC 标准，并将结果与环境 MDRO 污染和人员携带 MDRO 相结合。
IPC 审计于 2018 年 8 月至 2019 年 1 月之间进行。根据预先设定的标准（未满足/部分满足/满足=得分 0/1/2）对 34 个 IPC 区域的观察结果进行评分。对兽医人员的环境拭子以及鼻腔和粪便样本进行耐甲氧西林（MR）葡萄球菌和大球菌以及耐多粘菌素、广谱β-内酰胺酶和碳青霉烯酶产生（CP）肠杆菌科（CPE）的检测。通过 MALDI-TOF MS 鉴定物种，通过微量稀释法和β-内酰胺耐药基因检测确定抗生素耐药性，并通过 REP-/ERIC-PCR 和多位点序列分型评估遗传相关性。
在最大总分 68 分的情况下，各机构的中位数（范围）得分为 33 分（19-55 分）。在中位数（范围）为 8.2%（0-33.3%）的采样点检测到 MDRO。低 IPC 标准的诊所显示出广泛的环境污染，即重症监护病房、诊室和器械。在两家诊所中检测到 CPE；其中一家诊所广泛污染了 CP 肺炎克雷伯菌（ST11，bla）和 MR 中间葡萄球菌（ST551，mecA）。尽管 IPC 评分较低，但初级意见实践中的环境 MDRO 污染较低。有三名员工定植了大肠埃希菌 ST131（bla，bla，bla）。两名员工携带的 CP 大肠杆菌与环境（ST410，bla）和患者来源的分离株（ST167，bla）密切相关。在两家诊所中，从员工和环境中发现了相同序列类型且具有相似耐药谱的 MR 金黄色葡萄球菌（ST225，mecA）和 MR 中间葡萄球菌（ST551，mecA）。
该研究表明，伴侣动物诊所的 IPC 标准存在差异，IPC 标准不足可能导致 MDRO 的进化，MDRO 可以在环境和工作人员之间传播。应紧急在伴侣动物诊所推广 IPC 概念。
