Zoonotic Pathogens in Eurasian Beavers (Castor fiber) in the Netherlands.

Successful repopulation programs of Eurasian beavers (Castor fiber) have resulted in an increase in beaver populations throughout Europe. This may be of public health relevance because beavers can host multiple zoonotic pathogens. From March 2018 to March 2020, opportunistic testing of dead beavers was performed for hepatitis E virus, orthohantavirus, Anaplasma phagocytophilum, Bartonella spp., extended-spectrum-betalactamase or AmpC (ESBL/AmpC-)-producing Enterobacteriaceae, Francisella tularensis, Leptospira spp., Neoehrlichia mikurensis, Babesia spp., Echinococcus multilocularis, Toxoplasma gondii, and Trichinella spp. From the 24 beavers collected, three zoonotic pathogens were detected. One beaver was positive for T. gondii, one was positive for ESBL/AmpC-producing Enterobacteriaceae, and one was positive for N. mikurensis. The latter finding indicates that beavers can be bitten by Ixodes ricinus and be exposed to tick-borne pathogens. The detected ESBL/AmpC-gene was blaCMY-2 in an Escherichia coli ST6599. The findings suggest that the role of beavers in the spread of zoonotic diseases in the Netherlands is currently limited.

Faecal carriage of Clostridioides difficile is low among veterinary healthcare workers in the Netherlands.

Veterinary healthcare workers are in close contact with many different animals and might be at an increased risk of acquiring Clostridioides difficile. In this cross-sectional study, we assessed the prevalence and risk factors of C. difficile carriage in Dutch veterinary healthcare workers. Participants provided a faecal sample and filled out a questionnaire covering potential risk factors for C. difficile carriage. C. difficile culture positive isolates were polymerase chain reaction (PCR) ribotyped and the presence of toxin genes tcdA, tcdB and cdtA/cdtB was determined. Eleven of 482 [2.3%; 95% confidence interval (CI) 1.3-4.0] veterinary healthcare workers were carriers of C. difficile. Three persons carried C. difficile ribotype 078 (0.6%; 95% CI 0.2-1.8). Risk factors for carriage were health/medication and hygiene related, including poor hand hygiene after patient (animal) contact, and did not include occupational contact with certain animal species. In conclusion, the prevalence of C. difficile carriage in veterinary healthcare workers was low and no indications were found that working in veterinary care is a risk for C. difficile carriage.

ESBL/pAmpC-producing Escherichia coli and Klebsiella pneumoniae carriage among veterinary healthcare workers in the Netherlands.

BACKGROUND: Animals are a reservoir for ESBL/pAmpC-producing Escherichia coli/Klebsiella pneumoniae (ESBL-E/K). We investigated the association between occupational contact with different types of animals and the prevalence of ESBL-E/K carriage among veterinary healthcare workers, assessed molecular characteristics of ESBL-E/K, and followed-up on the ESBL-E/K carriage status of participants and their household members. METHODS: Participants completed a questionnaire about their contact with animals at work and at home, health status, travel behaviour and hygiene, and sent in a faecal sample which was tested for the presence of ESBL-E/K. Resistance genes were typed using PCR and sequencing. ESBL-E/K positive participants and their household members were followed up after 6 months. Risk factors were analysed using multivariable logistic regression methods. RESULTS: The prevalence of ESBL-E/K carriage was 9.8% (47/482; 95%CI 7.4-12.7). The most frequently occurring ESBL genes were blaCTX-M-15, blaCTX-M-14 and blaDHA-1. The predominant sequence type was ST131. None of the occupation related factors, such as contact with specific animal species, were significantly associated with ESBL-E/K carriage, whereas travel to Africa, Asia or Latin America in the past 6 months (OR 4.4), and stomach/bowel complaints in the past 4 weeks (OR 2.2) were. Sixteen of 33 initially ESBL-E/K positive participants (48.5%) tested positive again 6 months later, in 14 persons the same ESBL gene and E. coli ST was found. Four of 23 (17.4%) household members carried ESBL-E/K, in three persons this was the same ESBL gene and E. coli ST as in the veterinary healthcare worker. CONCLUSIONS: Despite the absence of specific occupation related risk factors, ESBL-E/K carriage in veterinary healthcare workers was high compared to the prevalence in the general Dutch population (5%). This indicates that occupational contact with animals is a potential source of ESBL-E/K for the population at large.

Prolonged carriage of (livestock-associated) MRSA in individuals without professional livestock contact.

OBJECTIVES: To investigate prolonged carriage of MRSA in adults from the general population living in a livestock-dense area, using WGS. METHODS: A cross-sectional study during 2014-15 among 2492 adults without professional livestock contact identified 14 (0.6%) nasal MRSA carriers, 10 of which carried livestock-associated (LA)-MRSA of multiple-locus variable-number tandem repeat analysis (MLVA) complex (MC) 398. Two years later, 12 MRSA-positive and 88 MRSA-negative participants provided a second nasal swab and filled in a short questionnaire. Isolates from persons who were MRSA positive at both timepoints were compared using MLVA and isolates with the same MLVA type were sequenced. The WGS data were used for core-genome MLST (cgMLST) and resistome analysis, including sequenced isolates from the national MRSA surveillance. RESULTS: All MRSA-negative persons tested negative again, while 6 of the 12 initially MRSA-positive persons tested positive again. MLVA revealed that isolate pairs from five individuals had the same MLVA type, of which three were LA-MRSA. cgMLST showed that the distance between these isolate pairs ranged between 3 and 13 genes, while the minimum distance to unrelated isolates from the national MRSA surveillance was 38 genes. Moreover, the resistome present in the five isolate pairs was identical within each pair. None of the prolonged carriers was hospitalized during the 3 months before the sampling moment and none of them with LA-MRSA had contact with livestock in this period. CONCLUSIONS: Prolonged carriage of MRSA, including LA-MRSA, can be demonstrated after more than 30 months in persons without professional livestock contact.

Do vegetarians less frequently carry ESBL/pAmpC-producing Escherichia coli/Klebsiella pneumoniae compared with non-vegetarians?

BACKGROUND: ESBL and plasmid-mediated AmpC (pAmpC)-producing Enterobacteriaceae are frequently found on meat products in Dutch retail, especially on poultry. OBJECTIVES: We investigated whether vegetarians are at lower risk of carrying ESBL/pAmpC-producing Escherichia coli/Klebsiella pneumoniae (ESBL-E/K) compared with persons who consume meat. METHODS: Vegetarians, pescatarians (vegetarians who eat fish) and non-vegetarians (persons who eat meat at least three times per week) were asked to send in a faecal sample and a questionnaire. ESBL-E/K were cultured and MLSTs were determined. ESBL/pAmpC genes were analysed using PCR and sequencing. The risk of ESBL-E/K carriage in the three study groups was analysed using multivariable logistic regression. RESULTS: Prevalence of ESBL-E/K carriage was 8.0% in vegetarians (63/785; 95% CI 6.3-10.1), 6.9% in pescatarians (27/392; 95% CI 4.8-9.8) and 3.8% in non-vegetarians (14/365; 95% CI 2.3-6.3). Multivariable analysis showed an OR for ESBL-E/K carriage of 2.2 for vegetarians (95% CI 1.2-4.0) and 1.6 for pescatarians (95% CI 0.8-3.2) compared with non-vegetarians. The predominant MLST was E. coli ST131 and the most common ESBL genes were blaCTX-M-15, blaCTX-M-27, blaCTX-M-14 and blaCTX-M-1 in all diet groups. Independent risk factors for ESBL-E/K carriage were travel to Africa/Latin America/Asia (OR 4.6; 95% CI 2.8-7.7) in the past 6 months and rarely/never washing hands before food preparation (OR 2.5; 95% CI 1.2-5.0). CONCLUSIONS: Vegetarians and pescatarians did not have a lower risk of ESBL-E/K carriage compared with non-vegetarians, indicating that eating meat is not an important risk factor for ESBL-E/K carriage.

Correction: Time to acquire and lose carriership of ESBL/pAmpC producing E. coli in humans in the Netherlands.

[This corrects the article DOI: 10.1371/journal.pone.0193834.].

Time to acquire and lose carriership of ESBL/pAmpC producing E. coli in humans in the Netherlands.

A subset of the study population from a cross-sectional study of carriership of ESBL/pAmpC-producing E. coli (ESBL-E) in the general population was followed up by five successive samples over an approximate half year period, leading to six samples in 333 persons. Fecal samples were cultured and analyzed for the presence of E. coli types as characterized by MLST, and ESBL/pAmpC genes were analysed by PCR and sequencing. The study included 255 persons who had a negative first sample, to allow observations of acquiring carriership of ESBL-E. Any individual record thus consisted of a series of snapshots of episodes of presence and absence of ESBL-E carriage. A survival model was built to estimate times to acquire or lose carriership, allowing for any combination of ESBL/pAmpC gene and E. coli MLST type. In carriers, the mean time to lose carriership was 1.1 (95% range 0.8-1.6) years. The estimated mean time to acquire carriership was 3.0 (95% range 1.6-6.3) years. Analysis of these times by ESBL/pAmpC gene found substantial variation among resistance genes both in persistence of carriership and in rates of acquiring carriership: blaCTX-M-1, blaCTX-M-14, blaCTX-M-15, blaCTX-M-27 and blaSHV-12 were easily acquired, but blaCTX-M-1 and blaSHV-12 were also easily lost, while blaCTX-M-15, blaCTX-M-27 and blaCMY-2 were more likely to persist. When in addition bacterial host types were included, some combinations appeared more persistent than others (blaCTX-M-1 in ST10 and ST58; blaCTX-M-14, blaCMY-2, and blaSHV-12 in ST69), or were acquired with higher frequency (blaCTX-M-14 in ST38, ST69, and ST131; blaCTX-M-15 and blaCTX-M-27 in ST131; blaSHV-12 in ST69). The relatively short duration of carriership means that when an intervention drastically reduces the exposure of humans to ESBL-E, the prevalence will be halved in 0.66 years. The observed differences between carriage rates of ESBL/pAmpC genes and E. coli strains need further investigation.

Ten years later: still a high prevalence of MRSA in slaughter pigs despite a significant reduction in antimicrobial usage in pigs the Netherlands.

OBJECTIVES: In 2005, 39% of pigs and 81% of the slaughter batches at Dutch slaughterhouses were MRSA positive. The objective of the present study was to investigate whether the 50% reduction of antimicrobial usage in finishing pigs in 2014 compared with 2009 in the Netherlands has led to a lower MRSA prevalence among Dutch slaughter pigs. METHODS: Nasal swabs from eight slaughter batches of on average 10 animals at seven slaughterhouses were taken and cultured using method 1, which was used in 2005, and method 2, using high-salt pre-enrichment. Suspected isolates were confirmed by PCR for two Staphylococcus aureus-specific DNA fragments and the mecA gene. A subset of MRSA isolates were further investigated using spa typing, multiple-locus variable number of tandem repeat analysis (MLVA) and antimicrobial susceptibility testing. RESULTS: Using methods 1 and 2, we found 461 of 558 (83%) and 552 of 558 (99%) of the pigs to carry MRSA in their nares, respectively. All 56 slaughter batches were MRSA positive. All MRSA isolates belonged to the livestock-associated MLVA complex 398, had a non-WT phenotype for tetracycline and spa type t011 predominated. CONCLUSIONS: A very high prevalence of nasal MRSA carriage was found in Dutch slaughter pigs and therefore the reduction in antimicrobial usage at the national level has not yet had an effect on the MRSA carriage rate of pigs entering the slaughterhouse. Therefore, there is still an increased risk of MRSA carriage for personnel working at pig slaughterhouses, particularly those having contact with living animals. Method 2, using high salt pre-enrichment, detected more MRSA-positive pigs and is currently the preferred method for screening of MRSA in livestock in the Netherlands.

Methicillin-resistant Staphylococcus aureus and extended-spectrum and AmpC ß-lactamase-producing Escherichia coli in broilers and in people living and/or working on organic broiler farms.

The aim of this study was to estimate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum and AmpC ß-lactamase (ESBL/AmpC)-producing Escherichia coli among broilers, and humans living and/or working on organic broiler farms; further characterise isolates; and compare these results with those from conventional farms. In the Netherlands, only 9 certified organic broiler farms were present. On 8 of these farms, 60 throat swabs and 20 cloacal swabs were taken per farm for MRSA and ESBL/AmpC-E. coli detection, respectively, at an average age of both 34 (T1) and 68 (T2) days. Faecal swabs and questionnaires were returned by 27 out of 36 humans. For selected ESBL/AmpC-producing E. coli isolates, phylogenetic groups, ß-lactamase genes, plasmid families, and sequence types were determined. MRSA was not detected in broiler and human samples. ESBL/AmpC-producing E. coli were isolated from broilers on 7/8 farms at T1 and on all farms at T2. Furthermore, 3 farmers at T1, and 2 farmers and 1 family member at T2 were positive. Genes found in broilers and humans were almost exclusively blaCTX-M-1 and blaCMY-2. Given the high overall human ESBL/AmpC-prevalence (18.5%), which is similar to conventional farms, contact with live broilers is assumed a risk factor for carriage. Farm and sample-level prevalence at T1 are consistent with those from conventional farms. At T2, just before slaughter, sample-level prevalence of ESBL/AmpC-E. coli appears to have decreased (94.3% vs. 80%), which could have important consequences for contamination of retail meat.

Transmission of methicillin-resistant Staphylococcus aureus isolates on broiler farms.

The aim of the present study was to investigate the resistance pheno- and genotypes and the molecular typing characteristics of methicillin-resistant Staphylococcus aureus (MRSA) isolates from broiler farms in order to explore transmission between the different reservoirs. Thirty-seven MRSA CC398 isolates (11 from broilers, 15 from the broiler houses, 5 from farm residences and 6 from humans living and/or working on the farms) cultured from samples at four different farms during a previous study, were included. In addition to the previously determined spa types, the isolates were characterized by dru typing, SCCmec typing, pulsed-field gel electrophoresis and DNA microarray. Resistance phenotypes were determined by broth microdilution. Resistance genes were detected by DNA microarray or specific PCR assays. Selected isolates from broilers and humans (n=7) were analysed by whole genome mapping. On the same farm, isolates from chickens, broiler houses, the farm residences and humans were often closely related or indistinguishable. On three of the four farms, however, MRSA isolates with different characteristics were present. On the one hand, the apparent similarity of MRSA isolates from the same farm indicates transmission between broilers, humans and their environment. On the other hand, different MRSA isolates were present on the same farm, indicating introduction from different sources or diversification over time. This study shows that different typing methods should be used to investigate epidemiological links between isolates and that whole genome mapping can be a useful tool to establish these links.

Resistance phenotypes and genotypes of methicillin-resistant Staphylococcus aureus isolates from broiler chickens at slaughter and abattoir workers.

OBJECTIVES: To comparatively investigate the resistance phenotypes and genotypes of various methicillin-resistant Staphylococcus aureus (MRSA) isolates from broilers at slaughter and workers at the respective poultry slaughterhouses. METHODS: Forty-six MRSA isolates (28 from broilers and 18 from humans) obtained at four different slaughterhouses were included. In addition to previously determined sequence types (STs) and spa types, the isolates were characterized by dru typing, SCCmec typing and PFGE. Resistance phenotypes were determined by broth microdilution. Resistance genes and clonal complexes (CCs) were detected by DNA microarray or specific PCR assays. RESULTS: MRSA of CC398, spa type t011 and varying dru types represented 23/28 broiler isolates and 12/18 human isolates. Three ST9/t1430/dt10a isolates were each seen among the isolates from the abattoir workers and the broilers. In addition, two human CC398/ST1453/t4652/dt3c isolates, a single human CC398/t034/dt6j isolate and two chicken CC398/t108/dt11a isolates were detected. All CC398 isolates (including ST1453) and some of the ST9 isolates from chickens and humans showed resistance to four to nine classes of antimicrobial agents and carried a wide range of resistance genes. While the resistance phenotypes and genotypes of the chicken isolates of the same flock were closely related, they usually differed from the resistance phenotypes and genotypes of the isolates from the workers at the respective slaughterhouse. CONCLUSIONS: The apparent homogeneity of MRSA isolates from the same flock suggests exchange of isolates between the respective animals. The apparent heterogeneity of MRSA isolates from abattoir workers might reflect their occupational contact with animals from numerous chicken flocks.