Trends of feline Escherichia coli minimum inhibitory concentrations over 14 years illustrate the need for judicious antimicrobial use in cats.

OBJECTIVE: This study aims to assess the antimicrobial resistance (AMR) trends among Escherichia coli isolated from cats between 2008 and 2022, utilizing MIC data, within a one-health framework. SAMPLE: The study analyzed MIC results from 1,477 feline E coli isolates that were obtained from samples submitted to the Cornell University Animal Health Diagnostic Center, primarily from the northeastern US. METHODS: MIC values were categorized as susceptible or not susceptible using the Clinical and Laboratory Standards Institute breakpoints. Multidrug resistance (MDR) was analyzed using a Poisson regression model. Additionally, accelerated failure time models were employed to analyze MIC values. RESULTS: Out of the 1,477 E coli isolates examined, 739 (50%) showed susceptibility to all tested antimicrobials. Among the tested antimicrobials, cefazolin (69%) and ampicillin (74% for urinary tract isolates) exhibited the lowest susceptibility. Overall, 15% of isolates were not susceptible to cefovecin. E coli isolates were highly susceptible (> 95%) to antibiotics typically reserved for human use. Almost one-third of the isolates were classified as MDR, with nonurinary isolates more likely to exhibit an MDR pattern. A decrease in MICs for fluoroquinolones and gentamicin in recent years was identified. However, MICs for cephalexin increased from 2016 to 2022 and cefovecin from 2012 to 2019. CLINICAL RELEVANCE: This study highlights the challenge of AMR in feline medicine, emphasizing the importance of responsible antimicrobial use and surveillance to address E coli AMR. The related Currents in One Health by Cazer et al, JAVMA, December 2023, addresses additional feline antimicrobial stewardship topics.

Pathways to sustainable antimicrobial use in cats.

Antimicrobial stewardship encompasses all the individual and collective actions that medical professionals take to preserve the efficacy of antimicrobials. It is a one-health problem, affecting animals and humans. The current state of antimicrobial use in cats, particularly (1) the overuse and improper use of cefovecin, which belongs to the third-generation cephalosporin class that is critically important to human health, and (2) use of antimicrobials when they are not needed, poses unsustainable risks of antimicrobial resistance. This paper describes the principles of antimicrobial stewardship and stewardship challenges faced by feline veterinarians, including (1) poor adherence to or awareness of antimicrobial use guidelines, (2) lack of access to affordable diagnostic tests and antibiograms, (3) lack of access to materials and tools for clients that may facilitate more sustainable antimicrobial use and help cat owners understand resistance risks, (4) underestimating the ability of cat owners to administer oral antimicrobials, and (5) limited time and resources to support stewardship efforts. Based on research described in this paper; an original research article by Cazer et al, JAVMA, December 2023; and a Currents in One Health article by Cobo-Angel et al, AJVR, December 2023, several solutions are proposed to advance antimicrobial stewardship in feline medicine. Many of these proposals were expressly requested by veterinarians interviewed in Cazer et al, JAVMA, December 2023. Education and training of veterinarians and cat owners is an essential step toward sustainable antimicrobial use, but it must be complemented with innovations in diagnostic testing, antimicrobial drug development, structural changes, and technological supports.

Understanding the role of veterinarians in antimicrobial stewardship on Canadian dairy farms: A mixed-methods study.

The aim of this study was to describe the factors that influence dairy cattle veterinarians´ antimicrobial prescribing, their attitudes toward reducing antimicrobial use (AMU) in the dairy industry, awareness of antimicrobial resistance (AMR), and perceived barriers to improving antimicrobial stewardship (AMS) on Canadian dairy farms. We used quantitative and qualitative research methods to consider the complexity of the antimicrobial prescription decision-making process. We designed and distributed an online survey, followed by four online focus groups with practicing veterinarians. We used frequency tables and unconditional associations to analyze quantitative data, and thematic analysis to analyze qualitative data. In total, 107 participants from four Canadian provinces responded to the survey, and 26 veterinarians participated in the focus groups. Results from both studies were triangulated to draw our key findings. We found that 1) Veterinarians must weigh numerous intra-personal and contextual considerations that could be conflicting in their decision-making process for prescribing antimicrobials. 2) Although less experienced veterinarians showed greater awareness of AMR and motivation to improve AMS than more experienced veterinarians, they also reported feeling more pressure to adapt their prescribing practices to farmers' wishes than more experienced veterinarians. 3) Some veterinarians experienced conflict between prescribing antimicrobials to maintain animal health, productivity, and welfare, and AMS, which could result in blaming others for inappropriate antimicrobial use and reducing the opportunity to critically review their own prescribing practices. 4) There were strategies and barriers in common between veterinarians and farmers such as collaborative reviews of disease treatment protocols and improving preventive medicine on dairy farms. 5) The main barriers to reducing AMU on dairy farms reported by veterinarians were concerns about animal welfare and AMU on dairy farms without consultation with the veterinarian. Our results can inform the development of AMS programs in the Canadian dairy industry.

Values and Risk Perception Shape Canadian Dairy Farmers' Attitudes toward Prudent Use of Antimicrobials.

Antimicrobial resistance (AMR) is an important challenge in public health. Ensuring rational antimicrobial use (AMU) on farms is one of the key components of antimicrobial stewardship. We aimed to describe a sample of Canadian dairy farmers' personal factors for AMUand their AMR risk perception, and to associate these factors with their attitude toward promotion of prudent AMU. We distributed an online survey among dairy farmers in Ontario and Atlantic Canada (New Brunswick, Nova Scotia, and Prince Edward Island). The questionnaire was designed to solicit information on dairy farmers' AMU decision-making process, attitudes toward AMU reduction, awareness of AMR, and individual values. We performed a factor analysis on 15 statements related to AMR awareness and AMU reduction and used a logistic regression model to identify variables associated with the probability of disagreeing with the need to increase promotion of responsible AMU in the dairy industry. Respondents' (n = 193) previous experience was the main reason to select an antimicrobial treatment for their cattle. We identified four groups of factors related to knowledge, risk perception, and emotional states among respondents. To the question "Should there be more initiatives to promote responsible use of antibiotics in the dairy industry?" 23% of respondents answered no, which was associated in a logistic regression model with being a farm owner, having a tie-stall barn, and considering their own experience as the most important factor in selecting antimicrobial treatments. The score for the conservation value dimension and score for a factor described as sense of responsibility when using antimicrobials were also retained in the final model. Our results indicate that tailored strategies to promote prudent AMU on dairy farms may be preferable to a generic strategy because there are individual differences in attitudes, values, and AMR awareness that shape AMR risk perception and willingness to modify current AMU practices.

A Focus Group Study of Canadian Dairy Farmers' Attitudes and Social Referents on Antimicrobial Use and Antimicrobial Resistance.

As part of broader actions to combat antimicrobial resistance (AMR), health authorities have promoted the reduction of antimicrobial use (AMU) in food animals. Farmers' attitudes and receptivity to reduction of AMU appear to be variable and context specific. Our research objectives were to gain insight into Canadian dairy farmers' attitudes toward AMU, AMR, and AMU-reduction in the dairy industry, and to explore drivers and barriers to change AMU, including the influence of social referents. We conducted seven focus groups with 42 farmers in two provinces of Canada (New Brunswick and Ontario) and used thematic analysis to identify, analyze, and report patterns in the data. Our results indicate that farmers usually rely on their previous experience and judgement of individual cases of disease when making decisions related to AMU. External referents included other farmers, family members, and veterinarians. However, veterinarians were generally only consulted for unusual cases. Participants in this study expressed that maintaining cattle welfare is their responsibility, and that they were not willing to jeopardize animal welfare in order to reduce AMU. In addition, farmers regarded the cost of investment in improved facilities to prevent disease as an important barrier to reduce AMU. Finally, the majority of participants considered themselves to be low users of antimicrobials and perceived a small role of AMU on dairy farms in AMR. In conclusion, farmers from this study showed self-reliance to decide about AMU on their farms and considered animal-related and economic factors in these decisions. There was a general lack of knowledge of how to reduce AMU without investing in facilities, and there is an opportunity to motivate increased involvement of the veterinarian in AMU-related decisions. These results should be considered to design and refine antimicrobial stewardship programs for dairy farms.

Potential group B Streptococcus interspecies transmission between cattle and people in Colombian dairy farms.

Group B Streptococcus (GBS), is a leading cause of neonatal death and an emerging pathogen in adults. Additionally, GBS is a bovine pathogen causing intramammary infections. The likelihood of GBS interspecies transmission is largely unknown. We explored the potential transmission of GBS between cattle and people on dairy farms in Colombia and compared the antimicrobial resistance (AMR) profiles of isolates from both host species. Across 33 farms, throat swabs and rectal swabs were collected from 191 people, and rectal swabs and composite milk samples from 2092 cattle, yielding 60 human isolates and 301 bovine isolates. The majority (64%) of isolates belonged to shared sequence types (ST). Sequence type (ST) 1 was the most common strain in both host species, suggesting that interspecies transmission may be possible. Two members of the bovine-specific clonal complex 61/67 were detected in human samples (ST718 and ST1175), providing evidence for the lack of genuine species barriers. Apparent prevalence of penicillin resistance was surprisingly high in human and bovine isolates. Further investigation of this phenomenon is needed and could lead to modification of standard testing and treatment recommendations in human and veterinary medicine.

Streptococcus agalactiae is not always an obligate intramammary pathogen: Molecular epidemiology of GBS from milk, feces and environment in Colombian dairy herds.

For many years Streptococcus agalactiae has been considered an obligate intramammary and strictly contagious pathogen in dairy cattle. However, recent reports of S. agalactiae isolation from extramammary sources have contradicted that premise. To gain further insight into the epidemiology of S. agalactiae infection in cattle, we examined its distribution and heterogeneity of strains in bovine milk, bovine feces, and the environment in Colombian dairy farms. First, a longitudinal study was conducted at herd level in 152 dairy herds. Bulk tank milk samples from each herd where collected twice a month for six months. A follow-up study with a cross sectional design at the cow level was conducted in a subset of 25 farms positive for S. agalactiae. Cow-level milk samples from 1712 lactatting cows and 1545 rectal samples were collected, as well as 120 environmental samples. Samples were used for S. agalactiae detection and genotyping using Multi Locus Sequence Typing. Results showed sporadic rather than repeated isolation of S. agalactiae from bulk tank milk in 40% of the positive herds, challenging the idea that S. agalactiae is a highly contagious pathogen causing chronic infections. S. agalactiae was isolated from rectal or environmental samples in 32% and 12% of cross-sectional study farms, respectively, demonstrating that the bacteria can survive in extramammary sources and that S. agalactiae is not an obligate intramammary pathogen. The same strain was isolated from rectal and bulk tank milk samples in eight farms, suggesting that fecal shedding is frequent, and contributes to the presence of S. agalactiae in bulk tank. High within-herd heterogeneity of strains was found, which is distinct from the situation in developed dairy industries. These new epidemiological findings should be considered to adjust surveillance and control recommendations for S. agalactiae.

Resistencia antimicrobiana de Streptococcus agalactiae de origen humano y bovino / Antimicrobial resistance of Streptococcus agalactiae of human and bovine origin / Resistência antimicrobiana de Streptococcus agalactiae de origem humana e bovina

Resumen Streptococcus agalactiae (SAG) es un agente etiológico importante en un amplio espectro de infecciones humanas y bovinas. En humanos, este patógeno es el principal responsable de septicemias severas y muertes neonatales, debido a la enfermedad conocida como "sepsis neonatal", la cual ha sido reportada en diferentes países, incluyendo a Colombia. Cerca del 36% de las mujeres embarazadas son colonizadas por esta bacteria y de ellas el 45% de los neonatos adquiere la infección por SAG. En adultos, la colonización de SAG asintomática ocurre frecuentemente en el tracto gastrointestinal y genitourinario. Sin embargo, puede llegar a causar enfermedades tales como meningitis, septicemia, abscesos, infecciones del tracto urinario y artritis especialmente en adultos inmunocomprometidos. Adicionalmente, SAG es considerado un patógeno de alta importancia en la producción lechera, por ser responsable de cuadros generalmente subclínicos y crónicos de mastitis en vacas, afectando la sanidad del hato, así como la calidad y cantidad de leche producida. La principal herramienta para el control de SAG es el uso de antimicrobianos tipo betalactámicos o tipo macrólidos en casos de pacientes alérgicos a las penicilinas. Sin embargo, se ha reportado aislamientos de SAG resistentes o con susceptibilidad disminuida a los antimicrobianos utilizados para su control en ambas especies: humanos y bovinos. El hallazgo de resistencia antimicrobiana en SAG está recibiendo atención entre la comunidad científica en todo el mundo debido a su impacto negativo en la salud pública. El presente trabajo es una revisión de literatura científica, no sistemática, que tiene como objetivo analizar los mecanismos y la prevalencia de la resistencia antimicrobiana de SAG, así como los genes asociados a esta condición en aislamientos de origen humano y bovino.

Abstract Streptococcus agalactiae (SAG) is an important etiologic agent in a wide spectrum of human and bovine infections. In humans, this pathogen is the main responsible of severe septicemia and neonatal dead, due to the disease known as "neonatal sepsis", which has been reported in different countries, including Colombia. About 36% of pregnant women are colonized by this bacterium and of them, the 45% of the newborns acquire the SAG infection. In adults, asymptomatic SAG colonization occurs frequently in gastrointestinal and genitourinary tract. However, it can cause diseases such as meningitis, septicemia, abscesses, infections in urinary tract and arthritis particularly in immunocompromised adults. Additionally, SAG is considered a highly important pathogen in dairy production for being responsible of mastitis cases generally subclinical and chronic in cows, affecting the herd health, as well as the quality and the quantity of milk produced. The main tool for SAG control is the use of beta-lactams antimicrobials or macrolides in cases of penicillin-allergic patients. Some of the studies reported resistant SAG isolates or with decreased susceptibility to the antimicrobials used for its control in both species: humans and bovines. The finding of antimicrobial resistance in SAG is getting attention from the scientific community around the world because its negative impact in public health. The present work is a non-systematic review of scientific literature, with the objective of analyzing the mechanism and prevalence of SAG antimicrobial resistance, as well as, the genes associated to this condition in human and bovine isolates.

Resumo Streptococcus agalactiae (SAG) é um agente etiológico importante em um amplo espectro de infecções humanas e bovinas. Nos seres humanos, esse patógeno é a principal causa de septicemia grave e mortes neonatais, devido à doença conhecida como "sepse neonatal", que tem sido relatada em diferentes países, incluindo a Colômbia. Cerca de 36% das mulheres grávidas são colonizadas por esta bactéria e destes 45% dos recém-nascidos adquirem a infecção pelo SAG. Em adultos, a colonização do SAG assintomático ocorre com freqüência nos tratos gastrintestinal e genitourinário. No entanto, pode levar a doenças como meningite, septicemia, abscessos, infecções do trato urinário e artrite, especialmente em adultos imunocomprometidos. Além disso, a SAG é considerado um patógeno de grande importância na produção de leite, sendo responsável mastite geralmente subclínica e crônica em caixas de vacas, afetando a saúde do rebanho, ea qualidade e quantidade de leite produzida. A principal ferramenta para o controle do SAG é o uso de antimicrobianos beta-lactâmicos ou do tipo macrolídeo em casos de pacientes alérgicos a penicilinas. No entanto, isolados de SAG resistentes ou com reduzida susceptibilidade aos antimicrobianos usados para controlá-los foram relatados em ambas as espécies: humanos e bovinos. O achado de resistência antimicrobiana no SAG está recebendo atenção entre a comunidade científica em todo o mundo devido ao seu impacto negativo na saúde pública. Este papel é uma revisão da literatura científica, não sistemática, ou seja para analisar os mecanismos e a prevalência de resistência antimicrobiana SAG, bem como os genes associados com esta condição em isolados humanos e bovinos.