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Article

Third Generation Cephalosporin Resistant Enterobacterales Infections in Hospitalized Horses and Donkeys: A Case–Case–Control Analysis

1
Koret School of Veterinary Medicine (KSVM), The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 7610001, Israel
2
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Beer Yaakov 70300, Israel
3
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
4
Department of Molecular Biology, Faculty of Natural Science, Ariel University, Ariel 40700, Israel
5
The Miriam and Sheldon Adelson School of Medicine, Ariel University, Ariel 40700, Israel
6
Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
7
Clinical Microbiology Lab, Meir Medical Center, Kfar Saba 4428164, Israel
*
Author to whom correspondence should be addressed.
These authors contributed equally to this paper.
Academic Editor: Nikola Puvača
Antibiotics 2021, 10(2), 155; https://doi.org/10.3390/antibiotics10020155
Received: 18 January 2021 / Revised: 31 January 2021 / Accepted: 1 February 2021 / Published: 4 February 2021
In human medicine, infections caused by third-generation cephalosporin-resistant Enterobacterales (3GCRE) are associated with detrimental outcomes. In veterinary medicine, controlled epidemiological analyses are lacking. A matched case–case–control investigation (1:1:1 ratio) was conducted in a large veterinary hospital (2017–2019). In total, 29 infected horses and donkeys were matched to 29 animals with third-generation cephalosporin-susceptible Enterobacterales (3GCSE) infections, and 29 uninfected controls (overall n = 87). Despite multiple significant associations per bivariable analyses, the only independent predictor for 3GCRE infection was recent exposure to antibiotics (adjusted odds ratio (aOR) = 104, p < 0.001), but this was also an independent predictor for 3GCSE infection (aOR = 22, p < 0.001), though the correlation with 3GCRE was significantly stronger (aOR = 9.3, p = 0.04). In separated multivariable outcome models, 3GCRE infections were independently associated with reduced clinical cure rates (aOR = 6.84, p = 0.003) and with 90 days mortality (aOR = 3.6, p = 0.003). Klebsiella spp. were the most common 3GCRE (36%), and blaCTX-M-1 was the major β-lactamase (79%). Polyclonality and multiple sequence types were evident among all Enterobacterales (e.g., Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae). The study substantiates the significance of 3GCRE infections in equine medicine, and their independent detrimental impact on cure rates and mortality. Multiple Enterobacterales genera, subtypes, clones and mechanisms of resistance are prevalent among horses and donkeys with 3GCRE infections. View Full-Text
Keywords: cephalosporins; extended-spectrum β-lactamase; equine; resistance; case–case–control cephalosporins; extended-spectrum β-lactamase; equine; resistance; case–case–control
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MDPI and ACS Style

Shnaiderman-Torban, A.; Marchaim, D.; Navon-Venezia, S.; Lubrani, O.; Paitan, Y.; Arielly, H.; Steinman, A. Third Generation Cephalosporin Resistant Enterobacterales Infections in Hospitalized Horses and Donkeys: A Case–Case–Control Analysis. Antibiotics 2021, 10, 155. https://doi.org/10.3390/antibiotics10020155

AMA Style

Shnaiderman-Torban A, Marchaim D, Navon-Venezia S, Lubrani O, Paitan Y, Arielly H, Steinman A. Third Generation Cephalosporin Resistant Enterobacterales Infections in Hospitalized Horses and Donkeys: A Case–Case–Control Analysis. Antibiotics. 2021; 10(2):155. https://doi.org/10.3390/antibiotics10020155

Chicago/Turabian Style

Shnaiderman-Torban, Anat, Dror Marchaim, Shiri Navon-Venezia, Ori Lubrani, Yossi Paitan, Haya Arielly, and Amir Steinman. 2021. "Third Generation Cephalosporin Resistant Enterobacterales Infections in Hospitalized Horses and Donkeys: A Case–Case–Control Analysis" Antibiotics 10, no. 2: 155. https://doi.org/10.3390/antibiotics10020155

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