Infections caused by extended-spectrum beta-lactamase-producing Enterobacterales in hospitalized neonatal foals: Can colonization predict infection?

Abstract

BACKGROUND: Infections with extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) contribute to morbidity and mortality in human neonates. In foals, data are scarce. OBJECTIVES: Determine the association between ESBL-PE gastrointestinal colonization on hospital admission and infections in hospitalized neonates. ANIMALS: Sixty-seven foals. METHODS: Prospective study of foals admitted to a veterinary hospital. Foals were screened for ESBL-PE colonization and for infections. Risk factors and clinical outcomes were analyzed. RESULTS: Seventy-six percent of foals suffered from at least 1 bacterial infection (n&#x2009;=&#x2009;51/67). Sixty-three non-ESBL bacterial species and 19 ESBL-PE species were isolated. Twenty foals (29.85%) had at least 1 hospital-acquired infection (HAI) and 30 foals (44.8%) suffered from multidrug resistant infections. The prevalence rates of ESBL-PE gastrointestinal colonization on admission and clinical ESBL HAIs were 47.8% (n&#x2009;=&#x2009;32/67, 41 isolates) and 19.40% (n&#x2009;=&#x2009;13/67, 19 isolates), respectively. On multivariable analysis, ESBL-PE HAIs were associated with colonization on admission (P&#x2009;=&#x2009;.03, odds ratio [OR]&#x2009;=&#x2009;4.60). In an outcome analysis, ESBL-PE infection and HAIs were associated with surgery (ESBL-PE infection: P&#x2009;=&#x2009;.04, OR&#x2009;=&#x2009;4.70; HAI: P&#x2009;=&#x2009;.004, OR&#x2009;=&#x2009;6.4) and HAI also was associated&#xa0;with increased duration of hospitalization (P&#x2009;<&#x2009;.001, OR&#x2009;=&#x2009;9.13). The major colonizing and infecting bacterial species were Escherichia coli and Klebsiella spp. Concordant ESBL-PE species were recovered from rectal screening and clinical samples in 7.46% (n&#x2009;=&#x2009;5/67) of foals. CONCLUSIONS AND CLINICAL IMPORTANCE: On-admission ESBL-PE rectal colonization was associated with ESBL-PE HAI in neonatal foals. The ESBL-PE infections were associated with surgery during hospitalization. These findings emphasize the importance of optimal infection control and treatment of clinical infections in equine neonatal intensive care units.