Monitoring planes of the occurrence of antimicrobial resistance among bacteria isolated from both animals and humans should be considered essential and strategic for preserving not only human health but also animal welfare (well-being). Moreover, the use of antimicrobial in companion animals (pets) received little attention and is not currently regulated in comparison with what happens in livestock; for this reason, the prevalence of antibiotic resistance in 165 different Enterococcus strains isolated from dogs (subjected to previous antibiotic treatment(s) or not) was determined. For each strain, the minimum inhibitory concentration (MIC) against 9 different antibiotics was assessed. While all isolated strains were susceptible to vancomycin, high resistance frequency toward erythromycin, rifampicin, enrofloxacin, and tetracycline was detected. Enterococcus faecium strains isolated from the previously treated dogs demonstrated more resistance to tetracycline compared to the control ones. Although canine enterococci showed a high degree of antibiotic resistance, they were susceptible to vancomycin, and for this reason, the hypothetical contamination of vancomycin-resistant enterococcal strains in dogs is still considered to be minimal in Italy.
- antimicrobial susceptibility
Multidrug resistance is an emerging problem in human pathogens, including zoonotic pathogens [1, 2]. Antimicrobial agents are routinely used to treat and prevent diseases in human and veterinary practices. The overuse and misuse of antibiotics provides tremendous selection, perhaps contributing spread of resistant clones, and acquisition of resistance determinants from resistant bacteria .
The problem of antimicrobial resistance has been declared to be one of the top concerns of the US Centers for Disease Control (CDC) .
In the United States, the annual healthcare cost associated with the treatment of antibiotic-resistant infections exceeds $4 billion/year .
This economic burden is associated with increased severity of illness due to treatment failure and long-term hospitalization. Longer hospital stays caused increased healthcare costs and more exposure to antibiotics. This has increased the severity of illness, and mortality rate is also high.
Inappropriate use of antibiotics for therapeutic and prophylactic purposes is considered a significant contributor to the emergence of antibiotic resistance in zoonotic pathogens  such as MRSA (methicillin-resistant
Commensal bacteria have become reservoirs of antibiotic resistance genes . Studies [8–10] revealed a high frequency of antibiotic resistance among the fecal microbiota in humans. Further, commensals can act as a source of horizontal transfer of resistance genes to pathogens. Similarly, clonal spread [11, 12] and the transfer of resistant genes from animal bacteria to human bacteria  is a concern associated with antimicrobial resistance among commensal bacteria.
Resistance gene transfer between commensals and pathogens depends on several factors such as total number of donors and recipients, nutrition, selective pressure, and transfer mechanisms. The gut gene pool is large, harboring diverse population of microbes and thus providing a suitable environment for antibiotic resistance gene transfer . The level of resistance among gut commensals such as
A major factor associated with the dissemination of resistant determinants is selection pressure exerted by the use of antibiotics, selecting resistant bacteria by killing the susceptible ones. The removal of selection pressure will not eliminate the resistance genes from this bacterial population . This increase in the fitness cost in the absence of any antibiotic selection pressure allows rapid spread of antimicrobial-resistant strains by replacing the susceptible ones .
Besides selective pressure by the antibiotics, there are other factors, such as “stress in animal,” that can play a role in the prevalence of resistant bacteria in the gut [16–18]. All bacteria including commensals obligate, or opportunistic pathogens within the host are subjected to stressful conditions. For example, enteric bacteria have to overcome the effects of gastric acid (with varying pH depending on the diet of the individual), bile and organic acids, competing gut commensals (for binding the receptor sites and for nutrition), and host immune responses. Animals subjected to stressors such as infection, transportation, and change in the environment can release stress hormones via the enteric nervous system. Evidence indicates that these stress hormones enhance the bacterial growth and the expression of virulence determinants in enteric pathogens [19, 20] and affect intestinal functions such as decreasing gastric acidity .
During the recent decades, enterococci have gained considerable attention among public health officials because of their increasing antimicrobial resistance and as important nosocomial pathogens.
Enterococci are a part of the normal microbial flora in the gastrointestinal tracts of humans, animals, and birds. The major enterococcal species include
In recent years, the appearance of vancomycin-resistant enterococci (VRE) has caused serious problems both in humans and in veterinary medicine .
Vancomycin is an antibiotic of last resort in the treatment of Gram-positive bacterial infections including enterococcal infections. The emergence of vancomycin-resistant enterococcal strains and the risk of transmission of resistance genes to the susceptible bacteria pose a serious risk to public health . The presence of VRE in clinical patients results in a 20% increase in treatment failure, and mortality is also increased from 27 to 52% [25, 26].
The contribution of enterococci to the problem of antimicrobial resistance is associated with its ability to pass the resistance determinants to other bacteria of the same species or different species by the process of conjugation. Thus, resistance gene transfer to pathogenic species and emergence of new type of resistance is a serious concern associated with these bacteria. Genome sequences have revealed that one-fourth of the total genome of
Cohabitation between household pets and humans creates advantageous conditions for transferring bacteria not only through direct contact such as by licking, petting, handling, and physical injuries but also through the intervention of domestic environment by food contamination as well as furnishing and so on.
Children represent the category most at risk because of their behavioral habits: close physical contact with dogs and cats but with environment eventually contaminated by the pets themselves (such as floor, toys, and carpets). It is important to remember that horizontal resistance gene transfer may occur in the opposite direction to bacterial transmission. In fact, sometimes, human bacteria that transmitted to pets can acquire resistance genes from animal microbiota and can be selected as a consequence of antimicrobial treatment occurred in these animals. Anyway, even in the case of human-to-household animal transmission, pets contribute to amplify and propagate acquired resistant bacteria through fecal shedding both in environment and in humans .
While there are several studies confirming the presence of VRE strains in livestock, few reports focus on the VRE colonization in household animals although VRE have been isolated from canine [31, 32] and feline gut  and direct contact with such animal species was considered as frequent infection source for humans .
A relatively high occurrence (7–23%) of VRE, mainly
Regular monitoring of the level of resistance in pathogens and in indicator bacteria of the normal flora, such as fecal
Thus, the aim of this study was, on the one hand, to determine the phenotypic resistance patterns in gastrointestinal enterococci in dog (with particular attention to vancomycin) and, on the other hand, to investigate whether enterococci belonging to the normal gut show more resistance in dogs that have been treated with antimicrobial therapy compared with non-treated ones.
2. Materials and methods
Ninety-nine dogs aged more than 6 months, randomly selected among those treated at the Didactic Veterinary Hospital of the Department of Veterinary Sciences in Parma (northern Italy), were collected from rectal swabs during the years 2005 and 2006.
The pets included in this research are dogs living in households located in Parma and its province. They followed a diet based on commercial products and were periodically vaccinated and treated for parasites.
In particular, fifty-six dogs had received, at least, one antimicrobial treatment over the six months preceding the survey, while the last treatment must have been made at least fourteen days before the collection of the samples.
As a whole, the dogs received 111 therapy cycles (having several subjects received two or more treatments). The formulation corresponding to amoxicillin–clavulanic acid corresponded to the most frequent (26.1%) antibiotics administered, while cephalosporins corresponded to approximately 20% of all the administered treatments; enrofloxacin and doxycycline accounted for about 15%.
The remaining 43 control dogs received no antimicrobial treatment since birth or during the preceding 12 months.
2.1. Bacteriological investigation
Rectal samples were, suitably, processed two hours after the collection. First, they were diluted in nutritive broth and kept at a temperature of 60°C in water bath; then, the samples were incubated in nutrient broth, opportunely enriched with NaCl 6.5%, and inoculated both on KF streptococcus agar (Difco) and on kanamycin aesculin azide agar base (Oxoid). After 24 and 48 h of incubation at 36°C, respectively, the suspicious colonies were subjected to biochemical characterization . After conducting this initial screening, which led to the identification of a preliminary biochemical profile, the strains were identified contextually by the Rapid ID 32 Strept System and/or by the API 20 Strep System (both from bioMérieux).
After the identification, only a single strain for species belonging to the same dog has been introduced in the research (in those situations in which the same species had been isolated several times in the same subject).
2.2. Susceptibility assay
The minimum inhibitory concentration (MIC) values were obtained using microdilution test according to the Clinical and Laboratory Standards Institute (CLSI) guidelines .
In this study, the following nine antibiotics were tested: amoxicillin, ampicillin, ciprofloxacin, enrofloxacin, erythromycin, ofloxacin, rifampicin, tetracycline, and vancomycin. In order to reach final concentrations ranging between 64 and 0.0312 μg/ml, each antibiotic was twofold-diluted.
MIC breakpoint was always set on the basis of CLSI guidelines .
The isolate was considered "resistant" in the case in which its MIC was equal or greater than the values (expressed in μg/ml) reported for each antibiotic tested: amoxicillin, 16; ampicillin, 16; ciprofloxacin, 2; enrofloxacin, 1; erythromycin, 1; ofloxacin, 4; rifampicin, 2; tetracycline, 8; and vancomycin 8.
The type strain used to devise the identification scheme and to verify the quality control was
The epidemiological study highlighted the presence of
This situation allowed to isolate 165 strains from 99 fecal specimens subjected to analysis. In particular, the following species were identified:
Moreover, the other species isolated were 11.5%
Results of susceptibility tests are presented in Figure 1, in which, for each species, the MIC50 and MIC90 values are summarized. These latter values represent the lowest concentration of an antimicrobial agent resulting in growth inhibition of 50% and 90% of the tested strains, respectively.
As previously underlined, no vancomycin-resistant
Most strains belonging to
The level of resistance to rifampicin, erythromycin, and tetracycline was high or very high, generally with more than 50% of strains resistant. When comparing the frequency of resistance between
In Table 1, the percentages of
|88.9||75.9||93.5 a||71.4 a|
The statistical analysis, comparing the resistance frequency in strains isolated from treated dogs and from control ones, showed a significant difference toward tetracycline (
In Figure 4, aggregate rates of multiresistance found in
The antibiotic resistance in bacteria, especially multidrug resistance (MDR) originating in household animals, represents a major health problem. The close contact established between pets, the dogs in this specific case, in situations of domestic coexistence clearly amplifies the possibility of bacteria transferring.
Enterococci as commensal bacteria possess natural gene transfer mechanisms and may, treacherously, spread multiple resistances. Therefore, it becomes crucial to first identify and then characterize the strains isolated from household animals .
Our results confirm that enterococci are constantly present in the intestine of the dog. The predominant species was shown to be
On the contrary, Cinquepalmi et al.  found in southern Italy (Bari) 61.6% of
The research has demonstrated how
Conversely, we found only one
The high resistance to erythromycin has already been observed in
We found no vancomycin-resistant strains in the 165 samples examined, which is consistent with a number of studies on enterococci from dogs and cats [22, 34]. On the basis of this, it can be estimated that the prevalence of vancomycin-resistant strains in dog enterococcal population is <0.018 (
Anyway, other European studies highlighted a relatively high VRE strain prevalence (mainly
VRE occurrence has also been reported in the United States and New Zealand, countries in which the VRE presence has not been, anyhow, documented in food animals.
Dogs’ VRE isolates largely contain the
In our study, antibiotic administration cannot be considered associated with an acquired antibiotic resistance increasing in the isolated strains analyzed, apart from tetracycline with reference to
Household dogs have long been recognized to be a potential source of zoonotic pathogens for human harboring them at intestinal level, and consequently, they have been shown to pose a significant sanitary risk for people. Humans are exposed to these pathogens through direct or indirect contact with infected dogs or their own feces, and they may also become infected after thoughtless ingestion of a zoonotic agent.
More neglected, but in any case not less important, is the fact that domestic dogs can act as the reservoir of antimicrobial-resistant agents; moreover, infections in humans and dog are often treated using similar antibiotics [30, 46].
Both the capability of non-human-origin antibiotic-resistant enterococci (e.g., sewage, raw meat, and animal feces) to colonize people and their ability to transfer resistance to human enterococci are actually not entirely known. In fact, although some researches have failed to demonstrate a relationship between antibiotic-resistant enterococci (glycopeptides included) isolated from humans and those isolated from non-human sources, some other studies have described a specific genetic relationship between
Our study data confirmed that multiresistant enterococci (in particular,
The resistance monitoring in enterococci, which circulate between domestic animals, humans, and possibly other organisms present in the environment, and the demonstrations of similarities between resistance genes and their localization in dog and human genome could reveal many secrets of this phenomenon .
There are few studies that deal with the presence of microorganisms pathogenic to humans in dog feces and that address the role of these ones as a reservoir of multidrug-resistant (MDR) bacteria such as
Starting from the consideration that antibiotic-resistance-encoding genes can be transferred between bacteria and that actually the contact between pets and people owning domestic animals is closer than in the past, but also on the basis of our collected data, it is possible to suggest that contamination with dog feces carrying MDR microorganisms could represent a real problem for environmental and public health.
Tenover FC, Hughes JH: The challenges of emerging infectious diseases. Journal of American Medical Association. 1996;275:300–304.
Akkina JE, Hogue AT, Angulo FJ: Epidemiologic aspects, control, and importance multiple-drug resistant Salmonella TyphimuriumDT104 in the United States. Journal of American Veterinary Medical Association. 1999;214:790–798.
Levy SB: The antibiotic paradox: How the misuse of antibiotics destroys their curative powers. The New England journal of Medicine. 2002;347:1213.
Stacey K: The resistance phenomenon in microbes and infectious disease vectors. 2003. Washington, DC: National Academy of Sciences.
McGowan JE: Economic impact of antimicrobial resistance. Emergence Infectious Diseases. 2001;7:286–292.
Marshall BM, Ochieng DJ, Levy SB: Commensals: unappreciated reservoir of antibiotic resistance. Microbe. 2009;4:231–235.
Levy SB, Marshall B, Schluederberg S, Rowse D, Davis J: High frequency of antimicrobial resistance in human fecal flora. Antimicrobial Agents and Chemotherapy. 1988;32:1801–1806.
Calva JJ, Sifuentes-Osornio J, Cerón C: Antimicrobial resistance in fecal flora: longitudinal community-based surveillance of children from urban Mexico. Antimicrobial Agents and Chemotherapy. 1996;40:1699–1702.
Salyers AA, Gupta A, Wang Y: Human intestinal bacteria as reservoirs of antibiotic resistance genes. Trends in Microbiology. 2004;12:412–416.
Kuhn I, Iversen A, Burman LG, Olsson-Liljequist B, Franklin A, Finn M, Aarestrup F, Seyfarth AM, Blanch AR, Taylor H, Caplin J, Morena MA, Dominguez L, Mollby R: Epidemiology and ecology of enterococci, with special reference to antibiotic resistant strains, in animals, humans and the environment. Example of an ongoing project within the European research programme. International Journal of Antimicrobial Agents. 2000;14:337–342.
van den Bogaard AE, Stobberingh EE: Epidemiology of resistance to antibiotics. Links between animals and humans. International Journal of Antimicrobial Agents. 2000;14:327–335.
Capriolo A, Busani L, Martel JL, Helmuth R: Monitoring of antibiotic resistance in bacteria of animal origin: epidemiological and microbiological methodologies. International Journal of Antimicrobial Agents. 2000;14:295–301.
Salyers AA, Amabile-Cuevas CF: Why are antibiotic resistance genes so resistant to elimination? Antimicrobial Agents and Chemotherapy. 1997;41:2321–2325.
Enne VI, Bennett PM, Livermore DM, Hall LM: Enhancement of host fitness by the sul2-coding plasmid p9123 in the absence of selective pressure. The Journal of Antimicrobial Chemotherapy. 2004;53: 958–963.
Molitoris ED, Fagerberg L, Quarles CL, Krichevsky MI: Changes in the antimicrobial resistance in the faecal bacteria associated with pig transit and holding times at slaughter plants. Applied and Environmental Microbiology. 1987;53:1307–1310.
Moro MH, Beran GW, Hoffman LJ, Griffith RW: Effects of cold stress on the antimicrobial drug resistance of Escherichia coliof the intestinal flora of swine. Letters in Applied Microbiology. 1998;27:251–254.
Moro MH, Beran GW, Hoffman LJ, Griffith RW: Effects of heat stress on the antimicrobial drug resistance of Escherichia coliof the intestinal flora of swine. Journal of Applied Microbiology. 2000;88:836–844.
Lyte M, Ernst S: Catecholamine induced growth of Gram-negative bacteria. Life Science. 1992;50:203–212.
Lyte M, Arulanandam BP, Frank CD: Production of shiga like toxins by Escherichia coliO157:H7 can be influenced by the neuroendocrine hormones. The Journal of Laboratory and Clinical Medicine. 1996;128:392–398.
Bailey MT: Psychological stress, immunity, and the effects on indigenous microflora. 2010. Microbial Endocrinology, Interkingdom Signaling in Infectious Disease and Health. New York, NY: Springer.
Kataoka Y, Umino Y, Hiroki O, Kazuki H, Takuo S: Antimicrobial susceptibility of enterococcal species isolated from antibiotic-treated dogs and cats. The Journal of Veterinary Medical Science. 2014;76(10):1399–1402.
Kataoka, Y, Ito C, Kawashima A, Ishii M, Yamashiro S, Harada K, Ochi H, Sawada T: Identification and antimicrobial susceptibility of Enterococci isolated from dogs and cats subjected to differing antibiotic pressures. The Journal of Veterinary Medical Science. 2013;75(6):749–753.
Pearson H:“Superbug” hurdles key drug barrier. Nature. 2002;418:469.
Walsh C: Molecular mechanisms that confer antibacterial drug resistance. Nature .2000;406: 775–781.
Brown DFJ, Brown NM, Cookson BD, Duckworth G, Farrington M, French GL, King L, Lewis D, Livermore DM, Macrae B, Scott GM, Williams D, Woodford N: National glycopeptides resistant enterococcal bacteremia surveillance working group report to the department of health-August 2004 .Journal of Hospital Infection. 2006;62(Suppl.1):1–27.
Paulsen IT, Banerjei L, Meyers GS, Nelson KE, Seshadri R, Read TD, Fouts DE, Eisen JA, Gill SR, Heidelberg J., Tettelin H, Dodson RJ, Umayam L, Brinkac L, Beanan M, Daugherty S, DeBoy RT, Durkin S, Kolonay J, Madupu R, Nelson W, Vamathevan J, Tran B, Upton J, Hansen T, Shetty J, Khouri H, Utterback T, Radune D, Ketchum K A, Dougherty B A, Fraser CM: Role of mobile DNA in the evolution of vancomycin resistant Enterococcus faecalis. Science. 2003;299:2071–2074.
Tomich PK, An FY, Damle SP, Clewell DB: Plasmid related transmissibility band multiple drug resistance in Streptococcus faecalissubsp. Zymogenes strain DS16. Antimicrobial Agents and Chemotherapy. 1979;15:828–830.
Dunny G, Funk C, Adsit J: Direct stimulation of transfer of antibiotic resistance by sex pheromones in Streptococcus faecalis.Plasmid. 1981;6:270–278.
Guardabassi L, Schwarz S, Lloyd D.H: Pet animals as reservoirs of antimicrobial-resistant bacteria. Journal of Antimicrobial Chemotherapy. 2004;54:321–332.
Devriese LA, Ieven M, Goossens H, Vandamme P, Pot B, Hommez J, et al.: Presence of vancomycin resistant enterococci in farm and pet animals. Antimicrobial Agents and Chemotherapy. 1996;40:2285–2287.
Van Belkun A, van den Braak N, Thomassen R, Verbrugh H, Endtz H: Vancomycin-resistant enterococci in cats and dogs. Lancet. 1996;348(9033):1038–1039.
Bates J, Jordens Z, Selkon JB: Evidence for an animal origin of vancomycin-resistant enterococci. Lancet. 1993;342:490–491.
Cinquepalmi V, Monno R, Fumarola L, Ventrella G, Calia C, Greco MF, de Vito D, Soleo L: Environmental contamination by dog’s faeces: A public health problem? International Journal of Environmental Research and Public Health. 2013;10:72–84.
Martel JL, Tardy F, Sanders P, Boisseau J: New trends in regulatory rules and surveillance of antimicrobial resistance in bacteria of animal origin. Veterinary Research. 2001;32(3-4):381–392.
Van den Bogaard AE, Stobberingh EE: Epidemiology of resistance to antibiotics. Links between animals and humans. International Journal of Antimicrobial Agents. 2000;14(4):327–335.
Herrero IA, Fernández-Garayzábal JF, Moreno MA, Domínguez L: Dogs should be included in surveillance programs for vancomycin-resistant Enterococci. Journal of Clinical Microbiology. 2004;42(3):1384–1385.
Manero A, Blanch AR: Identification of Enterococcusspp. with a biochemical key. Applied and Environmental Microbiology. 1999;65(10): 4425–4430.
Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: Fifteenth Informational Supplement. Villanova, PA: CLSI; 2005 Publication No. M100–S15.
Ossiprandi MC, Bottarelli E, Cattabiani F, Bianchi E: Susceptibility to vancomycin and other antibiotics of 165 Enterococcusstrains isolated from dogs in Italy. Comparative Immunology, Microbiology and Infectious Diseases. 2008;31:1–9.
Jackson CR, Fedorka-Cray PJ, Davis JA, Barrett JB, Frye JG: Prevalence, species distribution and antimicrobial resistance of enterococci isolated from dogs and cats in the United States. Journal of Applied Microbiology. 2009;107:1269–1278.
De Graef EM, Devriese LA, Baele M, Vancanneyt M, Swings J, Haesebrouck F, et al.: Identification of enterococcal, streptococcal and Weissellaspecies in the faecal flora of individually owned dogs. Journal of Applied Microbiology. 2005;99(2):348–353.
Huycke MM, Sahm DF, Gilmore MS: Multiple-drug resistant Enterococci: the nature of the problem and an agenda for the future. Emerging Infectious Diseases. 1998;4(2):239–249.
De Graef EM, Decostere A, Devriese LA, Haesebrouck F: Antibiotic resistance among fecal indicator bacteria from healthy individually owned and kennel dogs. Microbial Drug Resistance. 2004;10(1):65–69.
Leclerq R, Courvalin P: Bacterial resistance to macrolide, lincosamide and streptogramin antibiotics by target modification. Antimicrobial Agents and Chemotherapy. 1991;35:1267–1272.
Sternberg S: Antimicrobial resistance in bacteria from pets and horses. Acta Veterinaria Scandinavica. 1999;92:37–50.