Carbapenem-resistant Infections in Canine Patients: A Case Series

Abstract:

Background: Carbapenem-resistant Enterobacterales (CRE) are an emerging threat in veterinary medicine, resistant to nearly all antibiotics, transmissible within veterinary hospitals, associated with high mortality rates, and likely zoonotic pathogens. Hypothesis/

Objectives: Our primary objectives include analyzing clinical history, identifying mechanisms of resistance, and proposing hypotheses for future studies to develop tools for CRE prevention and management. Animals: This study includes an analysis of six CRE infections in dogs.

Methods: A case series was compiled outlining clinical history, management, and outcomes. Whole genome sequencing was performed on a subset of isolates to elucidate resistance mechanisms, strain types, and strain relationships.

Results: CRE species included Klebsiella pneumoniae, Escherichia coli, and Enterobacter cloacae. CRE infections were associated with a high mortality rate; 5/6 patients were euthanized due to clinical deterioration. 5/6 were prescribed enrofloxacin and a beta-lactam antibiotic in the three months preceding the CRE diagnosis. Clinical history analysis suggests that 4/6 patients had a hospital acquired infection. The NDM-5 carbapenemase resistance gene was detected in the three isolates submitted for sequencing and was extremely conserved between the isolates. Conclusions and Clinical Importance: CRE presents a complex and urgent challenge in veterinary medicine. The findings of this case series suggest a potential link between antibiotic therapy involving fluoroquinolone plus beta-lactam antibiotics and CRE infections, which justifies future studies to explore and validate this hypothesis. Furthermore, CRE appears to be spreading in veterinary hospitals and in the community. Comprehensive surveillance and genetic analyses are essential for understanding CRE epidemiology in veterinary species.