Weese MRSA

Community associated MRSA in animals: 

Community associated MRSA in animals J Scott Weese DVM DVSc DipACVIM

Slide2: 

We are not a population of people, in populations of dogs, cats, horses… We are a population of animals.

FAQ’s: 

FAQ’s I have diagnosed a dog/cat/horse with MRSA infection… What does this mean? Where did it come from? What should I tell the owners? Are there any precautions that should be taken? Might I be infected?

Slide4: 

I was diagnosed with MRSA. My physician… Said it came from my dog/cat… Told me to get rid of my pet Said it is of no concern for my pets Told me to bath my cat in triclosan daily for a week Told me to treat my dog/cat with ___ Has no clue that I have pets

Slide5: 

My dog is involved with therapeutic visitation…what are the risks? During visitation at a long term care facility, my dog interacted with someone with an MRSA infection…what does this mean to my dog/me? Animals regularly visit our hospital…is there anything we should be doing?

MRSA in Animals: 

MRSA in Animals Emerging problem Concerns Transmission of MRSA from infected animals to humans Colonized animals as reservoirs of MRSA in the community Human / animal origin Animal disease

Different species…different issues: 

Different species…different issues Horses Nasal/facial contact Fecal contamination International movement Household pets Degree/duration/intensity of contact Pet birds Fecal contact / aerosolization of fecal matter Food animals

MRSA in horses: 

MRSA in horses

Key Points: 

Key Points Appears to be endemic in certain horse populations worldwide Readily moves between horses and humans USA500 predominates internationally Reason unclear Does not appear to be related to commensal equine S. aureus Infection control measures can eradicate MRSA from farms

Skin Infections in Equine NICU Personnel: 

Skin Infections in Equine NICU Personnel

Slide11: 

Skin infections in equine NICU personnel (Weese et al, Vet Microbiol 2005) 3/36 (8.3%) personnel developed skin infections after 4 hour ‘barriered’ contact 10/107 (9.7%) of other screened individuals colonized 19% colonization rate in Foal Watch personnel

MRSA infection and colonization in household pets: 

MRSA infection and colonization in household pets

Slide13: 

Initial reports Sporadic infections or small clusters in US, UK, Canada, Australia, Korea (Pak et al J Vet Med Sci 1999, Tomlin et al Vet Rec 1999, Weese et al ISSSI Proc 2004)

Slide14: 

Rapid increase in reported cases 95 infections in pets in UK (Kearns et al ISSSI Proc 2004) 106 small animal infections in UK (Boag et al Vet Rec 2004, Rich et al Vet Rec 2004) 17 infected or colonized dogs, cat, rabbit, seal from Ireland (O’Mahoney et al 2005) PVL + MRSA from 11 dogs, cats, rabbit, parrot with SSTI, pneumonia in US (Rankin et al 2005) and transmission of PVL+ strain in household (van Duijkeren et al 2005)

Colonization: 

Colonization Uncommon in general pet population 2/203 (1%) dogs admitted to academic referral centre (Hanselman et al, ACVIM abstract 2005) 0/139 dogs and 0/39 cats at primary care veterinary clinics in Ontario (Murphy et al ACVIM abstract 2005) 2/131 (1.5%) dogs and 0/250 cats in the community (Unpublished data) Sporadically high in veterinary clinics 8.9% of dogs housed in a UK referral clinic (Loeffler et al 2005)

Typing: 

Typing Pet isolates indistinguishable from common human clones (Rich and Roberts 2004, Weese et al 2004/2006, Kearns et al 2004, Loeffler et al 2005, Baptiste et al 2005, Leonard et al 2006) Initially, USA 100 (CMRSA-2) predominated in Canada, United States, UK EMRSA-15 in UK, Ireland Recent identification of USA300 in pets First in California, now more widespread

Intra- and inter-species transmission: 

Intra- and inter-species transmission Weese et al, Vet Microbiol 2006

Washington: 

Clinic + + Washington

Slide19: 

Clinic + + +

Slide20: 

Home Clinic + + + + + + + +

Slide21: 

Animal Rescue Home Clinic + + + + + + + + +

New York: 

Clinic + New York

Slide23: 

Clinic + +

Slide24: 

+ Clinic A Clinic B Home + + + + + +

Recent Case: 

Recent Case March: MRSA infection in foot of a cat In veterinary hospital for amputation

Slide26: 

Jan female owner: MRSA abscess on hand, negative nasal screen Late Feb male owner: open heart surgery Early March female owner: MRSA ocular infection, negative nasal screen Late March infection in cat

Slide27: 

Where did MRSA originate? Was the cat involved in transmission? What to do with the cat in this household? Has there been subsequent transmission within the vet clinic? Is there a household cycle that needs to be broken?

Broader Picture: 

Broader Picture Is intra-household/inter-species transmission of bacteria common? Concurrent colonization of people and pets with S. aureus in 8.3% of households and S. intermedius in 5% of households

MRSA colonization of veterinary personnel: 

MRSA colonization of veterinary personnel

Slide30: 

Recent studies from Canada, UK and Ireland reporting colonization of veterinary personnel Is veterinary medicine an occupational risk factor?

Veterinary Internal Medicine Conference: 

Veterinary Internal Medicine Conference

Slide32: 

MRSA from 27/417 (6.5%) personnel 13/94 (13.8%) equine veterinarians US, UK, Denmark 9/239 (3.8%) small animal veterinarians US, Germany 5/34 (14.7%) technicians US Equine personnel 87% CMRSA-5/USA500 (including UK, Denmark) Small animal personnel 92% CMRSA-2/USA100

Animal Assisted Therapy: 

Animal Assisted Therapy Cross-sectional study in Ontario 0/102 (Lefebvre et al, J Hosp Infect 2006) Prospective study (ongoing) MRSA acquisition by 3 dogs following start of visitation careers 2: USA300 Hand contamination with MRSA after petting dog that had performed visitation

Questions: 

Questions Are pets important sources of community associated MRSA infection in humans? Do pets become colonized when an infected/colonized person returns from hospital? Impact on recurrence Are pets of healthcare workers more likely to become colonized? Source of recurrent colonization

Slide35: 

Should pets be screened in cases of CA-MRSA or recurrent MRSA infection? When, how, by whom? What precautions should be taken in households with infected/colonized people or pets? What about therapeutic visitation dogs? Screening, contacts, IC protocols…

Slide36: 

Should people that routinely contact horses be considered high risk and be screened upon admission to hospital? Is MRSA a concern for therapeutic riding facilities? Do people and their pets routinely ‘share’ a variety of pathogens?

The End: 

The End