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Prevalence of Colonization and Antimicrobial Resistance Among Coagulase Positive Staphylococci in Dogs, and the Relatedness of Canine and Human Staphylococcus Aureus

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Prevalence of Colonization and Antimicrobial Resistance Among Coagulase Positive Staphylococci in Dogs, and the Relatedness of Canine and Human Staphylococcus Aureus PREVALENCE OF COLONIZATION AND ANTIMICROBIAL RESISTANCE AMONG COAGULASE POSITIVE STAPHYLOCOCCI IN DOGS, AND THE RELATEDNESS OF CANINE AND HUMAN STAPHYLOCOCCUS AUREUS A Thesis Submitted to the College of Graduate Studies and Research In Partial Fulfillment of the Requirements For the Degree of Doctor of Philosophy In the Department of Veterinary Microbiology In the College of Graduate Studies and Research University of Saskatchewan Saskatoon, Saskatchewan By Joseph Elliot Rubin © Copyright Joseph Elliot Rubin, May 2011. All rights reserved Permission to use Postgraduate Thesis In presenting this thesis in partial fulfillment of the requirement for a postgraduate degree from the University of Saskatchewan, I agree that the libraries of this university may make it free available for inspection. I further agree that permission for copying of this thesis in any manner, in whole or in part, for scholarly purposes may be granted by the following: Dr. Manuel Chirino-Trejo, DVM, MSc., PhD Department of Veterinary Microbiology University of Saskatchewan In his absence, permission may be granted from the head of the department of Veterinary Microbiology or the Dean of the Western College of Veterinary Medicine. It is understood that any copying, publication, or use of this thesis or part of it for financial gain shall not be allowed without with author’s written permission. It is also understood that due recognition shall be given to the author and to the University of Saskatchewan in any scholarly use which may be made of any material in this thesis. Requests for permission to copy or make other use of materials in this thesis in whole or in part should be addressed to: Head of the Department of Veterinary Microbiology Western College of Veterinary Medicine University of Saskatchewan 52 Campus Drive Saskatoon, Saskatchewan S7N 5B4 i Abstract Coagulase positive staphylococci, Staphylococcus aureus and Staphylococcus pseudintermedius, are important causes of infection in human beings and dogs respectively. The rapid increase in the incidence of methicillin resistant S. aureus (MRSA) in people and its emergence in dogs has raised the profile of this organism in the veterinary community. Similarly, human S. pseudintermedius infections have also been recognized as the awareness of bidirectional human-dog transmission increases. Antimicrobial resistance has been complicating the treatment of S. aureus infections since the first penicillin resistance was observed in the 1940s. Methicillin resistance (resistance to the majority of β-lactams), is particularly troublesome as the β-lactams are a safe and effective class of antimicrobials for treating susceptible staphylococcal infections in both human beings and dogs. Additionally, resistance to other antimicrobial classes such as the macrolides, tetracyclines, sulfonamides and chloramphenicol, further complicates the treatment of staphylococcal infections. Particularly in small animal private practice, infections are often treated empirically, requiring knowledge of locally prevalent susceptibility patterns. The emergence of resistance to commonly used drugs necessitates surveillance to monitor the dissemination of resistance, and to guide antimicrobial therapy. In the last decade there have been many studies attempting to address gaps in our knowledge of the ecology of S. aureus and S. pseudintermedius in dogs. In particular, the prevalence of colonization with methicillin resistant staphylococci has been documented in different dog populations. However, failing to sample all relevant sites of colonization, may have decreased the sensitivity of these studies. The sites where coagulase positive staphylococci colonize dogs have not been systematically evaluated. ii The clinical and infection control implications of S. aureus infections, or colonization in the case of MRSA, requires timely laboratory identification. The tube coagulase test is arguably the most important tool used for identifying of staphylococcal species. Studies dating from the 1970s and 1980s suggested that the use of rabbit plasma, which is the current standard, may not be the ideal media for all situations and that different plasmas may need to be considered in different diagnostic situations. In this thesis, the ecology of coagulase positive staphylococci in dogs was studied from start to finish including sample collection, bacterial identification, antimicrobial susceptibility testing and molecular epidemiological investigations. This thesis will serve as a template to be used for follow up studies or by investigators setting up a surveillance program in their region. We found that multiple sites of colonization (nares, pharynx and rectum), are involved in both S. aureus and S. pseudintermedius carriage in dogs. Single site colonized dogs were identified, suggesting that maximal screening sensitivity requires sampling multiple body sites. When canine and rabbit plasma were compared, the time until clot formation was found to be significantly shorter with canine plasma. Although, the availability of canine plasma may limit its use in the diagnostic laboratory, investigators should be aware that rabbit plasma may not be ideal for all applications of the tube coagulase test. Antimicrobial susceptibility testing of canine S. aureus and S. pseudintermedius and human S. aureus isolates was done. Consistent with previous reports from Saskatoon, the S. pseudintermedius isolates were found to be overwhelmingly susceptible: pan-susceptibility was the most common phenotype identified. Antimicrobial resistance was more common among S. aureus than S. pseudintermedius including resistance to drugs which all S. pseudintermedius were susceptible to. No resistance to vancomycin, linezolid, daptomycin or quinupristin/dalfopristin was found. All isolates remained iii susceptible to at least one of tetracycline, clindamycin, chloramphenicol or trimethoprim/sulfamethoxazole which are often used for treating infections caused by multidrug resistant staphylococci. Finally, DNA fingerprinting revealed that the canine and human S. aureus isolates tested did not belong to mutually exclusive populations. Using AFLP, IS-typing and spa typing, many human and canine isolates were indistinguishable suggesting a common population, supporting the hypothesis that interspecies transmission occurs. The complex and under-characterized ecology of S. aureus and S. pseudintermedius requires more study so that risk factors for infection can be defined and effective infection control measures implemented. Because multiple species are involved, collaboration between veterinarians and human health professionals is imperative, and will no doubt yield the most success in our efforts to understand these potential pathogens. iv Acknowledgments The last four years has been a transformative experience and I owe thanks to a long list of people who prepared me for beginning this journey, helped me along the way and celebrated each accomplishment no matter how small. I would like to thank my parents for always encouraging my curiosity, and supporting me in pursuing my wildest dreams – thanks Mom and Dad. No less I would like to thank Casey Gaunt, the love of my life whose endless support and companionship not only motivated and inspired me, but made this whole journey a lot more fun! Of course this project would not have been possible without the tremendous support of my supervisor, Manuel Chirino-Trejo. I will be eternally grateful to Dr. Chirino not only for his mentorship and teaching me all the tricks that “aren’t in the books”, but also his encouragement in exploring intriguing side projects only tangentially related to my thesis. Thanks also to my entire graduate committee: Chris Clark, Janet Hill, Vikram Misra, Steve Sanche and Alice Wong for their guidance over the last few years – it was most appreciated. Special thanks to Scott Weese for taking the time to be my external examiner and travel to Saskatoon for my defense. I would like to thank the staff, students, administration and clinicians of the Western College of Veterinary Medicine (WCVM), Veterinary Teaching Hospital for helping me to collect samples. Thanks also to everyone in GMP, particularly Brian Osler and Vivian Pulga for their meticulous preparation of thousands of plates and biochemical tests and Fei Huang for teaching me how to interpret those tests! Thanks to Bonnie Chaban and Janet Hill for teaching me the basics of PCR and never tiring of my endless questions about molecular microbiology. Thanks to Joe Blondeau at Royal University Hospital in Saskatoon, for generously providing human S. aureus isolates for my project. v Thank you to Trish Dowling for sparking my interest in antimicrobials/resistance all those years back and pushing me to pursue an area that I’ve grown fascinated with! Thanks to Katherine Ball and Frannie Sampieri for always being there to work through problems, brainstorm, go for coffee, collaborate and being great friends! I would like to thank Dr. Paul Savelkoul at Vrije Universiteit medisch centrum (VUmc) in Amsterdam, the Netherlands for graciously hosting me in his lab and teaching me about AFLP. I would also like to thank Martine Rijnsburger, Madelone van der Bijl, Bianca Blok- Schuur, Dries Budding and Ascelijn Reuland at VUmc and Jaap Wagenaar at Utrecht University for helping me with my project in the Netherlands and making me feel at home in a new place. Finally, I would like to thank the Interprovincial Graduate Student Fund and the Companion Animal Health Fund for
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