Infections caused by extended-spectrum beta-lactamase-producing Enterobacterales in hospitalized neonatal foals: Can colonization predict infection?
Authors: Shnaiderman-Torban Anat, Meltzer Lilac, Zilberman-Daniels Tal, Navon-Venezia Shiri, Cohen Adar, Sutton Gila Abells, Blum Shlomo E, Amit Sharon, Steinman Amir
Journal: Journal of veterinary internal medicine
Summary
# Extended-Spectrum Beta-Lactamase-Producing Enterobacterales in Hospitalized Neonatal Foals Antimicrobial resistance in neonatal foals presents a significant clinical challenge, yet published data on extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) infections remain limited in equine medicine. This prospective Israeli study screened 67 hospitalised foals for gastrointestinal ESBL-PE colonisation on admission and tracked subsequent infections, analysing risk factors and clinical outcomes through multivariable statistical modelling. Nearly half the cohort (47.8%) carried ESBL-PE in their gastrointestinal tract at admission, with almost one-fifth (19.4%) subsequently developing clinical ESBL-PE hospital-acquired infections (HAIs), predominantly caused by *Escherichia coli* and *Klebsiella* species. Colonised foals carried a 4.6-fold increased odds of developing ESBL-PE HAI; moreover, those requiring surgery during hospitalisation were 4.7 times more likely to develop ESBL-PE infection, and HAI cases showed markedly prolonged hospitalisation (odds ratio 9.13). Notably, concordant bacterial species between rectal swabs and clinical samples occurred in fewer than 8% of cases, suggesting most infections arise from environmental sources rather than translocation of admission colonisers. These findings have direct practice implications: admission screening of hospitalised neonates could identify high-risk colonised individuals warranting heightened infection control precautions, whilst surgical interventions in this population demand particular vigilance regarding antimicrobial stewardship and biosecurity protocols within equine neonatal intensive care settings.
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Practical Takeaways
- •Screen neonatal foals for ESBL-PE gastrointestinal colonization on hospital admission, as colonization increases infection risk 4.6-fold and should inform infection control measures
- •Implement strict infection control protocols in equine neonatal intensive care units, particularly for foals undergoing surgery who have substantially higher risk of ESBL-PE infections
- •Prepare for potential longer hospitalization periods when HAI develops; implement early detection and appropriate antimicrobial stewardship to minimize duration of stay
Key Findings
- •47.8% of neonatal foals (32/67) were colonized with ESBL-PE on hospital admission, with 19.4% (13/67) developing clinical ESBL-PE HAIs
- •On-admission ESBL-PE rectal colonization was significantly associated with ESBL-PE HAI (P=0.03, OR=4.60)
- •ESBL-PE infections and HAIs were strongly associated with surgery during hospitalization (ESBL-PE: OR=4.70, P=0.04; HAI: OR=6.4, P=0.004)
- •Concordant ESBL-PE species between rectal colonization and clinical infection occurred in only 7.46% (5/67) of foals, with E. coli and Klebsiella spp. as the major organisms