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Applied and Environmental Microbiology, June 2006, p. 3940-3948, Vol. 72, No. 6
0099-2240/06/$08.00+0 doi:10.1128/AEM.02770-05
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
Department of Veterinary Science, The Pennsylvania State University, University Park, Pennsylvania
Received 23 November 2005/ Accepted 18 March 2006
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Calf mortality and treatment costs represent an enormous economic loss to the dairy industry, estimated to surpass $250 million annually in the United States (35). Numerous studies have shown that the most prevalent causes of death in calves from birth to weaning are diarrhea and respiratory diseases. A recent survey by the USDA National Animal Health Monitoring System reported that diarrhea accounted for 62.1% of the deaths of unweaned calves (24). The extended-spectrum cephalosporin ceftiofur (Cef) has been approved for therapeutic use in cattle in the United States since 1988. Ceftiofur has normally been used for the treatment of respiratory tract infections, metritis, and foot rot (43). The administration of ceftiofur to treat diarrhea in calves constitutes extralabel drug use and requires the approval of the herd veterinarian (10). In the past few years, Escherichia coli strains resistant to multiple, structurally unrelated drugs, including newer antibiotics used to treat severe cases of calf scours, such as aminoglycosides, fluoroquinolones, and expanded-spectrum cephalosporins, have been found in diarrheic calves (7, 41, 42). The emergence of such multidrug-resistant pathogenic strains of E. coli poses an increasing threat to the successful management of calf scours.
A recent study conducted by Sawant et al. (33) on antibiotic usage in Pennsylvania dairy herds showed that tetracycline (Tet), neomycin, and spectinomycin (Spt) were the most commonly used antibiotics in the treatment of enteritis in calves. In that study, a total of 113 dairy producers were surveyed on their antibiotic use practices. Producers of 6 of the 113 dairy herds volunteered for an ongoing study on the effects of tetracycline use on antimicrobial resistance in their herds. They were surveyed for 12 months on the prevalence and distribution of antibiotic-resistant gram-negative enteric bacteria (GNEB) in fecal samples from lactating cows and calves. The calves on one farm shed higher levels (88.5%) of ceftiofur-resistant (Cefr) GNEB than calves on the other five farms (0 to 1%). This observation was intriguing, and it was decided that conducting a more intensive study on the herd with high levels of ceftiofur resistance would help to decipher the molecular epidemiology of ceftiofur resistance of GNEB in dairy herds. The objective of this study was to understand and elucidate the molecular epidemiology of ceftiofur-resistant GNEB shed by healthy dairy heifer calves. It is anticipated that this further characterization of ceftiofur-resistant organisms will advance the knowledge of antibiotic-resistant GNEB isolated from healthy calves.
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Bacterial isolation and identification.
Fecal samples from 20 dairy heifer calves were collected every 4 weeks for a period of 5 months (April to August 2003). One gram of feces was diluted in 9 ml of 0.85% sterile saline solution. The contents were mixed thoroughly and 10-fold serially diluted. The dilutions were plated on MacConkey agar (MAC) (Oxoid Ltd., United Kingdom) supplemented with ceftiofur at 8 µg/ml (MAC-CEF) (Pharmacia & Upjohn Company, Kalamazoo, MI); a MAC plate without the antibiotic was used as the control plate. This concentration of ceftiofur (8 µg/ml) is recommended for the selection of ceftiofur-resistant bacteria by the NCCLS (now known as the CLSI), based on veterinary interpretative criteria for bovine respiratory disease pathogens (25). Currently, there are no CLSI breakpoints approved to indicate ceftiofur resistance in gram-negative enteric bacteria. The inoculated plates were incubated at 37°C for 24 h. The number of colonies on MAC and MAC-CEF were counted and expressed as total GNEB CFU/g of feces and total Cefr GNEB CFU/g of feces, respectively. Two to three colonies were selected from each MAC-CEF plate with bacterial growth and subcultured. The isolates were speciated using an API 20E kit (BioMérieux, St. Louis, MO). Isolates that had an identification score of >97% were included in the study.
Antimicrobial resistance testing.
Cefr E. coli isolates were screened for antibiotic resistance to ampicillin (Amp) (10 µg/ml), chloramphenicol (Chl) (30 µg/ml), gentamicin (Gen) (10 µg/ml), enrofloxacin (Eno) (5 µg/ml), Tet (30 µg/ml), Spt (100 µg/ml), ticarcillin (Tic) (75 µg/ml), ticarcillin-clavulanic acid (Tim) (75 and 10 µg/ml, respectively) (Remel, Lenexa, KS), ceftiofur (Cef) (30 µg/ml), and florfenicol (Ffc) (30 µg/ml) (Becton Dickinson and Company, Sparks, MD) using a Kirby Bauer disk diffusion assay according to standards and interpretive criteria described by NCCLS (25). Intermediate zones of inhibition were counted as sensitive for purposes of this study. Antimicrobial MICs were determined by the broth microdilution method in cation-adjusted Mueller-Hinton broth (Becton Dickinson and Company, Sparks, MD) as described by NCCLS, including suggested breakpoints to determine resistance and susceptibility (25). Currently, there are no CLSI breakpoints to analyze resistance to ceftiofur, spectinomycin, and florfenicol in E. coli of bovine origin; in this study, the resistance breakpoints for bovine respiratory disease pathogens were used. The isolates were screened for antibiotic resistance to Amp, Chl, Spt, and Tet (MP Biomedicals LLC, Aurora, OH) and Cef, Ffc, Gen, Tic, and Tim (Sigma-Aldrich, St. Louis, MO). The MIC was defined as the lowest concentration of antibiotic completely inhibiting visible growth. Two quality control strains, E. coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853 (American Type Culture Collection, Manassas, VA), were included in each assay.
Serotype analysis.
Cefr E. coli strains were grown on brain heart infusion agar slants (Oxoid Ltd., United Kingdom) at 37°C for 24 h. The isolates were serotyped for O and H groups at the Pennsylvania State University Gastroenteric Disease Center, University Park, Pa., using the procedures described by Orskov et al. (28). H groups were assigned based on restriction fragment length polymorphism analysis by digesting the amplified fliC gene with the HpaII restriction enzyme, as described by Machado et al. (21) with modifications. The profiles were compared to the 52 standard H groups for H type designation.
Pulsed-field gel electrophoresis.
The Cefr E. coli isolates (n = 122) were genotyped using the pulsed-field gel electrophoresis (PFGE) technique described by Hegde et al. (14). DNA was digested using the XbaI enzyme (New England BioLabs, Beverley, MA). Electrophoresis was performed using a CHEF Mapper XA PFGE system (Bio-Rad, Hercules, CA). Genotypic relatedness was determined using PFGE DNA fingerprint subtypes. Fingerprint subtypes were analyzed using Gel Doc 2000 Molecular Analyst Fingerprinting Plus software, version 6.1 (Bio-Rad, Hercules, CA). The relatedness of restriction profiling was generated by the unweighted pair group method with arithmetic average clusters based on Dice coefficients of each band pattern.
PCR-based assays.
Cefr E. coli isolates were evaluated for the presence of several virulence factors of veterinary significance, including STa, CNF1, CNF2, Stx1, Stx2, CS31A, F1845, and K99 (Table 1). The genes coding for STa, CNF1, CNF2, CS31A, F1845, and K99 were detected using the primers, PCR, and run conditions used by the Gastroenteric Disease Center, University Park, Pa. Identification of Stx-1 and -2 was done as described by Meng et al. (22). The E. coli isolates (n = 122) were screened for the presence of the cephamycinase gene blaCMY2. Isolates negative for blaCMY2 were screened for other beta-lactamase genes, including blaCTX-M2, blaFOX, blaSHV, blaTEM, and ampC (Table 1). Amplification was performed with consensus primers for ampC, which recognize any plasmid-borne cephamycinase genes derived from the chromosomal ampC gene of Citrobacter freundii (44). The PCR assays were performed in a thermocycler (PTC 200 Thermocycler; MJ Research, Watertown, MA). The total reaction volume was 25 µl and consisted of puRETaq Ready-To-Go PCR beads (Amersham Biosciences, Germany), forward and reverse primers, DNA template (5 µl of the bacterial DNA extract), and double-distilled water to the final volume. The PCR cycle conditions were optimized for each primer set. Briefly, the PCR cycling conditions consisted of initial denaturation at 94°C for 5 min, followed by 30 cycles each of denaturation at 94°C for 30 s, annealing at the temperature optimal for each primer set for 45 s, and extension at 72°C for 45 s. The amplified PCR product was electrophoresed on a 2% agarose gel in Tris-acetate-EDTA buffer. A 100-bp DNA ladder (Invitrogen, Carlsbad, CA) was used as a molecular weight marker. Positive and negative controls strains were used throughout the PCR-based assays.
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TABLE 1. PCR primers used in this study
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TABLE 2. Prevalence of Cefr GNEB isolated from dairy calves from April to August 2003
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Antibiotic susceptibility of Cefr E. coli isolates.
An antibiotic disk diffusion assay showed that the isolates were resistant to Amp (100%), Cef (100%), Chl (94%), Ffc (93%), Gen (89%), Spt (72%), Tet (98%), Tic (99%), and Tim (99%). No resistance to Eno was observed. Of the 122 isolates tested, all isolates were resistant to 3 or more antibiotics, with 82 of 122 isolates (67%) being resistant to 9 out of 10 antibiotics (Table 3). Antimicrobial MICs for the Cefr E. coli isolates were determined using a broth microdilution assay using NCCLS standards (25); the range of MICs and the MICs at which 50% and 90% of the tested strains were inhibited (MIC50 and MIC90, respectively) are presented in Table 4. MIC results confirmed antibiotic resistance profiles generated by the disk diffusion assay. Elevated MICs of all nine drugs were observed (Table 4). All Cefr E. coli isolates had a MIC of
16 µg/ml for ceftiofur. The MIC90 values for Chl and Ffc were >256 µg/ml, and the MIC90 values for Spt and Tic were >1,024 µg/ml. Amp and Tet each had MIC90 values of 512 µg/ml.
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TABLE 3. Characteristics of Cefr E. coli clonal types
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TABLE 4. MICs for Cefr E. coli isolates
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PFGE analysis.
The E. coli isolates were studied for genetic relatedness by means of PFGE. The 122 isolates belonged to 27 distinct PFGE profiles (PFPs) (Fig. 1). Cluster analysis showed that the 27 PFPs belonged to six clusters. Seventy-seven Cefr E. coli isolates (63.1%) belonged to cluster 4 (PFPs 2, 7, 8, 11, 13, and 14). PFP 7 was the most predominant profile observed, accounting for 58 isolates (47.5%). The isolates belonging to PFP 7 had identical antibiotic resistance profiles (Table 3). The isolates in clusters 1 to 3 belonged to PFPs that were found less frequently. Cluster 6 was the smallest, with only a single PFP.
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FIG. 1. Dendrogram showing the relationships between PFGE profiles of Cefr E. coli isolates.
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PCR detection of beta-lactamase genes.
All Cefr E. coli isolates were screened for the cephamycinase blaCMY2 gene by a PCR-based assay. A total of 117 isolates (96%) were positive for the gene (Table 5). The six isolates negative for blaCMY2 were screened for other beta-lactamase genes, including blaCTX-M2, blaFOX, blaSHV, blaTEM, and ampC. The ampC primers recognized any plasmid-borne cephamycinase gene other than blaCMY2. Three isolates carried the blaTEM gene, and three isolates were positive for ampC (Table 3). One isolate (ceftiofur MIC, 128 µg/ml) carried both blaTEM and ampC genes. None of the isolates contained the blaCTX-M2, blaFOX, or blaSHV gene. A single isolate (ceftiofur MIC, 32 µg/ml) was negative for all the beta-lactamase genes included in the PCR assays.
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TABLE 5. Prevalence of beta-lactamase genes in Cefr E. coli isolates
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6 weeks old) were less diverse (8 CTs) than CTs from 3- and 4-week-old calves (13 CTs). Clonal type 36 (n = 47 isolates) was isolated from 42 calves and found in all age groups. This E. coli CT belonged to the O8:H25 serotype, exhibited PFGE profile 7, and had a Amp-Chl-Gen-Ffc-Spt-Tet-Tic-Tim-Cef resistance profile. Clonal type 36 carried the blaCMY2 cephamycinase gene, as determined by PCR (Table 3). The incidence of CT 36 was analyzed with respect to calf age and sampling month using a chi-square test of independence (Table 6). There was no significance for the incidence CT 36 by calf age (P < 0.05); however, there was statistical significance for the incidence of CT 36 by the month of sampling (P < 0.001). |
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TABLE 6. Significance of clonal type 36 isolated from dairy calves
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The number of gram-negative bacteria, E. coli in particular, in calf feces is higher than that in adult cattle feces (18). The number of GNEB decreased as calf age increased, as shown in other studies (17, 18). The decrease in the prevalence of Cefr GNEB could be due to the overall decrease in total fecal E. coli. The decline in the proportion of Cefr GNEB may be related to changes in competition due to ruminal development and diet as the animals are weaned. Housing and dietary changes, such as weaning, may affect the prevalence of antibiotic-resistant strains by altering the calf's exposure to other animal stock and colonizing strains or changing the E. coli composition of the gut microflora (16).
Several classes of antibiotics are approved for the treatment of scours and enteritis in dairy calves in the United States (10). A recent survey of Pennsylvania dairy producers reported tetracycline, neomycin, and spectinomycin as the most commonly used antibiotics in treatment of enteritis in calves (33). Zwald et al. (46) found that 78% of the farms surveyed used antibiotics in the treatment of calf diarrhea, and the use of ceftiofur to treat calf diarrhea was reported by 11% of the farms. Treatment of bovine respiratory disease was the most commonly reported use of ceftiofur in both surveys (33, 46).
In this study, all E. coli isolates were resistant to three or more antibiotics. The most common antibiogram pattern observed was Amp-Chl-Gen-Ffc-Spt-Tet-Tic-Tim-Cef. The high level of multidrug resistance in healthy dairy calves has not been reported in previous studies. In a study by Werckenthin et al. (40), E. coli isolates from diarrheic calves were screened against a panel of 13 antibiotics, with 63% showing resistance to multiple drugs; 23% were resistant to nine or more drugs. Orden et al. (27) tested E. coli isolates from diarrheic calves against a similar panel of antibiotics and observed that 76.9% showed resistance to at least two antibiotics but that only 32% were resistant to eight or more antibiotics. We found the highest prevalence of multidrug resistance in 2-week-old calves. Remarkably, even day-old calves shed E. coli isolates resistant to 9 of the 10 antibiotics tested; other researchers have made similar observations (27, 40).
We observed that 93% of the Cefr E. coli isolates were resistant to both florfenicol and chloramphenicol. Florfenicol and chloramphenicol belong to the thiophenicol group of antibiotics. Although the use of chloramphenicol in food animals has been banned in the United States since the 1980s, the resistance observed in this study could be due to genes encoding florfenicol resistance. Florfenicol was approved by the Food and Drug Administration (FDA) in 1996 for the treatment of bovine respiratory disease (41). A similar level of cross-resistance has been reported by White et al. (41). They showed that 85% of E. coli isolates from diarrheic dairy calves were resistant to both chloramphenicol and florfenicol. Similar cross-resistance has also been reported for Salmonella spp. (2, 4). All E. coli strains were sensitive to the fluoroquinolone antibiotic Eno. Fluoroquinolone drugs are highly effective against E. coli infections in animals; however, emerging resistance to fluoroquinolones has been reported in Europe (8, 40). The findings of this study suggest that dairy-origin GNEB in Pennsylvania are not likely to be a reservoir of fluoroquinolone resistance genes.
The Cefr E. coli isolates exhibited elevated MICs for several unrelated classes of antibiotics. The MIC90 for ceftiofur was threefold higher than the NCCLS breakpoint value. A study by Sato et al. (32) reported ceftiofur MICs ranging from 0.5 to 16 µg/ml for E. coli samples from healthy calves; while Bradford et al. (7) reported ceftiofur MICs ranging from 0.25 to >128 µg/ml for E. coli samples from diarrheic calves. Elevated MICs for ampicillin (>128 µg/ml), ticarcillin (32 to >128 µg/ml), and ticarcillin-clavulanate (16 to >128 µg/ml) were also observed (7). Orden et al. (27) reported that E. coli isolates from diarrheic calves had elevated MIC90 values for ampicillin (>512 µg/ml), spectinomycin (>512 µg/ml), gentamicin (32 µg/ml), chloramphenicol (512 µg/ml), and tetracycline (256 µg/ml). Similar MIC90 values were observed in this study (Table 4).
Serotyping continues to be a fundamental method used to classify E. coli isolates and is considered the "gold standard." In a study on the ecology of E. coli in cattle, Hinton et al. (15) isolated 55 different O serogroups from 16 calves, whereas Glantz (13) reported 88 different O:H serotypes associated with E. coli isolates from calves. We found that 57.3% of the Cefr E. coli isolates belonged to the O8 serogroup and 49.2% belonged to serotype O8:H25. Interestingly, Glantz (13) also observed E. coli belonging to the O8 serogroup as the predominant O type isolated from young dairy calves. The O8 serogroup has been associated with diarrhea and extraintestinal infections in calves (23). In our study, other serogroups, including O4, O86, O106, and O or nontypeable strains, were identified. The O4 and O86 serogroups have been reported to be associated with calf scours (26, 39), and nontypeable E. coli strains have been isolated from bacteremic calves (12).
PFGE typing is often used to determine sources of food-borne outbreaks by comparing human isolates with those from food and animals. In this study, PFGE analysis of 122 Cefr E. coli isolates resulted in 27 PFPs, with 77 of 122 isolates (63.1%) belonging to a single cluster. PFGE and serotype analyses showed that cluster 4 on the phylogenetic tree contained nearly 60 isolates that had the same PFP and serotype. PFGE profiles correlated well with O serogroup and antibiotic resistance. A similar correlation between antibiotic resistance and PFGE profile has been seen in multidrug-resistant Salmonella enterica serotype Newport (4, 31).
Most studies of antibiotic resistance in animal agriculture have been directed toward pathogenic bacteria (6, 7, 11, 29, 42). The findings of this study provide a unique perspective on the role of commensal E. coli as a potential reservoir of resistance genes for multiple antibiotics. Monitoring resistance in commensal bacteria, such as E. coli, is important, as they can gain access to the food chain. Zhao et al. (45) reported the presence of extended-spectrum cephalosporin-resistant E. coli and Salmonella spp. in retail ground meat, signifying the public health importance of this issue. Nonpathogenic multidrug-resistant strains of E. coli in the intestinal microflora serve as an important reservoir of mobile resistance genes which can be transferred in the intestines to other bacterial species, including pathogens such as Salmonella spp. (1, 5, 16, 17, 37). This can be an important mechanism for acquiring antibiotic resistance in pathogenic bacteria that pose a challenge for effective antibiotic therapy. The findings of our study suggest that commensal E. coli can perhaps play a dynamic role in the ecology of multidrug resistance in the dairy environment.
The most common mechanism of cephalosporin resistance is through production of beta-lactamases. Broad-spectrum cephalosporins, like ceftiofur, have increased ring stability against some beta-lactamases but are susceptible to cephamycinases (20). Cephamycinases (blaCMY) share extensive homology to chromosomal ampC beta-lactamases. The blaCMY2 gene is closely related to the chromosomal ampC of Citrobacter freundii (44). Ceftiofur resistance in E. coli is typically due to the presence of the blaCMY2 gene (45). Our findings support this, as the blaCMY2 gene was found in 96% of the ceftiofur-resistant E. coli isolates in this study. For one Cefr E. coli isolate, none of the acquired beta-lactamase genes assayed in this study were detected. There are two possible mechanisms for ceftiofur resistance in this isolate, (i) presence of a cephamycinase gene not included in our assay (30) or (ii) mutations in the E. coli chromosomal ampC gene, causing hyperproduction of this enzyme (36).
There is concern that the widespread use of ceftiofur in cattle is selecting for and maintaining ceftriaxone-resistant Salmonella spp. in the intestinal flora of cattle (1, 5). Ceftriaxone, an analogue of ceftiofur, is an expanded-spectrum cephalosporin used for the treatment of Salmonella infections in children. In the cases of domestically acquired infections, most ceftriaxone-resistant Salmonella spp. carry blaCMY2 (43). Researchers have shown that transfer of the blaCMY2 gene between E. coli and Salmonella can occur (3, 44).
We used several methods to classify the ceftiofur-resistant E. coli isolates in this study. A total of 59 Cefr E. coli clonal types were identified, of which CT 36 was the most prevalent. Clonal type 36 appeared suddenly as the predominant CT, having not been observed in the preceding month, and continued to be the most prevalent CT for several months. The results show clonal expansion of this particular E. coli strain among the calf herd. We speculate that the source of this CT was the maternity pen, calf-to-calf contact, contact with farm workers, or a common source, such as contaminated water. Additionally, this farm did not keep records of antibiotic treatment, meaning that the misuse of antibiotics could be contributing to the high level of multidrug resistance seen among these calves.
In conclusion, we found that healthy dairy calves were rapidly colonized by antibiotic-resistant strains of E. coli shortly after birth. A recent study of the dynamics of E. coli in dairy calves showed that antibiotic-resistant strains had a greater selective advantage in newborn calves than antibiotic-susceptible strains, even in calves not treated or exposed to antibiotics (18). A selective advantage for antibiotic-resistant E. coli strains to thrive in the intestinal environment of young calves could explain why multidrug-resistant strains were isolated from day-old calves in this study. A significant public health concern is that multidrug-resistant commensal E. coli strains may constitute a potential reservoir of resistance genes that could be transferred to pathogenic bacteria (9). The findings of our study provide evidence to support earlier studies that suggest the existence of a reservoir of antibiotic resistance genes (7, 16). Infections with multidrug-resistant pathogens limit the options available to treat infectious disease of animals and humans. The high prevalence of multidrug-resistant bacteria observed in this study suggests there is a need for improved education and communication on the issue of antibiotic use between dairy farmers and veterinarians. Young dairy calves are susceptible to many pathogens, and infections with antibiotic-resistant organisms may lead to treatment failure that can result in economic losses for the producer. With the continuing emergence of antibiotic resistance, it is imperative that actions be taken to prolong the effectiveness of existing antibiotics while maintaining levels of food animal production.
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