Detection of Salmonella organisms and assessment of a protocol for removal of contamination in horse stalls at a veterinary teaching hospital

OBJECTIVES: To assess methods of detecting environmental contamination with Salmonella organisms and evaluate a cleaning and disinfection protocol for horse stalls in a veterinary teaching hospital. DESIGN: Original study. SAMPLE POPULATION: 37 horses with diarrhea likely to be caused by Salmonella infection and their stall environments. PROCEDURES: Fecal samples were collected from horses daily during hospitalization; samples were obtained from stall sites after cleaning and application of disinfectants. Fecal and environmental samples were cultured for Salmonella spp and tested via polymerase chain reaction (PCR) assay to detect Salmonella DNA. RESULTS: 1 horse died and 2 were discharged prior to sample collection. Fecal samples from 9 of 34 horses yielded growth of Salmonella organisms on bacteriologic culture, and 23 yielded positive results via PCR assay on > or = 1 occasion. Among environmental samples from 21 stalls, salmonellae were detected at > or = 1 stall site on 6 of 78 occasions, and > or = 1 stall site yielded positive results via PCR assay on 69 of 77 occasions. Salmonella DNA was detected more frequently in samples of stall drains, cracks, and corners. Salmonella spp were cultured from samples of 3 stalls after both initial and second cleaning and disinfection cycles, but no organisms were detected in samples obtained after use of a peroxygen disinfectant. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that stalls in which horses with salmonellosis were housed should only be used to accommodate newly hospitalized horses after samples (collected after 2 cycles of cleaning and disinfection) from drains, cracks, and corners yield negative results on bacteriologic culture.     

First Report of Methicillin-Resistant Staphylococcus aureus ST5 and ST398 from Purebred Lusitano Horses

Methicillin-resistant Staphylococcus aureus (MRSA) was first described in horses in 1996. The frequency of MRSA colonization in horses varies among European countries, but it is unknown in Portugal. The aim of this study was to screen for MRSA nasal carriage in a sample of horses entering the Equine Unit, Large Animal Veterinary Teaching Hospital of the Faculty of Veterinary Medicine, Lisbon, Portugal. Seventy-one horses were swabbed, and MRSA was identified by selective isolation on a chromogenic medium. Two S aureus isolates showed resistance to oxacillin (minimum inhibitory concentration >4 μg/mL) and contained the mecA gene. Both strains were isolated from purebred Lusitano horses that lived in farms with more than 20 equines. These MRSA strains represented two different clones: isolate FMVA3/10 was an MRSA sequence type ST5 with a staphylococcal cassette chromosome mec VI, coresistant to erythromycin and clindamycin; and isolate FMVA16/10 was sequence type ST398, with a staphylococcal cassette chromosome mec IV, coresistant to tetracycline, gentamicin, and trimethoprim. Isolate FMVA3/10 represents a human epidemic clone not previously reported among horses in Europe, which once again reinforces the fact that transmission of MRSA clones between horses and humans occurs. Isolate FMVA16/10 represents the first report of the detection of MRSA ST398 among horses in Portugal. Lusitano horses can carry animal and human MRSA in the nostrils, acting as reservoirs, which can potentially be transmitted to humans.     

Molecular epidemiology of environmental MRSA at an equine teaching hospital: introduction,circulation and maintenance

The role that environmental contamination might play as a reservoir and a possible source of Methicillin-resistant Staphylococcus aureus (MRSA) for patients and personnel at equine veterinary hospitals remains undefined, as the environment has only been monitored during outbreaks or for short periods. Therefore, the objectives of this study were to determine the monthly presence, distribution, and characteristics of environmental MRSA at an equine hospital, and to establish patterns of contamination over time using molecular epidemiological analyses. For this purpose, a yearlong active MRSA surveillance was performed targeting the environment and incoming patients. Antimicrobial susceptibility testing, SCCmec typing, PFGE typing, and dendrographic analysis were used to characterize and analyze these isolates. Overall, 8.6% of the surfaces and 5.8% of the horses sampled were positive for MRSA. The most common contaminated surfaces were: computers, feed-water buckets, and surgery tables-mats. Ninety percent of the isolates carried SCCmec type IV, and 62.0% were classified as USA500. Molecular analysis showed that new pulsotypes were constantly introduced into the hospital throughout the year. However, maintenance of strains in the environment was also observed when unique clones were detected for 2 consecutive months on the same surfaces. Additionally, pulsotypes were circulating throughout several areas and different contact surfaces of the hospital. Based on these results, it is evident that MRSA is constantly introduced and frequently found in the equine hospital environment, and that some contact surfaces could act as “hot-spots”. These contaminated surfaces should be actively targeted for strict cleaning and disinfection as well as regular monitoring.     

Methicillin-resistant Staphylococcus aureus in horses at a veterinary teaching hospital: frequency, characterization, and association with clinical disease

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging equine pathogen. To attempt to control nosocomial and zoonotic transmission, an MRSA screening program was established for all horses admitted to the Ontario Veterinary College Veterinary Teaching Hospital, whereby nasal screening swabs were collected at admission, weekly during hospitalization, and at discharge. MRSA was isolated from 120 (5.3%) of 2,283 horses: 61 (50.8%) at the time of admission, 53 (44.2%) during hospitalization, and 6 from which the origin was unclear because an admission swab had not been collected. Clinical infections attributable to MRSA were present or developed in 14 (11.7%) of 120 horses. The overall rate of community-associated colonization was 27 per 1,000 admissions. Horses colonized at admission were more likely to develop clinical MRSA infection than those not colonized at admission (OR 38.9, 95% CI 9.49 160, P < 0.0001). The overall nosocomial MRSA colonization incidence rate was 23 per 1,000 admissions. The incidence rate of nosocomial MRSA infection was at the rate of 1.8 per 1,000 admissions, with an incidence density of 0.88 per 1,000 patient days. Administration of ceftiofur or aminoglycosides during hospitalization was the only risk factor associated with nosocomial MRSA colonization. MRSA screening of horses admitted to a veterinary hospital was useful for identification of community-associated and nosocomial colonization and infection, and for monitoring of infection control practices.     

A veterinary perspective on methicillin-resistant staphylococci

Objective – To familiarize the reader with the epidemiology, diagnosis, and infectious and zoonotic potential of methicillin-resistant staphylococci.
Data sources – Original research publications, scientific reviews and abstracts, case reports, and conference proceedings.
Human Data Synthesis – Staphylococcus aureus is a common human commensal organism; acquisition of genes encoding an altered penicillin-binding protein confers resistance to β-lactam antimicrobial drugs. Methicillin-resistant S. aureus (MRSA) are often resistant to non–β-lactam antimicrobial drugs as well. Originally described as an important cause of nosocomial infection, MRSA colonization and infection are now often identified in humans outside healthcare settings. Like other S. aureus , MRSA may be present without clinical illness. However, when they do cause infection the consequences can be extremely serious.
Veterinary Data Synthesis – The major domestic animal species, including pets and livestock, may become contaminated, colonized, or infected with methicillin-resistant staphylococci, including MRSA. Dogs and cats are more likely to be colonized/infected with Staphylococcus pseudintermedius than S. aureus , but this pathogen can acquire genes encoding methicillin resistance (ie, MRSP). Diagnosis of MRSA or MRSP has implications not only for treatment of infected animals, but for potential zoonotic transmission.
Conclusions – MRSA infection is an important cause of morbidity and mortality in humans. Animals may be contaminated, colonized, or infected with MRSA, with implications for the animal's health and as a potential reservoir for human infection. Staphylococci other than S. aureus may also acquire genes for methicillin resistance, and these species can also result in animal and occasionally human morbidity or mortality.     

A review of the characteristics and treatment of methicillin‐resistant Staphylococcus aureus (MRSA) in the horse and a case series of MRSA infection in four horses

Methicillin‐resistant Staphylococcus aureus (MRSA) is an emerging cause of serious bacterial infection in the horse, with an increasing number of cases reported over the last decade. MRSA, along with other commensal staphylococcal species, can reside on the mucosa of several sites in the horse, particularly the nose. Nasal carriage of MRSA appears rare amongst horses in the community, although a higher prevalence has been found in hospitalised horses. MRSA infections can involve a variety of body sites, but most commonly encountered are soft tissue infections of either traumatic or surgical wounds. MRSA strain types isolated from horses are typically multidrug‐resistant and usually differ from those recovered from humans and other small animal species. Treatment of infection can be prolonged and is dependent on timely, accurate diagnosis and on appropriate therapy; often guided by antimicrobial susceptibility testing. The purpose of this review is to provide clinically relevant information for the equine practitioner and, for illustration, the diagnosis, treatment and outcome of 4 clinical cases of MRSA infection in horses is discussed.     

Community-associated methicillin-resistant Staphylococcus aureus in horses and humans who work with horses

OBJECTIVE: To evaluate the prevalence of nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) in horses and horse personnel. DESIGN: Prospective prevalence study. SAMPLE POPULATION: 972 horses and 107 personnel from equine farms in Ontario, Canada and New York state. PROCEDURE: Nasal swab specimens were collected from horses and humans on farms with (targeted surveillance) and without (nontargeted surveillance) a history of MRSA colonization or infection in horses during the preceding year. Selective culture for MRSA was performed. Isolates were typed via pulsed-field gel electrophoresis, and antibiograms were determined. RESULTS: MRSA was isolated from 46 of 972 (4.7%) horses (0/581 via nontargeted surveillance and 46/391 [12%] via targeted surveillance). Similarly, MRSA was isolated from 14 of 107 (13%) humans (2/41 [5%] from nontargeted surveillance and 12/66 [18%] from targeted surveillance). All isolates were subtypes of Canadian epidemic MRSA-5, an uncommon strain in humans. All isolates were resistant to at least 1 antimicrobial class in addition to beta-lactams. On all farms with colonized horses, at least 1 human was colonized with an indistinguishable subtype. For horses, residing on a farm that housed > 20 horses was the only factor significantly associated with MRSA colonization. For humans, regular contact with > 20 horses was the only identified risk factor. CONCLUSIONS AND CLINICAL RELEVANCE: Results confirm a reservoir of colonized horses on a variety of farms in Ontario and New York and provide evidence that 1 MRSA strain is predominantly involved in MRSA colonization in horses and humans that work with horses.     

Prevalence of lungworm D. arnfieldi (Cobbold 1884) in donkeys in Denmark and in horses in herds together with donkeys (author's transl)

During a 5 months' period from January to May 1981 faecal samples of 176 donkeys from 59 herds all over the country were examined at the Institute of internal medicine, The Royal Veterinary and Agricultural University, Copenhagen. In addition, the investigation also included 106 horses from 30 of the donkey herds and 34 horses hospitalized with symptoms of dyspnoea and chronic coughing. In all, 87.5% of the donkeys were shown to excrete D. arnfieldi larvae, often in very high numbers, and the larval excretion was the only symptom of lungworm infection. There was no significant correlation between larval excretion and age, sex or herd size. In horses, the frequency of D. arnfieldi infection was approximately the same in the horses from donkey herds and in horses hospitalized due to chronic cough (10.4% and 8.8% resp.). In contrast to the donkeys, the infection in horses was always accompanied by dyspnoea and coughing.     

Methicillin-resistant Staphylococcus aureus in a population of horses in Australia

Objective To evaluate if methicillin‐resistant Staphylococcus aureus (MRSA) is present in the horse population in Australia. Design A two‐part retrospective study of laboratory submissions of microbial culture results from horses. Methods Part A: medical records of 216 horses that had MRSA screening performed on nasal swabs collected over a 30‐day period at admission to the Scone Equine Hospital Clovelly Intensive Care Unit were retrieved. Part B: laboratory records from 2004 to 2009 of culture submissions to the Scone Veterinary Laboratory were reviewed and cultures that grew MRSA were identified. The MRSA isolates from Parts A and B were genotyped over an 18‐month period. Results MRSA screening of 216 horses identified eight (3.7%) positive samples. MRSA was isolated from cultures of 80 (0.002%) clinical bacteriology samples over a 6‐year period. Genotypic analysis was performed on 36 isolates. All MRSA characterised had the same pulse field gel electrophoresis pattern (type 1), with eight closely related subtypes identified (subtypes A–F and H) and 66% of isolates classified as subtype D, which multilocus sequence and staphylococcal cassette chromosome mec typing analysis identified as ST612‐MRSA‐IVa, a clonal complex (CC) 8 S. aureus strain. Antimicrobial resistance to more than two classes of antimicrobials was common. Conclusions MRSA was present in a population of horses in Australia. Genotypic analysis of the isolates identified the MRSA strain as CC8 S. aureus. Further research needs to be undertaken to evaluate MRSA infection and colonisation of horses and personnel in Australia.     

An outbreak of methicillin-resistant Staphylococcus aureus skin infections resulting from horse to human transmission in a veterinary hospital

There are increasing reports of methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization in horses and evidence that MRSA can be transmitted between horses and humans. The objective of this study was to investigate reports of skin infection in personnel working with a foal with community-associated MRSA colonization and subsequent infection. Clinical diagnostic specimens were collected from individuals reporting skin lesions following contact with the affected foal. Nasal and groin screening swabs were collected from other veterinary personnel that attended a voluntary screening clinic. MRSA skin infections were identified in three neonatal intensive care unit personnel. Nasal colonization was subsequently identified in 10/103 (9.7%) other veterinary hospital personnel. Isolates were indistinguishable by pulsed field gel electrophoresis, classified as Canadian epidemic MRSA-5, possessed SCCmecIV, were negative for the Panton-Valentine leukocidin and were multidrug resistant. Transmission to veterinary personnel despite short-term contact with standard protective barriers highlights the potential importance of MRSA as an emerging zoonotic pathogen, and indicates that further evaluation of interspecies transmission of MRSA and means to prevent zoonotic infection are required.     

Detection and Management of an Outbreak of Equine Herpesvirus Type 1 Infection and Associated Neurological Disease in a Veterinary Teaching Hospital

Background: Because of the serious disease sequelae associated with equine herpesvirus type 1 (EHV‐1) infections, awareness and control measures used to control outbreaks are important issues for all horse populations. Objectives: Describe the occurrence and management of an outbreak of EHV‐1 infection at a veterinary hospital. Animals: Horses hospitalized at a referral veterinary hospital. Methods: A horse with myeloencephalopathy associated with EHV‐1 infection (EHM) was admitted for diagnostic evaluation and treatment under strict infection control procedures. We describe the occurrence and management of a nosocomial outbreak of EHV‐1 infections associated with admission of this patient. Results: Despite institution of rigorous biosecurity precautions at the time of admission of the index case, EHV‐1 infections spread to 6 other horses that were hospitalized at the James L. Voss Veterinary Teaching Hopsital, including 2 that served as sources of infection for horses on their home premises after discharge. Infection with EHV‐1 was confirmed by polymerase chain reaction (PCR) and by seroconversion documented by glycoprotein G ELISA. A voluntary quarantine was imposed and admissions were restricted to prevent additional horses from being exposed. Quarantine duration was abbreviated by serial testing of all horses with PCR. Conclusions and Clinical Importance: These findings illustrate the contagious disease risk that can accompany management of horses with EHM. Horses with active nasal EHV‐1 shedding should be isolated in an airspace that is separate from other horses by strictly enforced biosecurity and isolation procedures. Serial testing with PCR may be a useful adjunct to determine when the risk of transmission has been minimized.     

Risk factors for nosocomial Salmonella infection among hospitalized horses.

OBJECTIVE: To identify risk factors for nosocomial Salmonella infections among hospitalized horses. DESIGN: Longitudinal study. ANIMALS: 1,583 horses hospitalized in an intensive care unit between January 1992 and June 1996. PROCEDURE: Survivor functions were used to estimate time to shedding salmonellae for various Salmonella serotypes. Survival analysis was then used to determine how variables associated with patient management, environmental conditions, hospital conditions, and other disease processes affected the risk of nosocomial Salmonella infection. RESULTS: 78 horses shed Salmonella organisms: 35 shed Salmonella krefeld, 26 shed S typhimurium, and 17 shed other Salmonella serotypes. Mean time from admission to shedding was significantly longer for horses shedding S krefeld or S typhimurium than for horses shedding other Salmonella serotypes. Therefore, infection with S krefeld or S typhimurium was considered nosocomial. Seven variables were found to be significantly associated with risk of nosocomial Salmonella infection: mean number of horses in the hospital shedding S krefeld during the 4 days prior to and the day of admission, mean number of horses shedding S typhimurium during this period, a diagnosis of large colon impaction, withholding feed, number of days fed bran mash, duration of treatment with potassium penicillin G, and mean daily ambient temperature. CLINICAL IMPLICATIONS: Results suggest that risk of nosocomial Salmonella infections is greater for horses with large colon impactions. In addition to implementing hospital protocols that minimize cross contamination between patients, strategies to reduce the risk of nosocomial Salmonella infection should include minimizing use of potassium penicillin G and regulation of environmental temperature in the hospital.     

Evaluation of arthrocentesis site bacterial flora before and after 4 methods of preparation in horses with and without evidence of skin contamination

OBJECTIVE: To evaluate the effectiveness of four methods of povidone-iodine preparation on skin bacterial flora of arthrocentesis sites, in horses, with and without evidence of skin contamination. STUDY DESIGN: Prospective randomized study. ANIMALS: Twenty-four adult horses. METHODS: Horses were assigned to either the clean or contaminated group based on housing environment and visual evidence of contamination. Using a moist sterile swab, microbial culture samples were obtained from the skin over the distal interphalangeal joints immediately before and after preparation. Each site was aseptically prepared with 1 of 4 povidone-iodine techniques: 10-minutes scrub, 5-minutes scrub, three 30-second scrubs, or commercial one-step iodophor surgical solution. Colony forming units (CFUs) were determined for each sample, 24 hours after inoculation, on blood agar plates. RESULTS: Mean (+/-SD) pre-scrub CFUs/mL was significantly higher in the contaminated group (9588.33+/-1223.65) compared with the clean group (4489.00+/-3842.03) (P<.01). After preparation of the arthrocentesis sites, there were no significant differences in post-scrub CFUs/mL among the 10 minutes (mean clean, 46.00+/-64.36; mean contaminated, 28.67+/-18.04), 5 minutes (mean clean, 84.17+/-109.80; mean contaminated, 40.33+/-44.52), three 30 seconds povidone-iodine scrubs (mean clean, 95.50+/-172.29; mean contaminated, 46.67+/-56.94), or application of a commercial one-step iodophor surgical solution (mean clean, 102.17+/-161.78; mean contaminated 117.67+/-143.78); or between the clean (81.96+/-131.69) and contaminated groups (58.33+/-85.90) (P<.01). CONCLUSIONS: Preparation of the distal interphalangeal joint arthrocentesis site with each of these techniques significantly reduces the bacterial flora to a similar level for arthrocentesis in horses with and without evidence of skin contamination. Clinical Relevance- Aseptic preparation of the skin over the distal interphalangeal joint may be accomplished with any of these techniques.     

Validation of a Commercial Enzyme Immunoassay for Detection of Clostridium difficile Toxins in Feces of Horses with Acute Diarrhea

Background: Clostridium difficile infection (CDI) is a recognized cause of colitis in the horse. Identification of its toxins is important for management of individual cases and for prevention of transmission and zoonosis. In humans, CDI diagnosis is performed with enzyme immunoassays, none of which have been validated for horses. Hypothesis/Objectives: (1) Establish which test for CDI diagnosis was more frequently used by diagnostic laboratories, (2) determine the identified test's performance, sensitivity, and specificity, and (3) validate its use in diarrheic horses. Animals: Samples were obtained from 72 horses presented with acute diarrhea and hospitalized at the Ontario Veterinary College, University of Guelph. Methods: A survey was conducted to establish which of the tests for CDI diagnosis in horses is most commonly used throughout North America. A questionnaire was sent to all laboratories registered in the Veterinary Infection Control Society and the American Association of Veterinary Laboratory Diagnosticians. The performance of the test was evaluated by comparison to a cell cytotoxicity assay (CTA), the accepted Gold Standard for C. difficile toxin detection. Results: The Techlab C. difficile Tox A/B II ELISA was the most frequently used test. Compared with the CTA, no significant difference was observed, and a good level of agreement (93%) was obtained. The diagnostic performance of the ELISA test was adequate (84% sensitivity and 96% specificity). Conclusions and Clinical Importance: Results demonstrate that the Techlab C. difficile Tox A/B II ELISA is a reliable, adequate, and practical tool for identification of C. difficile toxins in horse feces.     

Attempted eradication of methicillin-resistant staphylococcus aureus colonisation in horses on two farms

REASONS FOR PERFORMING STUDY: Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging equine and zoonotic pathogen. Infection control protocols can be used to control MRSA in human hospitals, but measures to eradicate MRSA on horse farms have not been evaluated. OBJECTIVES: To describe an MRSA eradication programme that was used to attempt to eliminate MRSA colonisation among horses and horse personnel on 2 equine farms. METHODS: Active surveillance cultures and infection control protocols were implemented on 2 farms with endemic MRSA. RESULTS: Active screening and strict implementation of infection control protocols resulted in a rapid decrease in number of colonised horses on both farms. The majority of horses eliminated MRSA without antimicrobial treatment. On one farm colonisation was eradicated, while only 2 (3%) colonised horses remained on the other farm at the end of the study. CONCLUSIONS: Although at this stage the benefit of eradication of MRSA from populations of horses and cost-benefit studies have not been established, this study illustrates that short-term eradication can be achieved with a policy of segregation, enhanced infection control precautions and repeated testing of groups of animals. POTENTIAL RELEVANCE: Infection control practices should form the basis of MRSA control. Antimicrobial therapy does not appear to be required for eradication of MRSA colonisation in horses and control of MRSA on farms. In appropriate circumstances, these methods may be useful for controlling the spread of this potentially serious pathogen.     

Effects of Blood Contamination on Peritoneal D-Dimer Concentration in Horses with Colic

Background: Peritoneal D-Dimer concentration can be determined to assess peritoneal fibrinolysis activity in horses with gastrointestinal disorders. However, blood contamination of peritoneal fluid may occur during collection and could alter peritoneal D-Dimer concentration.
Hypothesis/Objectives: Blood contamination in peritoneal fluid does not affect interpretation of peritoneal D-Dimer concentration in horses with colic.
Animals: Thirty-four horses with colic and 4 healthy horses.
Methods: Peritoneal fluid and blood samples were simultaneously collected upon admission. Then, peritoneal fluid was serially contaminated with the horse's own blood; final contaminations corresponded to 1, 5, 10, and 20% of blood in peritoneal fluid. D-Dimer concentration was determined in blood, peritoneal fluid, and contaminated peritoneal fluid samples. Data were analyzed using a longitudinal linear model and a generalized estimating equations analysis to assess the quantitative and qualitative variations of the effect of blood contamination on peritoneal D-Dimer concentration.
Results: Peritoneal D-Dimer concentration was only quantitatively affected when peritoneal fluid was contaminated at 20% of blood. However, when using increasing cut-off values of peritoneal D-Dimer concentration (100, 2,000, 8,000, and 16,000 ng/mL), this effect disappeared at the highest cut-off values (8,000 and 16,000 ng/mL). When peritoneal fluid contamination was grouped as "minimally contaminated" (≤1% of blood) and "highly contaminated" (≥5% of blood), no significant differences on D-Dimer concentration between both groups at each cut-off value were observed.
Conclusions and Clinical Importance: Although quantitative results of peritoneal D-Dimer concentration could be affected by high levels of blood contamination (≥20%), interpretation of increased peritoneal fibrinolytic activity was not significantly affected.     

Environmental Salmonella in Agricultural Fair Poultry Exhibits in Colorado

Salmonella enterica is a common zoonotic pathogen in humans. Transmission typically occurs through consumption of contaminated food products or contact with infected animals, including poultry or their environment. The objective of this study was to estimate the frequency of Salmonella contamination in the environment in poultry exhibits at agricultural fairs. Samples were collected from cages, feed, floors and tables in the exhibit and cultured for Salmonella. At least one environmental sample was positive for Salmonella in 10 of 11 fairs (91%), and Salmonella was isolated from 28 of 55 environmental samples (50.9%). Eleven different serotypes were detected. Results of this study demonstrate that environmental surfaces at agricultural fairs can be contaminated with Salmonella and could potentially serve as a route of transmission to bird owners and the general public. Poultry owners and the general public should be educated about the risks of Salmonella infection from the poultry exhibit environment. Agricultural fairs should consider instituting policies and practices to improve hygiene and mitigate the risk of zoonotic salmonellosis.     

Methicillin-resistant Staphylococcus aureus (MRSA) on the skin of long-term hospitalised horses

Given the significance of methicillin-resistant Staphylococcus aureus (MRSA) infections for both horses and staff in equine veterinary hospitals, protocols are required to minimise the risk of nosocomial transmission, including the screening of the skin and nasal chambers of equine patients for evidence of infection. The objective of this study was to clarify the potential existence and extent of MRSA on the skin of horses requiring long-term hospitalisation (?6months). Thirty such horses were sampled at eight different locations on their skin and from their nasal chambers. MRSA was isolated from 12 animals (40%), with all sample sites testing positive on at least one occasion. Organisms were most frequently detected in the nasal chambers (relative sensitivity, 83.3%; 34.5% positive horses; isolation rate 33.3%). Skin presence was found in 30% of animals with the highest isolation rates found at the carpus (16.7%), neck, withers and croup (13.3% each). To achieve a relative screening sensitivity of >90%, at least one skin site was required in addition to nasal sampling. This evidence of skin as well as nasal reservoirs of MRSA in long-term hospitalised horses should facilitate the design of effective screening and containment protocols.