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New Delhi Metallo-β-Lactamase-5–Producing Escherichia coli in Companion Animals, United States

We report isolation of a New Delhi metallo-β-lactamase-5–producing carbapenem-resistant Escherichia coli sequence type 167 from companion animals in the United States. Reports of carbapenem-resistant Enterobacteriaceae in companion animals are rare. We describe a unique cluster of blaNDM-5–producing E. coli in a veterinary hospital.

A retrospective review of hospital records showed that, during July 11-August 3, 2018, seven carbapenem-resistant E. coli isolates were isolated from 6 animals (Table). Isolates were obtained from 5 dogs and 1 cat; all were from respiratory tract specimens, except for 2 isolates from the urine of 1 dog. All animals were housed in the intensive care unit for >24 hours (Appendix Figure, https://wwwnc.cdc.gov/ EID/article/26/2/19-1221-App1.pdf). All animals overlapped with >1 other affected animal.
We evaluated antimicrobial use; 5/6 animals received >4 antimicrobial drugs before specimen submission. No animals received a carbapenem drug in the 30-day period before sample submission. A β-lactam was given to 5/6 animals, azithromycin to 5/6 animals, metronidazole to 4/6 animals, and enrofloxacin to 4/6 animals (Table).
NDM-5-producing E. coli have been reported in dogs from Finland, South Korea, and Algeria (3)(4)(5). The isolates from Finland were also ST167; the isolates from South Korea and Algeria were obtained from canine feces and identified as ST410 and ST1284. ST1284 is a double-locus variant of ST167, which suggests possible distant relatedness of these isolates; ST410 does not share any multilocus sequence type alleles with ST167 (5). In 2011, the NDM-5 carbapenemase was We report isolation of a New Delhi metallo-β-lactamase-5producing carbapenem-resistant Escherichia coli sequence type 167 from companion animals in the United States. Reports of carbapenem-resistant Enterobacteriaceae in companion animals are rare. We describe a unique cluster of bla NDM-5 -producing E. coli in a veterinary hospital.
described in an isolate of E. coli (ST648) from a human in the United Kingdom who was previously hospitalized in Goa, India (6). In February 2018, three isolates of NDM-5-positive E. coli (ST43) were isolated from 2 patients in a skilled nursing facility in New York, New York (7). Spread of NDM-5-positive E. coli has occurred globally and included reports of ST167 in persons in Europe and Asia (8,9).
Healthcare-associated spread of this E. coli strain in the veterinary intensive care unit emphasizes the need to rapidly identify and characterize carbapenem-resistant isolates from animals. Methods to control the spread of CRE in veterinary medical settings have not yet been studied; these studies are needed to limit the spread of these pathogens in animal populations. Control measures in human healthcare settings include strict hand hygiene, use of personal protective equipment, and environmental decontamination (10). The risk for transmission of CRE from animals to persons is currently poorly understood.
It has been documented that bla NDM-5 , ST167, and carbapenem-resistant E. coli strains can infect humans and animals (4). Additional investigations are needed in the context of transmission between humans and animals. Characterization of CRE isolates from animals is needed to build a knowledge base and provide guidance for future studies because CRE will continue to emerge in veterinary medical settings. CRE will be a major challenge across all health fields as these organisms become more prevalent in the community. A One Health approach to antimicrobial resistance surveillance, infection prevention, and antimicrobial stewardship could limit the spread and potential global dominance of CRE.

About the Author
Dr. Cole is a veterinary microbiologist and a lecturer at the University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA. His research interests include infectious diseases of dogs and cats and antimicrobial stewardship educational strategies in veterinary medicine.  Hantavirus pulmonary syndrome (HPS) is associated with pneumonitis and has a broad clinical spectrum that ranges from mild or no symptoms to fulminant respiratory failure. Hemorrhagic fever with renal syndrome (HFRS) is a characteristic clinical entity that manifests with fever, hypotension, and renal failure (1) and can also manifest as a mild glomerulonephritis and renal insufficiency (2). Eurasian hantaviruses (Hantaan virus, Puumala virus, and Seoul virus [SEOV]) cause HFRS; SEOV has a worldwide distribution (1). However, HPS is the clinical manifestation of most domestically acquired hantavirus infections in the United States.
HFRS in the United States was first reported in 2008 in a 22-year-old man with SEOV infection (2). Investigating a SEOV outbreak in 2017, the Centers for Disease Control and Prevention described 17 human cases in 11 states, including Colorado (3). Of these 17 patients, 9 were asymptomatic, 8 became ill, and 3 were hospitalized and recovered. The index case-patient was an 18-year-old woman with hematuria and mildly elevated creatinine who owned a pet rat (4). Published descriptions of hantavirus infection with renal manifestations in the United States are few, and the clinical characteristics of the renal injury are not often described.
We report a 61-year-old man with predominant renal manifestations of hantavirus who acquired the virus in Colorado, USA, apparently after exposure to aerosolized rodent droppings. He lived on a farm in northeastern Colorado and had cleaned his garage of extensive mouse and rat droppings 2 weeks earlier.
He did not wear a mask to clean and did not own pet rats or snakes. He sought care in April 2019 for a 4-day history of fever up to 38.3°C, headache, fatigue, and myalgia. He also reported abdominal pain, anorexia, neck stiffness, and photophobia.

RESEARCH LETTERS
In North America, hantaviruses commonly cause hantavirus pulmonary syndrome (HPS). Clinical descriptions of hantavirus-associated renal disease in the Americas are scarce. Herein, we discuss the case of a 61-year-old man whose predominant manifestations were acute kidney injury and proteinuria. Clinical recognition of renal signs in hantavirus infections can reduce risk for death.