Dogs Are a Reservoir of Ampicillin-Resistant Enterococcus faecium Lineages Associated with Human Infections

Ampicillin resistance is a marker for hospital-associated Enterococcus faecium. Feces from 208 dogs were selectively screened for the occurrence of ampicillin-resistant E. faecium (AREF). AREF was detected in 42 (23%) of 183 dogs screened in a cross-sectional study in the United Kingdom and in 19 (76%) of 25 dogs studied longitudinally in Denmark. AREF carriage was intermittent in all dogs studied longitudinally. Multilocus sequence typing of 63 canine AREF isolates revealed the presence of 13 distinct sequence types. Approximately 76% of the isolates belonged to hospital-adapted clonal complex 17 (CC17), including those of sequence types ST-78 and ST-192, which are widespread in European and Asian hospitals. Longitudinal screening of 18 healthy humans living in contact with 13 of the dogs under study resulted in the identification of a single, intermittent CC17 carrier. This person carried one of the sequence types (ST-78) recovered from his dog. Based on PCR and Southern hybridization analyses, the putative virulence gene cluster from orf903 to orf907 was widespread in canine AREF isolates (present in 97%), whereas orf2351 (present in 26% of isolates) and orf2430 (present in 31%) were strongly associated with CC17-related sequence types (P < 0.05). Surprisingly, esp and hyl were not detected in any of the isolates. The antimicrobial resistance profiles of canine AREF isolates generally differed from those previously described for clinical human isolates. The results indicate that dogs are frequent carriers of CC17-related lineages and may play a role in the spread of this nosocomial pathogen. The distinctive virulence and antimicrobial resistance profiles observed among canine AREF isolates raise interesting questions about the origin and evolution of the strains causing human infections.Enterococci are opportunistic pathogens and form part of the normal gastrointestinal flora in humans and animals. Over the last two decades, nosocomial infections caused by enterococci have emerged and their incidence has increased rapidly, first in the United States and recently in Europe (25, 26, 29). Although Enterococcus faecalis is the causative agent in most enterococcal infections, a shift toward infections caused by multidrug-resistant E. faecium has been noted in the last years, and presently, up to one-third of enterococcal infections in some countries are attributed to this species (17). This shift may be explained by changes in the patterns of antimicrobial usage, which may have resulted in the emergence of a distinct genogroup of hospital-associated ampicillin-resistant E. faecium (AREF) strains, currently labeled clonal complex 17 (CC17) (33). CC17 isolates are characterized by resistance to ampicillin and fluoroquinolones, as well as by the presence in most isolates of putative virulence genes encoding the enterococcal surface protein (esp) and hyaluronidase (hyl) and five recently described open reading frames (ORFs; orf903, orf904.5, orf906.7, orf2351, and orf2430) encoding LPXTG surface proteins, which are found less frequently among other E. faecium lineages (15, 20, 27).Based on the results of multilocus sequence typing (MLST) (28) and amplified fragment length polymorphism analysis (34), E. faecium isolates of animal origin seem to be host specific and generally unrelated to human lineages of clinical importance. Prior to this study, AREF CC17 strains have been isolated only sporadically from animals, including pigs (2, 10) and more recently dogs (8). Following these unexpected findings, the present study was designed to investigate the prevalence and shedding patterns of AREF in dogs. A cross-sectional study and two longitudinal studies involving a total of 208 dogs and 479 canine fecal samples were conducted in the United Kingdom and in Denmark, respectively. Canine isolates were characterized by MLST, antimicrobial susceptibility testing, and putative virulence gene profiling to assess the genetic relationship between human and canine AREF strains.