Antimicrobial
Resistance in Bacteria Isolated From Dairy Herds in Chile
B. San Martín, MV, DMV*
J. Kruze, MV, PhD†
M. A. Morales, MV, MsSc*
H. Agüero, MV, MsSc*
D. Iragüen, MV*
S. Espinoza, MV, MsSc*
B. León, MV‡
C. Borie, MV, MsSc*
*Laboratory of Pharmacology and
Laboratory of Microbiology, Facultad de Ciencias Veterinarias y Pecuarias,
Universidad de Chile, POB 2, Correo 15, La Granja, Santiago, Chile
†Facultad de Ciencias, Universidad
Austral de Chile, POB 167, Valdivia, Chile
‡COOPRINSEM, POB 827, Osorno,
Chile
KEY
WORDS: Antimicrobial agent,
bacterial resistance, dairy cow
ABSTRACT
Minimum inhibitory concentration (MIC) was determined
in a total of 1,419 strains of Escherichia coli, streptococci, and
staphylococci isolated from lactating cows suffering from clinical
mastitis in Chile during the 2000 to 2001 period. Antimicrobial agents
tested were penicillin, amoxicillin, ampicillin, cefoperazone, gentamicin,
sulfamethoxazole, oxytetracycline, cefquinome, trimethoprim, enrofloxacin,
florfenicol, ceftiofur, lincomicyn, and pirlimycin. Staphylococcus
aureus showed the highest level of resistance to lincomycin (38.9%),
amoxicillin (38.1%), penicillin (28.8%), ampicillin (26.0%), and cefquinome
(24.7%). The corresponding values for cuagulase-negative staphylococci
(CNS) strains were 56.9%, 42.3%, 31.5%, and 26.8% against penicillin,
lincomycin, amoxicillin, and ampicillin, respectively. Streptococcal
strains were highly resistant only to lincomycin (61.9%), and E.coli
was sensitive to most antimicrobials assayed, with the exception of
oxytetracycline and enrofloxacin (20.6% and 19.3% resistance, respectively).
The study found that 34.9% of staphylococcal strains were betalactamase
producers; none of the E. coli strains showed extended spectrum betalactamase
(ESBL). Finally, due to the high resistance levels detected in the
present study, we believe that it is necessary for Chile to set up
permanent resistance surveillance programs.
INTRODUCTION
Antimicrobial agents represent one of the main therapeutic
tools both in human and veterinary medicine to control and, in some
cases, to eradicate a wide range of bacterial infectious diseases.
However, currently, the judicious use of these drugs is of great global
concern.1–4
Bovine mastitis is one of the most important bacterial
diseases in dairy cattle throughout the world, and it is responsible
for great economic losses to milk producers as well as to the milk
processing industries. In the United States, the annual losses due
to mastitis have been estimated at 1.8 billion dollars, and the average
cost of clinical mastitis is about $185 per cow/year. These losses
include reduced milk production, discarded milk, replacement cost,
extra labor, treatment, and veterinary services.5
Many factors can influence the development of mastitis;
however, the inflammation of the mammary gland is usually a consequence
of invasion and colonization in the secretory tissue by one or more
microorganisms, especially Staphylococcus aureus, Streptococcus agalactiae,
Streptococcus dysgalactiae, Streptococcus uberis, and Escherichia
coli.1,6 To successfully control these intramammary infections and
to avoid increases of bacterial resistance and treatment failure,
veterinarians should be aware of the antimicrobial activity characteristics
against these major mastitis pathogens before administering in vitro
susceptibility tests. Increased resistance of S. aureus and cuagulase-negative
staphylococci (CNS) isolated from bovine mastitis cases to antimicrobial
agents was reported by Gentilini et al.7 and Myllys et al.3
Antimicrobial
agents are the main therapeutic tool used in Chile to control bacterial
diseases, representing about 45% of total drugs used in livestock.1
However, little information is available concerning sensitivity patterns
in veterinary medicine, including mastitis pathogens. Some regional
studies conducted in dairy herds have shown 6.2% of Streptococcus
spp resistant to penicillin; a higher proportion of Staphylococcus
aureus organisms have shown resistance to penicillin and ampicillin
(26% and 21%, respectively), but were sensitive to cefotaxime and
cefradine.8,9
Conversely, Borie et al.10 found E. coli strains highly
resistant to tetracycline (62.6%) but highly sensitive to gentamicin,
cefoperazone, cefotaxime, neomycin, and sulfadiazine/trimethoprim
(more than 92%). More recently, San Martín et al.11 found that a number
of E. coli, S. aureus, and Staphylococcus spp strains were sensitive
to sulfadiazine/trimethoprim.
Considering these results and the recommendations of
the World Health Organization (2000), the aim of this study was to
develop a systematic and programmed evaluation protocol of bacterial
resistance of the main mastitis pathogens isolated from dairy cows
in Chile during a 2-year period. These results will allow veterinarians
to evaluate updated information on bacterial resistance, providing
a more rational use of antimicrobial agents.
MATERIALS AND METHODS
Bacterial Isolates
During a 2-year
period (2000–2001), 2,914 quarter milk samples were aseptically collected
from dairy cows with clinical mastitis from different dairy herds
in Chile. All milk samples were collected before milking using sterile,
disposable 15 mL screw cap tubes after standardized procedures recommended
by the National Mastitis Council (NMC).5 Isolation and bacterial identification
were performed according to NMC5 and International Dairy Federation12
recommendations. Within 8 hours after collection, 25 mL of each milk sample was
plated onto trypticase agar plates (BBL® Becton Dickinson and Company,
Cockeysville, MI) containing
5% sheep blood and 0.1% esculin. After 24 to 48 hours incubation at
37˚C, all plates were examined under ultraviolet light for bacterial
growth and esculin splitting. Staphylococcal isolates were identified
according to morphologic and hemolytic properties and coagulase and
DNAse tests. Streptococci were identified on morphologic and hemolytic
characteristics, CAMP test reaction, and biochemical tests (SVA Strep,
Uppsala, Sweden). Identification of coliform bacteria was based on
morphology and biochemical tests (API 20E, BioMerieux, Chile).
Antibacterial Agents
The antibacterial agents selected for this study included
1) antimicrobial agents used for mastitis in Chile: penicillin (Sigma
Chemical), amoxicillin (Sigma Chemical), ampicillin (Sigma Chemical),
cefoperazone (Sigma Chemical), lincomycin (Pharmacia, Chile), and
pirlimycin (Pharmacia); and 2) antimicrobial agents used to treat
other infections in bovine species: sulfamethoxazole (Sigma Chemical),
oxytetracycline (Sigma Chemical), cefquinome (Intervet, Chile), trimethoprim
(Intervet), enrofloxacin (Bayer, Chile), florfenicol (Schering-Plough
Animal Health, Chile), ceftiofur (Pharmacia), and gentamicin (Sigma
Chemical).
Antibacterial Sensitivity Test
Determination of minimum inhibitory concentration (MIC)
was performed following NCCLS recommendations.13 S. aureus ATCC 29213
and E. coli ATCC 25922 were used as control organisms. Stock solutions
were prepared in solvent as described in the NCCLS13 or according
to manufacturer and stored at 4° to 8°C until used (1 month maximum).
Stepwise 2-fold dilution of each antibacterial drug was prepared on
the test day to cover the expected ranges of MICs.
Bacterial isolates were grown overnight at 37˚C
in Mueller Hinton broth (BBL) supplemented with 5% (v/v) desfribinated
sheep blood for streptococci strains. Bacterial inocula were adjusted
with sterile saline to the 0.5 McFarland´s standard. Using a Steer’s
replicator, 104 cfu/spot of each test strain was inoculated
on the Mueller Hinton agar plate with different concentrations of
the antimicrobial agents.
Chromogenic Cephalosporin Disc
Method
The Cefinase disc test (BBL) was used as a screening
test for detection of b-lactamase
enzymes on staphylococcal strains that showed resistance to any b-lactam or cephalosporin. The test was performed according to
manufacturer directions. A yellow to red color change within 1 hour
on the area where the culture was applied was considered a positive
reaction. S. aureus ATCC 29213 was included as the positive control.
Detection of Extended-Spectrum
b-Lactamase
The presence of extended-spectrum b-lactamase (ESBL) enzyme was determined on all E. coli strains
that showed resistance to at least one cephalosporin in study. This
was done using the inhibitor-potentiated disc-diffusion test based
on the standard disc-diffusion method described by the NCCLS.13 All
bacterial isolates were grown overnight at 37˚C in Mueller Hinton
broth (BBL) supplemented with 0.5% bovine serum. Bacterial inocula
were adjusted with sterile saline to the 0.5 McFarland´s standard
and plated onto Mueller-Hinton agar plates (BBL). Paper discs containing
standard concentrations of cefotaxime, 30 g, cefotaxime-clavulanic
acid, 30/10 g, ceftazidime, 30 g, and ceftazidime-clavulanic acid,
30/10 g (Becton and Dickinson Microbiology Systems) were simultaneously
placed on the same culture medium. A more than 5-mm increase in a
zone diameter for either antimicrobial agent tested in combination
with clavulanic acid versus its zone when tested alone was considered
a positive result for ESBL. E. coli ATCC 25922 and K. pneumoniae ATCC
700603 were used as negative and positive control strains, respectively.
Statistical Analysis
A percentage analysis of each bacterial species was
performed on the total tested strains. For resistance analysis, it
was considered that every single strain reacts individually to different
antimicrobial concentrations, expressing the results as absolute MIC
values (mg/mL). MIC was defined as the lowest concentration
of antimicrobial agent that completely prevented the visible growth
of the organism; MIC50 and MIC90 were defined as the concentration of the antimicrobial
agents able to inhibit the growth of 50% and 90% of the population
of microorganisms, respectively. The MIC breakpoints employed were
those published by NCCLS14,13 and Schering-Plough Animal Health, Chile.
Presence of the b-lactamase was expressed as percentage of positive
strains.
RESULTS
A total of 1,419 isolates were identified from 2,914
milk samples cultured. S. aureus, CNS, and E. coli were the three
most frequently isolated, representing 44.7%, 24.2%, and 15.7% of
total isolates, respectively.
All isolates were tested for bacterial resistance. MIC
values of the control strains were within the expected ranges of all
antimicrobials assayed. MIC ranges of each antimicrobial tested as
well as MIC50 MIC90
values and percentage of resistance of all tested strains are presented
in Tables 1 through 4.
According to breakpoint analysis, a high percentage
of bacterial resistance was observed among gram-positive microorganisms
against some antimicrobials tested. Staphylococcus aureus strains
were resistant to amoxicillin (38.1%), ampicillin (26.0%), cefquinome
(24.7%), penicillin (28.8%), and lincomycin (38.9%). For other antimicrobials
tested (cefoperazone, ceftiofur, pirlimicyn, and sulfamethoxazole
and trimethoprim), the values were below 9%. CNS showed high resistance
rates to penicillin (56.9%), lincomycin (42.3%), amoxicilllin (31.5%),
and ampicillin (26.8%). Resistance values for all other antimicrobials
tested were below 8%. A high resistance rate was observed among Streptococcus
spp isolates, in particular, against lincomycin (61.9%) and enrofloxacin
(38.1%). Resistance values for all other antimicrobials varied between
10% and 37%.
E. coli showed low
resistance levels to all antimicrobials tested compared with gram-positive
bacteria. Resistance to ceftiofur, enrofloxacin, gentamicin, and oxytetracycline
ranged between 11% and 21%. For all other antimicrobials, resistance
varied between 1% and 7%, with the exception of sulfamethoxazole and
trimethoprim, which were 100% sensitive strains. Regarding b-lactamase production, 34.9% of all Staphylococcus
spp resistant to at least one cephalosporin or b-lactamic agent gave a positive result to a cefinase
test. ESBL producer strains were not found in E. coli isolates.
DISCUSSION
Frequency and distribution of mastitis pathogens isolated
in the present study are very similar to those previously reported
in Chile.8,15,16 However, it is interesting to note that the isolation
rate of CNS has been increasing during recent years compared with
previous reports. This trend had also been described in other countries
such as Finland, Brazil, and Belgium.3,17,18 The role of CNS as a
mastitis pathogen is not clearly established. Although it is well
known that these microorganisms can easily colonize the teat canal,
increasing somatic cell count in milk and lowering milk quality, they
also contribute to improving the white cell barrier of the mammary
gland impairing invasion and colonization of other major mastitis
pathogens.19,20
To analyze the resistance of the isolated strains to
amoxicillin, cefoperazone, cefquinome, ceftiofur, enrofloxacin, gentamicin,
lincomycin, and sulfamethoxazole and trimetoprim, we used the breakpoints
for other animal infections caused by the bacteria we studied. This
was necessary because the NCCLS13 only provides this information in
bovine mastitis for penicillin, ampicillin, oxytetracycline, and pirlimycin.
To analyze the isolated strains to florfenicol, we considered the
breakpoints given by Schering Plough Animal Health, Chile.
The high level of resistance documented in this study
among gram positive bacteria probably reflects the lack of an organized
antimicrobial resistance surveillance program for animal foods in
Chile as has been implemented in the European Community and other
countries.2,21,22 The World Health Organization has stated that antimicrobial
resistance is a serious, complex hazard of international concern and
recommends that such programs be established world wide for both human
and veterinary medicine.4
Analyzing the resistance of each strains isolated, the
high level of CNS resistance to b-lactam
is alarming. This situation was already described in Finland3 and
Sao Paulo, Brazil.17 Though CNS are considered minor pathogens and
can be treated successfully with antibiotics,23 the result in this
study must be considered. These organisms may be a reservoir of resistant
strains and become an important clinical hazard, a situation that
has already been observed in other places.3,17
Also, our results for Streptococcus species are interesting.
A number of international reports have shown that this genus is highly
sensitive to b-lactam and
cephalosporin.3,24 However, this was not the case in our study: a
high proportion of Streptococcus species were resistant to this group
of drugs. This situation can be explained by the extensive use of
these drugs in Chile for many years. A high resistance level of Streptococcus
species was also found against enrofloxacin; although little information
is available about resistance to this drug. It is important to note
that Myllys et al.3 found 7% of Streptococcus strains isolated from
bovine mastitis in Finland were resistant.
The high resistance to lincomycin seen among gram-positive
bacteria may be a consequence of its extended use in Chile for the
treatment of bovine mastitis for more than 20 years. It is well known
that the defense mechanisms of Streptococcus and Staphylococcus against
macrolides and lincosamines are plasmid or transposons encoded that
can be strongly induced, resulting in high resistance levels.25,26
Sensitivity of E. coli strains to most antibiotics tested
was greater than most gram-positive organisms, and a high resistance
level was only observed against oxytetracycline and enrofloxacin.
The high percentage of b-lactamase-producing
Staphylococcus strains detected by the Cefinase test (34.9%), correlates
well with the high MIC values obtained against the b-lactamic
and cephalosporin agents. Similar results were reported for Staphylococcus
aureus isolated from bovine mastitis in Sweden, Switzerland, the United
States, Ireland,1 Finland,3 and Australia.24 However, they are much
lower than those reported in Argentina,27 England, and Germany.1 According
to De Oliveira et al,1 the percentage of b-lactamase-producing
strains would have been higher after induction with penicillin or
oxacillin. Therefore, we suggest that induction procedures should
be incorporated as routine testing in our country to improve the detection
of this type of enzyme.
In human medicine, the prevalence of ESBL of 1% to 4.8%
among isolates of E. coli has been reported by other authors.28,29
In veterinary medicine, the ESBL has been report in E. coli isolates
associated with bovine calf diarrheal disease.30 In our study, ESBL
was not detected among isolates from bovine mastitis.
According to the results reported here, it is possible
to conclude that veterinary medicine experts in Chile are not aware
of the worldwide hazard of bacterial resistance as denounced by the
World Health Organization.4 This situation further reinforces the
urgent need for establishing a rational, organized control program
for antimicrobial usage in animal health. To avoid further misuse
of antibiotics in veterinary prescription, a permanent national bacterial-resistance
surveillance program must be implemented as soon as possible. To this
end, Aarestrup31 indicated that highest level of bacterial resistance
is seen in countries in which there are no restriction policies on
antimicrobial use.
CONCLUSIONS
Staphylococcus aureus remains the most frequent mastitis
pathogen in Chile, followed by the environmental mastitis-causing
organisms CNS and E. coli. Bacterial resistance is greater among gram-positive
bacteria, especially against b-lactamic
agents and lincomycin. A high proportion of Staphylococcus strains
produce b-lactamase. E. coli organisms that are resistant
to third-generation cephalosporins are not ESBL producers. The results
in the present study clearly show that our country is at risk for
the world hazard of bacterial resistance.
ACKNOWLEDGMENT
The authors gratefully acknowledge all private veterinarians
who took part in this research project by either arranging dairy farm
visits or collaborating in the sampling routine. The financial support
from FONDECYT Chile (Research Project N1000–782) is also fully acknowledged.
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Table 1. Minimun
Inhibitory Concentrations and Percentage of Resistance of 635 Staphylococcus
aureus Strains Isolated From
Clinical Bovine Mastitis Against Different Antimicrobial Agents
Antimicrobial
agent
MIC50 MIC90
Range Breakpoint % Resistance
Amoxicillin
0.125 1.0 0.06–4.0
³ 0.5
38.1
Ampicillin
0.125 1.0 0.06–4.0
³ 0.5
26.0
Cefoperazone
0.5 2.0 0.25–16.0
³ 8.0
6.1
Cefquinome
2.0 16.0 0.25–32.0
³ 8.0
24.7
Ceftiofur
0.5 2.0 0.125 16.0 ³ 8.0 6.1
Enrofloxacin
0.125 0.5 0.06–8.0
³ 2.0
2.5
Florfenicol
0.5 2.0 0.25–128.0
³ 32.0
4.9
Gentamicin
1.0 4.0 0.25–32.0
³ 16.0
3.3
Lincomycin
0.5 8.0 0.125–16.0
³ 2.0
38.9
Oxytetracycline 2.0 4.0 0.5–64.0 ³ 16.0 6.8
Penicillin
0.25 1.0 0.062–2.0
³ 0.25
28.8
Pirlimycin
0.5 2.0 0.125–16.0
³ 4.0
8.3
Trimethoprim
0.25/4.75 1.0/19.0
0.25/4.75 to 8.0/152.0 ³ 4.0/76.0 6.9
+Sulfamethoxazole
Table 2. Minimun
Inhibitory Concentrations of 343 Coagulase-Negative Staphylococcus (CNS) Strains Isolated From Clinical and Subclinical
Bovine Mastitis Against Different Antimicrobial Agents
Antimicrobial
agent
MIC50 MIC90
Range Breakpoint % Resistance
Amoxicillin
0.25 2.0 0.125–4.0
³ 0.5
31.5
Ampicillin
0.125 1.0 0.06–4.0
³ 0.5
26.8
Cefoperazone
0.25 1.0 0.125–16.0
³ 8.0
2.6
Cefquinome
0.25 2.0 0.125–32.0
³ 8.0
7.6
Ceftiofur
0.25 2.0 0.125–16.0
³ 8.0
2.6
Enrofloxacin
0.25 1.0 0.125–8.0
³ 2.0
2.9
Gentamicin
0.50 4.0 0.25–64.0
³ 16.0
4.1
Lincomycin
1.0 4.0 0.25–16.0
³ 2.0
42.3
Oxitetracycline 2.0 8.0 0.25–32.0 ³ 16.0 1.9
Penicillin
0.25 1.0 0.06–4.0
³ 0.25
56.9
Trimethoprim
0.25/4.75 1.0/19.0
0.125/2.38 to 4.0/76.0 ³ 4.0/76.0 0.9
+Sulfamethoxazole
Table 3. Minimun
Inhibitory Concentrations of 218 Streptococcus Strains Isolated From Clinical and Subclinical Bovine
Mastitis Against Different Antimicrobial Agents
Antimicrobial
agent
MIC50 MIC90
Range Breakpoint % Resistance
Amoxicillin
2.0 16.0 0.5–64.0
³ 8.0
31.2
Ampicillin
2.0 16.0 0.5–64.0
³ 8.0
34.9
Cefoperazone
1.0 8.0 0.25–32.0
³ 8.0
20.2
Cefquinome
1.0 8.0 0.25–32.0
³ 8.0
18.8
Ceftiofur
1.0 8.0 0.25–32.0
³ 8.0
14.2
Enrofloxacin
0.5 4.0 0.25–8.0
³ 2.0
38.1
Florfenicol
2.0 32.0 0.25 (128.0
³ 32.0
11.0
Lincomycin
1.0 4.0 0.25–8.0
³ 1.0
61.9
Oxitetracycline 1.0 16.0 0.25–64.0 ³ 8.0 27.5
Penicillin
1.0 8.0 0.25–64.0
³ 4.0
36.7
Pirlimycin
0.5 2.0 0.062–1 6.0
³ 4.0
10.1
Trimethoprim
0.50/9.0 4.0/76.0
0.125/2.38-32.0/608.0 ³
4.0/76.0 17.4
+Sulfamethoxazole
Table 4. Minimun
Inhibitory Concentrations of 223 Escherichia coli Strains Isolated From Clinical and Subclinical Bovine Mastitis
Against Different Antimicrobial Agents
Antimicrobial
agent
MIC50 MIC90
Range Breakpoint % Resistance
Cefoperazone 0.5 2.0 0.125–32.0 ³ 8.0 3.6
Cefquinome
0.5 2.0 0.125–32.0
³ 8.0
6.3
Ceftiofur
1.0 8.0 0.125–32.0
³ 8.0
11.2
Enrofloxacin
0.25 4.0 0.062–16.0
³ 2.0
19.3
Florfenicol
1.0 8.0 0.25–64.0
³ 32.0
6.7
Gentamicin
2.0 32.0 0.5 -128.0
³ 16.0
15.7
Oxitetracycline 2.0 32.0 0.25 ³ 128.0 ³ 16.0
20.6
Trimethoprim
0.125/2.38 0.5/9.5
0.063/1.20 to 2.0/38.0 ³ 4.0/76.0 0.0
+Sulfamethoxazole