Infections caused by extended‐spectrum beta‐lactamase‐producing Enterobacterales in hospitalized neonatal foals: Can colonization predict infection?

Abstract Background Infections with extended‐spectrum beta‐lactamase‐producing Enterobacterales (ESBL‐PE) contribute to morbidity and mortality in human neonates. In foals, data are scarce. Objectives Determine the association between ESBL‐PE gastrointestinal colonization on hospital admission and infections in hospitalized neonates. Animals Sixty‐seven foals. Methods Prospective study of foals admitted to a veterinary hospital. Foals were screened for ESBL‐PE colonization and for infections. Risk factors and clinical outcomes were analyzed. Results Seventy‐six percent of foals suffered from at least 1 bacterial infection (n = 51/67). Sixty‐three non‐ESBL bacterial species and 19 ESBL‐PE species were isolated. Twenty foals (29.85%) had at least 1 hospital‐acquired infection (HAI) and 30 foals (44.8%) suffered from multidrug resistant infections. The prevalence rates of ESBL‐PE gastrointestinal colonization on admission and clinical ESBL HAIs were 47.8% (n = 32/67, 41 isolates) and 19.40% (n = 13/67, 19 isolates), respectively. On multivariable analysis, ESBL‐PE HAIs were associated with colonization on admission (P = .03, odds ratio [OR] = 4.60). In an outcome analysis, ESBL‐PE infection and HAIs were associated with surgery (ESBL‐PE infection: P = .04, OR = 4.70; HAI: P = .004, OR = 6.4) and HAI also was associated with increased duration of hospitalization (P < .001, OR = 9.13). The major colonizing and infecting bacterial species were Escherichia coli and Klebsiella spp. Concordant ESBL‐PE species were recovered from rectal screening and clinical samples in 7.46% (n = 5/67) of foals. Conclusions and Clinical Importance On‐admission ESBL‐PE rectal colonization was associated with ESBL‐PE HAI in neonatal foals. The ESBL‐PE infections were associated with surgery during hospitalization. These findings emphasize the importance of optimal infection control and treatment of clinical infections in equine neonatal intensive care units.