Animals & MRSA

MRSA in Pets

Link: D for Dog - Article: MRSA in Pets.
Thanks to our friends at D for Dog for publicising this site and the story of Bella. Check out their very helpful site.

VET TIMES 25/10/2004

VETERINARY hospitals and clinics are being urged to take precautions against so-called superbug, MRSA, after a bereaved dog owner launched a risk-awareness campaign.

Evidence is on the increase, that methicillin-resistant Staphylococcus aureas (MRSA) bacteria which infected around 7,700 patients last year alone in British hospitals — is taking hold in veterinary surgeries. Jill Moss, owner of a I0 year- old Samoyed which died after being infected by MRSA, has launched a campaign to educate pet owners and veterinarians about the risks to animals.

Ms Moss believes her dog, Bella, was infected after a routine knee operation and is now asking for tighter regulations in veterinary practices.

“I hope that Bella’s story will alert dog owners to the risks that exist in veterinary clinics and hospitals,” said Ms Moss. It is not just the risk of contamination through surgery, but also the risk that MRSA does exist in animals and that, just like us, they can become colonised and be susceptible to further infection at any time. To reach as many people as possible, Ms Moss has created a website — pets-mrsa.com to provide further information to pet owners.

Bella’s death is thought to be one of the first recorded cases of a dog dying of MRSA in the UK. Research by David Lloyd, professor in veterinary dermatology at the Royal Veterinary College, and colleagues, suggests that MRSA infection in veterinary practice is on the increase.  In a letter to the veterinary press in March 2004, Professor Lloyd gave details of 12 confirmed cases over a period of a few months at the RVCs Queen Mother Hospital for Animals.

‘We’ve surveyed the Queen Mother Hospital. We sampled everyone in the hospital, all the veterinary staff, all the dogs, all the cats and the environment in one day, he told Veterinary Times. “We found that members of staff were colonised — as you would expect, because up to 30 per cent of the general population seems to be colonised — and we found that the numbers of staff colonised were comparable, if slightly lower,”

He went on: “There is potential to transfer the infection to animals. Any animal that is being treated with antibiotics and is susceptible to staphylcoccal infection which is often the reason they’re given the antibiotic — can then pick up MRSA.”

Professor Lloyd said animals which are repeatedly treated with antibiotics are more at risk and, in their survey of the Queen Mother Hospital, nearly all of the isolated cases showed close relation to hospital epidemic MRSA.

“The implication is that they’ve come from humans with hospital infections,” he said. “And often we find that if we go into the history of the owner, either the owner or somebody in the owner’s family has been in hospital or an old people’s home.”

There is little evidence so far to suggest that MRSA infection is passing from animals to humans though recent research suggests there are certain bacteria species with potential for zoonotic transmission. The problem is that sometimes the owners are worried and occasionally the dog is put down because the owners don’t want to persist with the treatment, said Professor Lloyd. One of the factors must be that they’re worried about this organism.

“If you are suffering from reduced immunity— if you’re old, if you’re already suffering from another disease or if you have some sort of injury such as joint damage — then you can become seriously ill.”

The QM Hospital has established routines and isolation procedures to control MRSA, based on the best practice from NHS and private hospitals.

Don’t panic
He stressed: People shouldn’t panic but clearly it’s something we need to recognise and take precautions against in veterinary practices so this organism does not become as common as it is in hospitals.”
Total human infections rose 5.5 per cent between the year 2001 and the end of 2003, whilst a total of 800 human deaths were said to be attributable to the MRSA virus in 2002 — according to the latest Health Protection Agency figures.

Speaking for the British Veterinary Hospitals Association, president Bob Partridge said there were no MRSA-specific guidelines drawn up at present. “We do have very strict guidelines about cleanliness and the use of vacuum autoclaves and various other things which are likely to cut down the instance of transmission,” he said. I strongly suspect that the cases of MRSA that we see in our pet cases will be because of human activity, rather than originating with the pet.

Mr Partridge stressed that veterinary hospital procedures were already stringent enough to combat cases of MRSA transmission In pets, but said there would be no complacency on their part. ‘It is a relatively minor problem, when we think about the number of pets that die of parvovirus or feline leukaemia,” Mr Partridge stressed.

Concerned
He went on; ‘In some ways I’d be more concerned about making sure that ET tubes are sterilised properly in-between feline patients. “There is a very good chance for vets acting as carriers of feline leukaemia and spreading it around the cat population by intubating them with FT tubes that have not been properly disinfected. “So we need to look at where it’s most important to focus attention. Don’t be complacent about MRSA, but look at the relative risk that’s involved.”

The Mail on Sunday 18/10/04

The deadly hospital superbug MRSA has spread to pets, experts warned last night. Now scientists believe that the bug, which kills 5,000 NHS patients every year, could become just as widespread in veterinary clinics.

An expert at the Royal Veterinary College called for urgent action to alert vets and pet owners to the danger. Professor David Lloyd said: ‘Vets may not be looking out for MRSA, and more and more infected animals are being referred to us.‘If we’re not careful, veterinary hospitals will become as badly affected as NHS hospitals. There must be more research.’

The risk of infection between animals and humans is slim, but a sick pet is more likely to contract MRSA from a human than vice versa. Scores of pets have been hit by MRSA but only one, a ten-year-old pedigree Samoyed dog, is known to have died. The animal, called Bella, suffered blood poisoning, pneumonia and organ failure caused by MRSA after an operation on a hind leg.

Bella’s owner, actress Jill Moss, 34, said last night: ‘It has been a terrible experience. Bella was my companion for more than eight years. She was a real personality and my best friend. I lost my partner in a plane crash four years ago and Bella and I were inseparable.

‘In July she ruptured a cruciate ligament while chasing a squirrel. Fixing the problem is a routine operation — a lot of footballers have it - but the wound became infected. ‘I kept getting conflicting opinions about what was wrong with her and she was given various drugs. By the time they identified MRSA, it was too late.

‘Having her put to sleep was the hardest decision of my life, but she was in agony. By that stage, veterinary nurses didn’t want to treat her because they were scared of becoming infected.’

Bella died in August and Miss Moss who has appeared in TV shows including The Bill, Birds Of A Feather and EastEnders, has created a website warning other pet owners to be on their guard. She added: ‘Vets aren’t waking up fast enough to the possibility of animal infections like this. I can’t bring back Bella but I can warn other owners.’

Sixty years ago, most post-operative infections in humans could be controlled by antibiotics, but bugs have evolved to become resistant to methicillin, the synthetic form of penicillin. The staphylococcus aureus bacteria that causes MRSA is harmless to healthy people — it is carried by many in the nose and armpits but it can prove fatal for those with a weakened immune system, such as the sick and the elderly.

Dogs and cats do not commonly carry the bacteria, making it harder for them to pick up MRSA. Dr Alistair Gibson, of the British Small Animal Veterinary Association, said last night: ‘There is little risk of MRSA spreading from pets to humans if owners take common-sense hygiene precautions.’

• Jill Moss’s website is www.pets-mrsa.com

The Radio 2 Interview

Transcript of Jill’s Interview with Jeremy Vine, October 19th, 2004

JV      Now, here’s a troubling story. Evidence is emerging that MRSA is able to claim the lives of pets after a woman lost her pet this summer. Jill Moss believes her pet, Bella, contracted the super-bug during surgery at a Medivet in London. Medivet is a chair of veterinary practices – a chain, I’m sorry, of veterinary practices. Bella had to be put down in August because of her illness, and Jill Moss joins us. This is believed to be the first recorded case of an animal dying because of MRSA in the UK.

JM That’s right

JV Good to meet you. What an awful thing to happen.

JM Yes it is, it’s absolutely awful and it’s been very difficult for me. I watched Bella suffer and I suffered too and it was an unnecessary death, it could have been avoided.

JV Tell us how you think it happened.

JM Well, she was chasing a squirrel, as dogs do, and she ruptured a Cruciate ligament, which is routine surgery. Now, she had surgery but didn’t recover very well. I had a lot of conflicting advice, most of the main vets were away on holiday I must say, and she just became worse and worse and in the end I was so unhappy with the way she was being treated that I removed her into specialist veterinary care. They performed immediate surgery, washed out the knee, found an infection, took cultures and determined MRSA. What they said to me was, if they had had her earlier it could have been contained in the wound, not spread through her body.

JV Which is what happened?

JM Yes.

JV And the result of that was what?

JM Well, the result was that they did do their best to get her recovered, and wanted to do reconstructive surgery, but – she was fighting, antibiotics would be given to her, it’s like a war going on in the body, The antibiotics keep losing the war and then she would win, and it would be an ongoing kind of treatment, really. But she did recover well enough to come home, unfortunately she deteriorated and this specialist centre is only a referral hospital and I had to take her back to the original vet who performed the surgery.

JV You’ve got a photo of her there…

JM I have, yes.

JV Let’s just have a look at it. This is a picture, a very nice black and white picture of you with Bella sitting at your knees, and she’s a Samoyed?

JM Samoyed, yes.

JV Which means…she’s largish? And you’re sitting on a park bench, and these were happier times?

JM Yes, very much.

JV And you’ve been devastated by this.

JM Absolutely devastated. So much so that I’ve launched a website, it’s not a scaremongering website, it’s informative, it offers owners advice, it talks about MRSA in people and animals, and hopefully it’s going to go some way towards making some changes so this doesn’t happen to any other animal or owner.

JV You can tell what the website is, if you like.

JM Thank you, Jeremy, it’s www.pets-mrsa.com

JV And you’re sure that this was MRSA and you’re sure that your dog caught it in the operation?

JM Absolutely. I have the bacteriological report from the specialist centre, and what they told me was that infections do occur post-surgery. Now a lot of experts that I’ve talked to have said it bad luck if a dog gets an infection, but it’s not bad luck if that infection is not recognised, not picked up on, and isn’t treated in time, let alone being contaminated in the first place, because MRSA – you and I, anybody in this studio, could be colonised – we wouldn’t know it, it’s only when you have surgery and perhaps transmitted from the nose during an anaesthetic into a wound, that the bacteria gets in, it’s sewn up, it likes dark, warm places, and it breeds. That’s how you become effectively infected with the bacteria.

JV And that wasn’t the end of the story because you were then infected by your dog, correct?

JM Well, now, I have to say this is very rare. The statistics do prove that it’s passed from human to animal, not from animals to human. But, if animals are exposed to people who are colonised then they become ill, or their immune system is suppressed they are more susceptible to getting the bacteria, which is what happened to Bella. I was nursing her without protective clothing, dealing with her extremities, and I had a cut in my hand and one in my foot, the bacteria got in. But it only got into me because I had an open wound and I was directly exposed to the bacteria. It’s really important to stress that people don’t abandon their animals for fear that they’re going to become infected with MRSA. That’s just not the case.

JV So when it got into you, what happened?

JM Well, I began to get a skin rash, and abscess on the hand and foot, only where I’d been in direct contact with the floor, really and with Bella and nursing her. And I’m on antibiotics, now. And a couple of them haven’t worked, but one seems to be working quite well.

JV Well Jill, thank you very much indeed for telling us about that, we have now got Arnold Levy, who is a senior partner at Medivet to give your version, Mr Levy.

AL Yes, hi there. Yes, this MRSA situation is quite a difficult situation. It’s not as clear-cut as Miss Moss has described. In Bella’s case there were many other factors which she hasn’t mentioned. One of the things she didn’t mention was that her dog was suffering from a benign tumour of the adrenal gland, which is an immuno-suppressant condition, and Bella’s immunity was very depressed, and even with a non-resistant infection, and with good antibiotics cases like that can spiral out of control.

JVB But it sounds as if you are conceding there that the MRSA was picked up by the dog during the operation which Medivet did.

AL Well, look, the infection had to start at some point at or after the operation. That is clear. The problem is how did the bug get into the wound? Now, was the bug on the dog before the wound was created? Or did the bug get onto the dog after the wound was created?  Miss Moss has an MRSA infection; it is entirely possible that Bella had been infected by Miss Moss handling her dog. It is a normal event, it’s not a reflection on Miss Moss, the bug passes from one organism to another. So when you cut through the skin these bugs can be in the hair follicle on the skin, they will, no matter how careful you clean the skin, or how sterile your theatre may be, a certain amount of bacteria will be carried into the wound by the surgical instrument.

JV Could you not have taken more care, though?

AL I don’t think we could have taken more care in the theatre, our theatre procedures are very tight, we also swab down our premises on a routine basis with very strong disinfectants, we also use steam cleaning so we are very careful about hygiene because there are many other bacteria which are – we view as even more dangerous than MRSA, in fact, Bella had another bug in the wound, called pseudomonas which we view as more aggressive than MRSA.

JV Yes, while you’ve been speaking Jill Moss has been angrily holding up a series of notes for me to read so it might be better if you actually spoke, Jill, instead of writing.

JM OK. What I’d like to say first of all is the infection I have is in my skin, I’m not colonised, there is no way that I could have colonised Bella, that is proved and I have experts backing me up on that. All animals, prior to surgery, should be swabbed. The Royal Veterinary College is now doing that. If MRSA is found colonised on the animal they are given extra antibiotics as a precaution prior to surgery. That is what should be done with all animals. And every single vet surgery should be actually looking for MRSA before they perform surgery, not after.

JV Mr Levy?

AL Yes. I do believe that the veterinary practice should be looking at MRSA. Let me say that this is an extremely rare condition in pets at the moment. That doesn’t mean it may not become more prevalent in the future. The research that has been done tends to suggest that dogs don’t carry the same type of Staphylococcus – which is what MRSA is – as the human population, but even so, I agree with Miss Moss that we ought to be cautious. Whether we ought to swab every single pet before surgery, that is obviously a risk and benefit situation which all our clients will have to decide upon.

JV Ok.

AL And it is an option that we could undertake.

JV Alright. David Bently……(e-mail response to the interview) 

LBC Radio Interview October 20th

LBC Radio Wednesday October 20th 2004 8.45am.  Nick Farrari Programme

NF:  Now we have talked many times about the problems of MRSA and the devastation that it has brought on families, the problems it creates on our hospital wards, it costs billions and the NHS still can’t combat it. More importantly than that it also costs thousands of lives, thousands of humans lives that is, up until now, when it has been proven that MRSA can transfer to domestic pets Jill Moss is founder of the website www.pets-mrsa.com don’t worry if you didn’t get it, I will give you the address again after we speak with Jill.  Jill, tell the listeners how you found out about MRSA transferring from humans to animals?

JM: My own dog Bella injured her leg and went into the vets for routine surgery. She didn’t recover and it was later discovered that she had MRSA bacteria inside the joint of her knee, which I believe she got during surgery.  By the time this was detected it had spread through her body and took her life.

NF: It was surgery on a cruciate ligament wasn’t it? She was chasing another animal or something?

JM: She was chasing a squirrel like dogs do everyday. She had to have this routine surgery and was contaminated with the bacteria. Once it gets into a wound it breeds through the body if it can’t be caught in time.  She died prematurely and I was confined in a room with her. The last few hours of her life was hell, with nurses refusing to treat her because she had this infection that they didn’t want to come into contact with.

NF: Hang on, so the same canine MRSA could become human MRSA?

JM: There are two strains; there is MRSI, which is very common in dogs and can be successfully treated with antibiotics, but Bella had the human strain which is MRSA.  I need to make this clear; the transmission comes from humans to animals and not the other way around.

NF: So it’s only one-way traffic? JM: It is at the moment.  The research shows that it is human colonisation taking the bacteria into veterinary practices.

NF: So why were the nurses so leery to attend to Bella?

JM: She was contaminated with MRSA. In her last few hours, she needed a lot of nursing, and their attitude was that they could not be exposed to it. One particular nurse told me that she had a child with a suppressed auto-immune system, and I was literally left alone confined in a room nursing Bella myself.

NF: Even though, there is no way that, at this time, humans can contract it from canines. That was the nurses reaction?

JM: Nick, it’s lack of knowledge.  That’s why my website is to inform and alert owners to the risks of MRSA in animals.  Not to panic; it’s not a question of animals bringing it to humans, but the risk is we, humans, taking it into veterinary premises.  The website is also there to educate vets and make them a little bit more aware of what can be done to prevent animals dying and suffering in the way that Bella did.

NF: what age was Bella?

JM: She was ten, but a fit bird for ten!

NF: So that we have a picture of Bella, what sort of dog was she?

JM: Beautiful white Samoyed. If you don’t know what that breed is – it is a white dog that comes from the Arctic Circle.  Looks like a polar bear.

NF: Oh, she must have been such a part of your life.

JM: Yes, she was.  I know that you have dogs Nick

NF: I do, unfortunately I lost a dog last year, I had a Spinoney, you probably haven’t heard of this, which is an Italian breed.  I also have a golden retriever who is eleven, he is absolutely part of the family life, and so I know how important they are.

JM: So when you take your dog out for a walk, and they chase a squirrel, you don’t expect them to die.

NF: So the dog contracted this through an instrument or something that occurred in the vet’s. What guidelines should there be. What should vets be doing?

JM: Oh, Nick, there are so many, and I won’t have time to go into detail on your programme. I suggest that people do visit the website to see more on this subject and get all the up-to-date information.  The most important thing to do if your animal is going in for surgery, any surgery, talk to the vet, ask them have they ever had a case of MRSA? Do they have infection control policies in place?, Do they employ barrier nursing techniques?  Look behind the doors, and on the floor – see how dirty or clean are the premises. That’s an important one. And, question the vet taking care of your animal. Don’t allow animals to be over-prescribed with antibiotics; this reduces their immune system. And make sure your vet is aware and up to date with infection control standards, because these are voluntary; they are not compulsory and each different vet can choose whether to adopt them or not, they really do need to become compulsory.

NF: I tell you what – Jill, out of your personal sadness clearly a campaign has emerged. Credit to you for doing all that you have done.  I am going to give that website address out again.   Jill Moss, thank you for your time and good luck with the website. Good luck and I hope that you recover from losing Bella. I know how key animals are to us.  Gosh, that website address and this is so important, once again is www.pets-mrsa.com.  I know that some of you listening right now, right now, will be taking your animals to vets at some point this week, you want to make a note of this website. (Repeat address). All of what Jill spoke about, the guidlines for vets are spelt out on www.pets-mrsa.com. I will do it again (repeat address again). Jill Moss is the founder, thanks for your time.

MRSA Pet Evidence Emerging

Entrez PubMed
Twelve strains of the methicillin-resistant Staphylococcus aureus (MRSA) recovered from hospitalized dogs were analyzed for in vitro antimicrobial susceptibility and virulence, and were genetically characterized by pulsed-field gel electrophoresis (PFGE). This report is the first such cases in the veterinary literature in Korea and may indicate the frequent emergence of MRSA in veterinary clinic hereafter.

London Evening Standard 18/10/04

This is London
For Jill Moss, it was bad enough losing the dog she loved. Even more traumatic was watching Bella, a Samoyed, become the first known animal to die from an infection caused by the MRSA superbug.

It has since emerged Ms Moss has also contracted the bacteria. The 34-year-old actress said: "It was heartbreaking watching my dog suffer so. I didn't know dogs could get MRSA. It spread like wildfire through her body and took over her vital organs."  She believes she caught MRSA from Bella. Such cross-contamination is virtually unheard of in the UK and experts are warning vets and pet owners to be extra vigilant.

Bella's Story in Hendon Times

Hendon Times
Evidence that the MRSA superbug, which kills 5,000 patients a year in British hospitals, is now claiming the lives of pets emerged this week, after an Edgware woman revealed that her dog died from the bacteria this summer. Bella, a ten-year-old Samoyed dog, is believed to be one of the first recorded cases of a dog dying of MRSA in the UK. Her owner Jill Moss, 34, of Edgwarebury Lane, is now launching a campaign to educate pet owners and vets about the risks to animals.

Experts believe the spread of MRSA to animals is of concern, and are demanding more research into the risks, but also stress that the chances of the bug transferring to humans is small. David Lloyd, professor of dermatology at the Royal Veterinary College, North Mymms, first documented MRSA in small animals in 1999 and researched the risks involved.

Click the link above for full story

Articles and Research Papers

PHLS Press Release

03 September 1999
PHLS 24th Annual Scientific Conference Open Day: Monday 13 September 1999, Warwick University
PHLS surveillance shows that the proportion of all Staphylococcus aureus bloodstream infections caused by methicillin-resistant strains (MRSA) has increased from less than 3% before 1991 to a provisional figure of 36% for the first quarter of 1999. Dr Barry Cookson of the PHLS Laboratory of Hospital Infection will show how the pattern of infections caused by different epidemic strains of MRSA around the country has changed with time, and the factors, which affect the extent of the problem. He will also look at how infection control measures, in particular hand washing, can help tackle MRSA.

Central European Symposium in Antimicrobial Resistance, Brijuni, Croatia, 4-7 July 2003.
Overlooked Aspects Concerning Development and Spread of Antimicrobial Resistance Prof. David Lloyd, Royal College of Veterinary Surgeons.

…focused on canine dermatology, a discipline where recurrent bacteriological infections requiring both topical and systemic antimicrobial treatment provide a situation in which dogs and their owners may exchange resistant bacteria.

British Society for Antimicrobial Chemotherapy.
June 2002
Antibiotics are used roughly equally between human and animal medicine. In the case of humans around 95 /o is used m general practice and only 5 in hospitals. Antibiotics are used a great deal in general practice and 60 to 70 of the use is questionable. ln the case of animals, 80 is really used for commercial purposes, as growth promoters or it has been commented, to overcome the problems of poor animal husbandry. Altogether 70-80 of all antibiotic use is highly questionable and should or could be reduced There are even more dreadful uses of antibiotics than in animals:
1.    Five hundred grams of tetracycline treats 500 patients, but in the USA 50,000 Ibs of tetracycline is used to spray fruit trees to prevent a disease called Tire Blight', caused by an erwinia organism Streptomycin is also used and it has been observed that isolates of erwinia are now becoming resistant.                                                                           
2.    In the USA and Norway 150 Ibs per acre of antibiotics are put into salmon farming lakes. Often these are fluoroqumolones, antibiotics that are particularly useful in man. Scotland is trying to reduce the amount of fluoroquinolones used.
3.    In Canada there is a disease of lobsters called Gafkyinia, an organism like the staphylococcus and very large amounts of vancomycin are used to treat this disease.
4.   Disinfectants are one of society's answers to the big problems of resistance. Chopping boards are impregnated with disinfectants; most household cleaners have antibacterials in them.  This is not the answer to any of the problems because there is a linked resistance to certain agents, for example triclosan and other agents used in these disinfectants. So by heavy use of disinfectants there is heavy pressure for antibiotic agents as well.

Methicillin-resistant Staphylococcus aureus infections in 11 dogs (Prof. David Lloyd)
The Veterinary Record, January 16 1999
Tomlin J. et al
There have been reports of MRSA infections in bovine mastitis (Devriese 1975) and in a surgical wound in a horse (Hartmann and others 1997). Little information is available about the colonisation and infection of dogs and cats with MRSA, although links with human MRSA have been reported for a dog with MRSA conjunctivitis (Cefai and others 1994), and a healthy cat in a nursing home ward, from whose skin MRSA was isolated (Scott and others 1988).
Infection is a recognised complication of any surgical treatment, and infection rates of 2-5 per cent have been reported for clean elective procedures (Vasseur and others 1988). Microbial contamination occurs to a small but measurable extent even with routine aseptic technique (Klapes and others 1987). Factors such as the patients immune status, tissue injury, adequate haemostasis, prevention of dead space and the numbers of bacteria and their virulence are important in determining whether a contaminated wound develops a clinical infection (Romatowski 1989).

No La Leonard
Bacterial and Epidemiological Investigation University Veterinary Hospital (UVH)
Paper title “MRSA isolates from vet surgeries in five dogs”

MRSA is primarily of concern in human medicine due to the increasing prevalence of hospital outbreaks of infection with this organism.  Typically, these isolates are multi-drug resistant and thus difficult to treat.  The source of infection in humans lies either clinically or sub clinically in infected people.
Prior to 2001 MRSA had not been isolated by the diagnostic bacteriology department of University Vet Hospital, Dublin.  Recently we have isolated MRSA from animal specimens on several occasions.  Infection has always been associated with orthopaedic surgery or traumatic wounds in dogs or horses.  Initial typing of selected isolates suggests that they are the same as those isolated from human hospitals in Ireland.  It is difficult to definitely identify the source of MRSA infection in animals.  Further investigation of the isolates obtained is ongoing but veterinary practioners should be aware of the possibility of the infection in companion animals particularly associated with surgical or traumatic wounding.