Fecal carriage of extended-spectrum β-lactamase-, AmpC β-lactamase- and carbapenemase-producing Escherichia coli in stray cats in Italy

The spread of carbapenem-resistant bacteria is a global threat to public health and the role of pets in the rise in antimicrobial resistance is gaining attention worldwide. This study aimed to determine the fecal carriage of extended-spectrum β-lactamase (ESBL)-, AmpC- and carbapenemase (CP)-producing E. coli and associated risk factors in healthy and unhealthy stray cats admitted to the Veterinary Teaching Hospital of Lodi, University of Milan, Italy. Fecal samples collected in, 2020-2022 were microbiologically and molecularly analyzed. Overall, ESBL-/AmpC-/CP-producing E. coli were detected in 18/94 (19.1 %) stray cats. Twelve (12.8 %), 4 (4.3 %) and 7 (7.4 %) stray cats carried ESBL-, AmpC- and CP-producing E. coli phenotypes respectively, supported by the detection of bla_CTX-M in all ESBL-producing E. coli, bla_CMY-2 in all AmpC-producing E. coli and bla_NDM (4/7; 57.1 %) or bla_OXA-48 (3/7; 42.9 %) genes in CP-producing E. coli. Multiple combination of resistance genes and phenotypes were detected. MIC results showed that all E. coli were multidrug resistant isolates. Risk factors associated with ESBL-, AmpC- and/or CP-producing E. coli fecal carriage were hospitalization (P < 0.0001), antibiotic treatment during hospitalization (P < 0.0001) and unhealthy status (P < 0.0001). Fecal carriage of CP-producing E. coli is of concern and highlights the need of specific surveillance programs for CP-producing Enterobacteriaceae and antimicrobial stewardship in stray cats to reduce the emergence and spread of resistant bacteria. Limitations of this study suggest a One Health approach to characterize the whole genome of the isolates and the epidemiology of AMR bacteria among stray cats, including additional bacterial species and the environment.