Discussion
Epidemiologic, laboratory, and traceback evidence indicates that puppies sold through the commercial dog industry, an uncommon source of Campylobacter outbreaks, were the source of a multistate outbreak of multidrug-resistant Campylobacter infections. This evidence, combined with the prolonged nature of the outbreak and the potential for puppy commingling, indicates a potential for continued transmission of multidrug-resistant Campylobacter industrywide, including at breeders, distributors, transporters, and stores, and ultimately in customers' homes. Although the investigation is completed, the risk for multidrug-resistant Campylobacter transmission to employees and consumers continues.
Dog-associated Campylobacter outbreaks have been reported previously, but those outbreaks involved fewer illnesses, and the isolates were not multidrug-resistant.[4–6] The investigation of this outbreak revealed widespread administration of multiple antibiotic classes, including all classes to which the outbreak Campylobacter strains were resistant. Hygiene and animal husbandry practices can reduce the need for antibiotics and decrease transmission of Campylobacter between animals and from animals to humans.[7] Adherence to antibiotic stewardship practices in these settings might reduce the selection of highly drug-resistant Campylobacter. Implementation of antibiotic stewardship principles and practices in the commercial dog industry is needed.
Clinicians should consider that persons can acquire Campylobacter infections, including multidrug-resistant infections, from puppies. If antibiotics are indicated, consider stool culture and antibiotic susceptibility testing. Pet stores, commercial distributors, transporters, and breeders should ensure that existing biosecurity measures are sufficient to reduce ongoing risk for Campylobacter transmission between puppies and humans. Pet stores should provide employee and customer education and training on handwashing and provide employees with personal protective equipment when cleaning animal areas.[8] Educational information§ that veterinarians and pet stores provide to pet owners could include information on reducing the risk for pathogen transmission. Finally, antibiotics should only be administered under veterinary supervision with a valid veterinary-client-patient relationship, consistent with existing stewardship principles.¶
Acknowledgments
Karen Baransi, Jason Herr, Larry King, Glen McGillivary, Jade Mowery, Justin Seikel, Ohio Department of Health; Bev Byrum, Ohio Department of Agriculture; Nancy Pickens, John Nasir, Matthew Schimenti, Florida Department of Health; Ashley Vineyard, Heyda Rodriguez, Florida Department of Health in Orange County; Nelly Amador Jehn, Florida Department of Agriculture and Consumer Services; Renate Reimschuessel, Food and Drug Administration Veterinary Laboratory Investigation and Response Network, Washington, DC; Michael Hughes, Ellyn Marder, Meseret Birhane, Hayat Caidi, Beth Karp, Ian Plumb, Janet Pruckler, Jared Reynolds, Kaitlin Tagg, Jean Whichard, CDC.
Morbidity and Mortality Weekly Report. 2018;67(37):1032-1035. © 2018 Centers for Disease Control and Prevention (CDC)
