<!DOCTYPE html>
<html xmlns="http://www.w3.org/1999/xhtml">
	<head>
		<meta charset="utf-8" />
		<title>check AAVS_MH20141203091259_Milton AP</title>
		<link href="http://nexusacademicpublishers.com/uploads/cssfiles/check AAVS_MH20141203091259_Milton AP.css" rel="stylesheet" type="text/css" />
	</head>
    
    <style> 
.pt{
	background-color:#BDF;
	border-top-style:solid;
	
	border-top-color:#d3d1d1;
	border-top-width: 1px;
	border-bottom-style: solid;
	
	border-bottom-color:#d3d1d1;
	border-bottom-width: 1px;
	height:90px;
	}
	  
.img_display{
	float:left;
	padding:5px;
	
	}
	.img_text{ padding:10px;
		
		}
		
		.Txt_Dis{
			padding-right:20px;
			}
</style>



	<body id="check-AAVS_MH20141203091259_Milton-AP" lang="en-US">
		<p>&nbsp;</p>
		<div class="Basic-Text-Frame">
		  <p class="Type-of-Article" lang="en-GB"><span class="CharOverride-1">Review Article</span></p>
		</div>
		<div class="Basic-Text-Frame">
			<p class="title- ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="title- ParaOverride-1" lang="en-GB">Nosocomial Infections and their Surveillance in Veterinary Hospitals</p>
		</div>
		
        <div class="Basic-Text-Frame">
			<p class="Authors ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Authors ParaOverride-1" lang="en-GB"><span class="CharOverride-3">Arockiasamy Arun Prince Milton</span><span class="CharOverride-4">1</span><span class="CharOverride-3">, Govindarajan Bhuvana Priya</span><span class="CharOverride-4">2</span><span class="CharOverride-3">, Manivasagam Aravind</span><span class="CharOverride-4">3</span><span class="CharOverride-3">, Swain Parthasarathy</span><span class="CharOverride-4">1</span><span class="CharOverride-3">, Mani Saminathan</span><span class="CharOverride-4">4</span><span class="CharOverride-3">, Karuppannan Jeeva</span><span class="CharOverride-4">5</span><span class="CharOverride-3">, Rajesh Kumar Agarwal</span><span class="CharOverride-4">2</span></p>
		</div>
        
        <div class="Basic-Text-Frame">
			<p class="Affiliations ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Affiliations ParaOverride-1" lang="en-GB"><span class="CharOverride-2">1</span>Division of Veterinary<span class="CharOverride-2"> </span>Public Health; <span class="CharOverride-2">2</span>Division of Bacteriology and Mycology; <span class="CharOverride-2">3</span>Division of Parasitology; <span class="CharOverride-2">4</span>Division of Pathology, Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly (UP)–243122, India; <span class="CharOverride-2">5</span>Department of Veterinary Parasitology, Madras Veterinary College, Chennai-600007, Tamilnadu, India.</p>
		</div>
		
	<div>
			<p class="Abstract ParaOverride-1" lang="en-GB">&nbsp;</p>
	  <p class="Abstract ParaOverride-1" lang="en-GB"><span class="CharOverride-5">Abstract</span> | Nosocomial, or hospital-acquired, infections are well-thought-out to be the most common problem affecting hospitalized human patients as well as veterinary patients. These are of great consequence in veterinary medicine and can have considerable adverse effects on the individual patient as well as on the veterinary hospital as a whole. Different infectious agents like MRSA, <span class="CharOverride-6">Cl. difficile</span>, MDR <span class="CharOverride-6">E. coli</span>, <span class="CharOverride-6">Salmonell</span>a spp. and many more are of prodigious significance in causing NIs. A surveillance and control measure for these NIs in veterinary settings needs to be addressed in future. This review consolidates some Nosocomial infections and the strategy for its surveillance in veterinary practice.</p>
			<p class="Abstract ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Abstract ParaOverride-1" lang="en-GB"><span class="CharOverride-5">Keywords </span>| Nosocomial infections, Surveillance, Veterinary, Hospitals, MDR</p>
		</div>
		<div class="Basic-Text-Frame">
			<p class="Editor----Citation" lang="en-GB">&nbsp;</p>
			<p class="Editor----Citation" lang="en-GB"><span class="CharOverride-8">Editor</span> | Ruchi Tiwari, College of Veterinary Sciences, Department of Veterinary Microbiology and Immunology Uttar Pradesh Pandit Deen Dayal Upadhayay Pashu Chikitsa, Vigyan Vishvidhyalaya Evum Go-Anusandhan Sansthan (DUVASU), Mathura (U.P.) – 281001, India.</p>
			<p class="Editor----Citation" lang="en-GB"><span class="CharOverride-8">Special Issue</span>| 2 (2015) “Reviews on Trends and Advances in Safeguarding Terrestrial /Aquatic Animal Health and Production”</p>
            
		  <p class="Editor----Citation" lang="en-GB"><span class="CharOverride-5">Received</span> | December 03, 2014; <span class="CharOverride-5">Revised</span> | December 15, 2014; <span class="CharOverride-5">Accepted</span> | December 16, 2014; <span class="CharOverride-5">Published</span> | December 29, 2014&#9;&#9;</p>
            
		  <p class="Editor----Citation" lang="en-GB"><span class="CharOverride-5">*Correspondence</span> | Arockiasamy Arun Prince Milton, Indian Veterinary Research Institute, Izatnagar, Bareilly, India; <span class="CharOverride-5">Email:</span> vetmilton@gmail.com</p>
			<p class="Editor----Citation" lang="en-GB"><span class="CharOverride-5">Citation</span> | Milton AAP, Priya GB, Aravind M, Parthasarathy S, Saminathan M, Jeeva K, Agarwal RK (2015). Nosocomial infections and their surveillance in veterinary hospitals. Adv. Anim. Vet. Sci. 3(2s): 1-24.  </p>
			<p class="Editor----Citation" lang="en-GB"><span class="CharOverride-8">DOI</span> | <a href"http://dx.doi.org/10.14737/journal.aavs/2015/3.2s.1.24">http://dx.doi.org/10.14737/journal.aavs/2015/3.2s.1.24</a></p>
			<p class="Editor----Citation" lang="en-GB"><span class="Editor---Citation CharOverride-5" lang="en-US">ISSN </span><span class="Editor---Citation CharOverride-5" lang="en-US">(</span><span class="Editor---Citation CharOverride-5" lang="en-US">Online</span><span class="Editor---Citation CharOverride-5" lang="en-US">)</span> | 2307-8316; <span class="Editor---Citation CharOverride-5" lang="en-US">ISSN </span><span class="Editor---Citation CharOverride-5" lang="en-US">(Print)  | </span>2309-3331</p>
			<p class="Editor----Citation" lang="en-GB"><span class="CharOverride-8">Copyright </span>© 2015 Milton et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p>
		</div>
		<div class="Basic-Text-Frame">
			<p class="Heading-1--Introduction----" lang="en-GB">&nbsp;</p>
			<p class="Heading-1--Introduction----" lang="en-GB">&nbsp;</p>
			<p class="Heading-1--Introduction----" lang="en-GB"><span class="Body-text">Introduction</span></p>
			<p class="Heading-1--Introduction----" lang="en-GB">&nbsp;</p>
		  <p class="Heading-1--Introduction----" lang="en-GB">&nbsp;</p>
			<p class="Caps-on-First-Para ParaOverride-1" lang="en-GB"><span class="_idGenDropcap-1">N</span><span class="Body-text">osocomial </span><span class="Body-text">infections are  hospital acquired infections which may be localized or systemic form acquired by the patient who was admitted for reasons other than infection, because of the existence of an infectious agent or its toxin which was not present or incubating at the time of hospital admittance (</span><a href="#Horan-TC--Andrus-M--Dudeck-MA--2008-."><span class="Hyperlink">Horan</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 2008</span></a><span class="Body-text">). Furthermore they are the high-flying reasons for the failure of advanced health treatment (</span><a href="#Mielke-M--2010-"><span class="Hyperlink">Mielke, 2010</span></a><span class="Body-text CharOverride-9">). Generally Nosocomial infections are frequent impediment encountered by the hospitalized human beings, and nosocomial bloodstream infections are the eighth leading cause of death in the United States (</span><a href="#Burke-JP--2003-"><span class="Hyperlink">Burke, 2003</span></a><span class="Body-text CharOverride-9">). About 5–10% of patients acquire infections from human hospitals and approximately 90,000 deaths per year due to nosocomial infections (</span><a href="#Burke-JP--2003-"><span class="Hyperlink">Burke, 2003</span></a><span class="Body-text CharOverride-9">). The risk factors in veterinary hospitals are comparable to those in human hospitals. Prevalence studies have shown that 4-9% patients endure from a nosocomial infection (</span><a href="#Mielke-M--2010-"><span class="Hyperlink">Mielke, 2010</span></a><span class="Body-text CharOverride-9">). The occurrence of nosocomial infections in veterinary hospitals has not been w</span><span class="Body-text">ell established and in nascent stage (</span><a href="#Boerlin-P--Eugster-S--Gaschen-F--Straub-R--Schwalder-P--2001-."><span class="Hyperlink">Boerlin et al., 2001</span></a><span class="Body-text">; </span><a href="#Johnson-JA--2002"><span class="Hyperlink">Johnson, 2002</span></a><span class="Body-text">; </span><a href="#Morley-PS--2004-."><span class="Hyperlink">Morley, 2004</span></a><span class="Body-text">; </span><a href="#Smith-BP--2004-."><span class="Hyperlink">Smith, 2004</span></a><span class="Body-text">; </span><a href="#Traub-Dargatz-JL--Dargatz-DA--Morley-PS--Dunowska-M--2004"><span class="Hyperlink">Traub-Dargatz et al., 2004</span></a><span class="Body-text">; </span><a href="#Morley-PS--Weese-JS--2008-."><span class="Hyperlink">Morley and Weese, 2008</span></a><span class="Body-text">), even though the nosocomial infections are of immense significance in the field of veterinary medicine since quite a lot of nosocomial outbreaks of different etiologies in veterinary hospitals has been documented (</span><a href="#Castor-ML--Wooley-RE--Shotts-EB--Brown-J--Payeur-JB--1989-."><span class="Hyperlink">Castor et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">1989</span></a><span class="Body-text">; </span><a href="#Madewell-BR--Tang-YJ--Jang-S--Madigan-JE--Hirsh-DC--Gumerlockm-PH--Silva-J--1995-."><span class="Hyperlink">Madewell et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">1995</span></a><span class="Body-text">; </span><a href="#Hartmann-FA--Callan-RJ--McGuirk-SM--West-SE--1996-."><span class="Hyperlink">Hartmann</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 1996</span></a><span class="Body-text">; </span><a href="#Konkle-DM--Nelson-KM--Lunn-DP--1997-"><span class="Hyperlink">Konkle et al</span><span class="Hyperlink CharOverride-6">.</span><span class="Hyperlink">, 1997</span></a><span class="Body-text">; </span><a href="#Tillotson-K--Savage-CJ--Salman-MD--Gentry-Weeks-C--Rice-D--Fedorka-Cray-PJ--Traub-Dargatz-JL--1997-"><span class="Hyperlink">Tillotson et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">1997</span></a><span class="Body-text">; </span><a href="#Seguin-JC--Walker-RD--Caron-JP--Kloos-WE--George-CG--Hollis-RJ--Pfaller-MA--1999"><span class="Hyperlink">Seguin et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">1999</span></a><span class="Body-text">; </span><a href="#Schott-HC--Ewart-SL--Walker-RD--Dwyer-RM--Dietrich-S--Eberhart-SW--Derksen-FJ--2001-."><span class="Hyperlink">Schott et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">2001</span></a><span class="Body-text">; </span><a href="#Weese-JS-Armstrong-J--2003-"><span class="Hyperlink">Weese and Armstrong, 2003</span></a><span class="Body-text">; </span><a href="#Cherry-B--Burns-A--Johnson-GS--Pfeiffer-H--Dumas-N--Barrett-D--McDonough-PL--Eidson-M--2004-."><span class="Hyperlink">Cherry et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">2004</span></a><span class="Body-text">; </span><a href="#Wright-JG--Tengelsen-LA--Smith-KE--Bender-JB--Frank-RK--Grendon-JH--Angulo-FJ--2005-."><span class="Hyperlink">Wright et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">2005</span></a><span class="Body-text">; </span><a href="#Weese-JS--Caldwell-F--Willey-BM--Kreiswirth-BN--McGeer-A--Rousseau-J--Low-DE--2006a-"><span class="Hyperlink">Weese et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">2006a</span></a><span class="Body-text">; </span><a href="#Dallap-Schaer-BL--Aceto-H--Rankin-SC--2010-."><span class="Hyperlink">Dallap et al., 2010</span></a><span class="Body-text">; </span><a href="#Goehring-LS--Landolt-GS--Morley-PS--2010-."><span class="Hyperlink">Goehring et al., 2010</span></a><span class="Body-text">; </span><a href="#Steneroden-KK--Van-Metre-DC--Jackson-C--Morle-PS--2010-."><span class="Hyperlink">Steneroden et al., 2010</span></a><span class="Body-text">). Six of those outbreaks had evidence of zoonotic infection (</span><a href="#Konkle-DM--Nelson-KM--Lunn-DP--1997-"><span class="Hyperlink">Konkle et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">1997</span></a><span class="Body-text">; </span><a href="#Seguin-JC--Walker-RD--Caron-JP--Kloos-WE--George-CG--Hollis-RJ--Pfaller-MA--1999"><span class="Hyperlink">Seguin et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">1999</span></a><span class="Body-text">; </span><a href="#Schott-HC--Ewart-SL--Walker-RD--Dwyer-RM--Dietrich-S--Eberhart-SW--Derksen-FJ--2001-."><span class="Hyperlink">Schott et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">2001</span></a><span class="Body-text">; </span><a href="#Cherry-B--Burns-A--Johnson-GS--Pfeiffer-H--Dumas-N--Barrett-D--McDonough-PL--Eidson-M--2004-."><span class="Hyperlink">Cherry et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">2004</span></a><span class="Body-text">; </span><a href="#Wright-JG--Tengelsen-LA--Smith-KE--Bender-JB--Frank-RK--Grendon-JH--Angulo-FJ--2005-."><span class="Hyperlink">Wright et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">2005</span></a><span class="Body-text">; </span><a href="#Weese-JS--Caldwell-F--Willey-BM--Kreiswirth-BN--McGeer-A--Rousseau-J--Low-DE--2006a-"><span class="Hyperlink">Weese et al., 2006a</span></a><span class="Body-text">).</span></p>
			<p class="Caps-on-First-Para ParaOverride-1" lang="en-GB">&nbsp;</p>
		  <p class="Caps-on-First-Para ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-1--Introduction----" lang="en-GB"><span class="Body-text">History</span></p>
		  <p class="Heading-1--Introduction----" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><span class="Body-text">In the middle ages, the hospitals were established to treat pitiable plague victims and to till date the hospitals and health care personnel are serving the society with great dedication and hospitals has become more obligatory in the healthy living of both human and animals. In 1869, Sir James Young Simpson did an initial signature in the field of hospital epidemiology by his study with more than 4000 amputees in Scotland and England where he found the mortality rate was higher in patients who remained in the hospital for post-operative care. He used the term “hospitalism” to express the risk linked to hospital care. After many years of dedicated works by people like Oliver Wendell Holmes, Ignaz Philipp Semmelweis, Louis Pasteur, Joseph Lister, and Robert Koch, to illuminate the risk factors connected with hospital-related infections (</span><a href="#Semmelweis-I--1848-"><span class="Hyperlink">Semmelweis, 1848</span></a><span class="Body-text">; </span><a href="#Major-RH--1954-"><span class="Hyperlink">Major, 1954</span></a><span class="Body-text">; </span><a href="#Eickhoff-TC--1981-."><span class="Hyperlink">Eickhoff, 1981</span></a><span class="Body-text">) and introduction of rectification guidelines like hand washing and sterilization of instruments used for surgery reduced the propagation of disease and death (</span><a href="#Major-RH--1954-"><span class="Hyperlink">Major, 1954</span></a><span class="Body-text">). The “tide of complacency” in the history of control of nosocomial infection is after the discovery of antibiotics, since the understanding and research of nosocomial infections was not highly developed in the time of world wars (</span><a href="#Eickhoff-TC--1981-."><span class="Hyperlink">Eickhoff, 1981</span></a><span class="Body-text">). In 19</span><span class="Body-text CharOverride-2">th</span><span class="Body-text"> century after the commencement of advanced research in medicine and surgery which revolutionised the healthcare facilities and interventions but also unearthed the unintended harm to patients i.e. Nosocomial infections through health care settings.</span></p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-1--Introduction----" lang="en-GB"><span class="Body-text">Epidemiology and Risk Factors</span></p>
		  <p class="Heading-1--Introduction----" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><span class="Body-text">Nowadays, some of the important factors which have been often associated with the nosocomial infections in human health care centres like employing invasive devices (e.g., intravenous and urinary catheters), lengthened hospitalization of decisively ill patients, complex medical treatment  and surgical procedures, and the extensive exploitation of antibiotics (</span><a href="#Boerlin-P--Eugster-S--Gaschen-F--Straub-R--Schwalder-P--2001-."><span class="Hyperlink">Boerlin et al., 2001</span></a><span class="Body-text">; </span><a href="#Johnson-JA--2002"><span class="Hyperlink">Johnson, 2002</span></a><span class="Body-text">) are increasing in  veterinary hospitals. Intensive care Patients are at 5 to 10 times higher risk of developing a nosocomial infection than normal patients (</span><a href="#Weber-DJ--Raasch-R--Rutala-WA--1999"><span class="Hyperlink">Weber et al., 1999</span></a><span class="Body-text">). The threat of developing infection for hospitalized patients are due to extrinsic risk factors, such as the use of invasive devices and intrinsic risk factors, like underlying ailment during hospitalization (</span><a href="#National-Nosocomial-Infections-Surveillance--NNIS--System.--1991"><span class="Hyperlink">National Nosocomial Infections Surveillance System, 1991</span></a><span class="Body-text">; </span><a href="#Emori-TG--Gaynes-RP--1993"><span class="Hyperlink">Emori and Gaynes, 1993</span></a><span class="Body-text">). Nosocomial infections are either site specific (e.g., surgical site infection) or unit specific (e.g., intensive care unit). The possible source for nosocomial agents are the patient’s own flora, health personnel, instruments and equipment of hospital (</span><a href="#Hardy-KJ--Oppenheim-BA--Gossain-S--Gao-F--Hawkey-PM--2006-."><span class="Hyperlink">Hardy et al., 2006</span></a><span class="Body-text">; </span><a href="#Marshal-BM--Ochieng-DJ--Levy-SB--2009-."><span class="Hyperlink">Marshal et al., 2009</span></a><span class="Body-text">) (</span><a href="#Figure-1"><span class="Hyperlink">Figure 1</span></a><span class="Body-text">). The amplifying risks which favours the transmission of antibiotic resistant pathogens and other nosocomial infections in veterinary hospitals are lack of hygiene, employing invasive devices, prolonged treatment, longer visits by health care worker and caseloads (</span><a href="#D-Agata-EM--Horn-MA--Ruan-S--Webb-GF--Wares-JR--2012-."><span class="Hyperlink">D’Agata et al., 2012</span></a><span class="Body-text">), delayed and breaks in treatment (</span><a href="#D-Agata-EM--Dupont-Rouzeyrol-M--Magal-P--Olivier-D--Ruan-S--2008"><span class="Hyperlink">D’Agata et al., 2008</span></a><span class="Body-text">), lengthy hospital stay (</span><a href="#D-Agata-EM--Magal-P--Olivier-D--Ruan-S--Webb-GF--2007-."><span class="Hyperlink">D’Agata et al., 2007</span></a><span class="Body-text">) and dependence on antimicrobials (</span><a href="#Johnson-JA--2002"><span class="Hyperlink">Johnson, 2002</span></a><span class="Body-text">; </span><a href="#Morley-PS--Apley-MD--Besser-TE--Burney-DP--Fedorka-Cray-PJ--2005"><span class="Hyperlink">Morley et al., 2005</span></a><span class="Body-text">), administration of antiulcer drugs (</span><a href="#Ruple-Czerniak-A--Aceto-HW--Bender-JB--Paradis...2013"><span class="Hyperlink">Ruple-Czerniak et al., 2013</span></a><span class="Body-text">).</span></p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><span class="Body-text">In one individual-based model study to scrutinize the effect of movement of dogs to various locations in a veterinary teaching hospitals, it was found out that nosocomial infection transmission is greater in diagnostic rooms, intensive care units and housing wards than operation theatre and lobby and it also revealed that transmission following the contact with healthcare personnel was more common (</span><a href="#Suthar-N--Roy-S--Call-DR--Besser-TE--Davis-MA--2014-."><span class="Hyperlink">Suthar et al., 2014</span></a><span class="Body-text">). Veterinary hospitals are the major source and accountable for increasing prevalence of a MDR&#160;E. coli&#160;</span><span class="Body-text">in horses&#160;(</span><a href="#Ahmed-MO--Williams-NJ--Clegg-PD--van-Velkinburgh-JC--Baptiste-KE--2012-"><span class="Hyperlink">Ahmed</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 2012</span></a><span class="Body-text">). Veterinary personnel and veterinary hospital environments are allegedly most important key factors in risk of gaining antibiotic resistant pathogens by hospitalized dogs (</span><a href="#Hamilton-E--Kruger-JM--Schall-W--Beal-M--Manning-SD--2013-"><span class="Hyperlink">Hamilton et al., 2013</span></a><span class="Body-text">; </span><a href="#Heller-J--Kelly-L--Reid-SW--Mellor-DJ--2010-."><span class="Hyperlink">Heller</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">et al., 2010</span></a><span class="Body-text">; </span><a href="#KuKanich-KS--Ghosh-A--Skarbek-JV--Lothamer-KM--Zurek-L--2012-"><span class="Hyperlink">KuKanich et al., 2012</span></a><span class="Body-text">).</span></p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
		  
          <div class="pt" > <a href="http://nexusacademicpublishers.com/uploads/figures/20150104220649.png" target="new"><img class="img_display" src="http://nexusacademicpublishers.com/uploads/figures/20150104220649.png" width="80" height="80"></a>
    <p class="Figure--and-Table-Heading ParaOverride-1" lang="en-GB"><span class="CharOverride-5"><a id="Figure-1"></a>Figure 1: </span>Spread of nosocomial infections in veterinary hospitals</p></div>
          
      
			<p class="Heading-1--Introduction----" lang="en-GB">&nbsp;</p>
			<p class="Heading-1--Introduction----" lang="en-GB">&nbsp;</p>
			<p class="Heading-1--Introduction----" lang="en-GB"><span class="Body-text">Impacts of Veterinary hospital associated infections</span></p>
			<p class="Heading-1--Introduction----" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><span class="Body-text">Nosocomial infections are the growing cause of morbidity and mortality in both human and veterinary medicine&#160;(</span><a href="#Weese-JS--2008a"><span class="Hyperlink">Weese, 2008a</span></a><span class="Body-text">; </span><a href="#Weese-JS--2008b"><span class="Hyperlink">Weese, 2008b</span></a><span class="Body-text">; </span><a href="#Owens-CD--Stoessel-K--2008-"><span class="Hyperlink">Owens et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">2008</span></a><span class="Body-text CharOverride-6">; </span><a href="#Faires-MC--Traverse-M--Tater-KC--Pearl-DL--Weese-JS--2010-"><span class="Hyperlink">Faires et al., 2010</span></a><span class="Body-text">). Implication of multiple drug resistant bacterias in nosocomial infections are the main concern because of high morbidity, high cost and duration of treatment and more challenging to eliminate (</span><a href="#Weese-JS--2008a"><span class="Hyperlink">Weese, 2008a</span></a><span class="Body-text">; </span><a href="#Owens-CD--Stoessel-K--2008-"><span class="Hyperlink">Owens et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">2008</span></a><span class="Body-text">;</span><span class="Body-text CharOverride-6"> </span><a href="#Faires-MC--Traverse-M--Tater-KC--Pearl-DL--Weese-JS--2010-"><span class="Hyperlink">Faires et al., 2010</span></a><span class="Body-text">)</span><span class="Body-text"> and there is potential zoonotic risk (</span><a href="#Suthar-N--Roy-S--Call-DR--Besser-TE--Davis-MA--2014-."><span class="Hyperlink">Suthar </span></a></p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><a href="#Suthar-N--Roy-S--Call-DR--Besser-TE--Davis-MA--2014-."><span class="Hyperlink">et al., 2014</span></a><span class="Body-text">). The food animals with resistant antimicrobial  bacteria pose a serious public health risk (</span><a href="#Howard-DH--Scott-RD--Packard-R--Jones-D--2003-."><span class="Hyperlink">Howard et al., 2003</span></a><span class="Body-text">), but the pet animals transmit the resistant bacteria directly to human population by acting as a reservoir (</span><a href="#Guardabassi-L--Schwarz-S--Lloyd-DH--2004-."><span class="Hyperlink">Guardabassi</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 2004</span></a><span class="Body-text">; </span><a href="#Lloyd-DH--2007-"><span class="Hyperlink">Lloyd, 2007</span></a><span class="Body-text">;  </span><a href="#Murphy-C--Reid-Smith-RJ--Prescott-JF--Bonnett-BN--Poppe-C--Boerlin-P--Weese-JS--Janecko-N--McEwen-SA"><span class="Hyperlink">Murphy et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">2009</span></a><span class="Body-text">;&#160; </span><a href="#Song-SJ--Lauber-C--Costello-EK--Lozupone-CA--Humphrey-G--2013-."><span class="Hyperlink">Song et al., 2013</span></a><span class="Body-text">). MDR in companion animals encompass stern public health impacts (</span><a href="#Abraham-S--Wong-HS--Turnidge-J--Johnson-JR--Trott-DJ--2014-"><span class="Hyperlink">Abraham</span><span class="Hyperlink CharOverride-5">&#160;</span><span class="Hyperlink">et al., 2014</span></a><span class="Body-text">). Undue exploitation of antibiotics and horizontal gene transfer may lead to increased possession of antibiotic resistance, thereby escorting to longer period of antibiotic treatment and treatment failure (</span><a href="#Levin-BR--Rozen-DE--2006-"><span class="Hyperlink">Levin et al., 2006</span></a><span class="Body-text">; </span><a href="#Bootsma-MC--van-der-Horst-MA--Guryeva-T--ter-Kuile-BH--Diekmann-O--2012-."><span class="Hyperlink">Bootsma et al., 2012</span></a><span class="Body-text">). The occupational risk to the veterinary health personnel and staff are other concern (</span><a href="#Jordan-D--Simon-J--Fury-S--Moss-S--Giffard-P--Maiwald...2011"><span class="Hyperlink">Jordan</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 2011</span></a><span class="Body-text">). There will be huge economic loss due to this outbreaks and it may tarnish the reputation of the concerned veterinary hospital with reduced client confidence and increased panic.</span></p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-1--Introduction----" lang="en-GB">&nbsp;</p>
		  <p class="Heading-1--Introduction----" lang="en-GB"><span class="Body-text">MRSA&#9;</span></p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><span class="Body-text">With all the evidence </span><span class="Body-text CharOverride-6">Staphylococcus aureus</span><span class="Body-text"> is an important pathogen of both human and animal causing meek skin infections to grave bacteraemia. Generally almost all </span><span class="Body-text CharOverride-6">S. aureus</span><span class="Body-text"> strains are resistant to beta-lactam antibiotics since it is producing pencillinases. Owing to this resistance, meticillin which is resistant to penicillinases were extensively used to treat </span><span class="Body-text CharOverride-6">S. aureus</span><span class="Body-text"> Infections. In late 1950s the meticillin use was initiated in human medicine to treat resistant </span><span class="Body-text CharOverride-6">S. aureus</span><span class="Body-text"> infections. Meticillin resistance was accounted in the early 1961 (</span><a href="#Jevons-MP--1961"><span class="Hyperlink">Jevons, 1961</span></a><span class="Body-text">) and the resistance development was demonstrated (</span><a href="#Barber---1961-."><span class="Hyperlink">Barber, 1961</span></a><span class="Body-text">). In 1970s MRSA emerged as a staid public health issue in US hospitals (</span><a href="#Panlilio-AL--Culver-DH--Gaynes-RP--Banerjee-S--Henderson-TS--Tolson-JS--Martone-WJ--1992-"><span class="Hyperlink">Panlilio et al., 1992</span></a><span class="Body-text">). In 1990s MRSA expanded itself as a solemn nosocomial infection throughout the world (</span><a href="#Ayliffe-GA--1997"><span class="Hyperlink">Ayliffe, 1997</span></a><span class="Body-text">). Eventhough MRSA was first emerged as a human pathogen, nowadays MRSA reports in animals are gradually increasing mainly in equine and companion animals. It is known that </span><span class="Body-text CharOverride-6">S.aureus</span><span class="Body-text"> is one of the chief cause for mastitis and the extensive use of intramammary antibiotics in cattle, so it is not unanticipated that, MRSA was isolated from milk of a mastitic animal, which is first among animals (</span><a href="#Devriese-LA--Vandamme-LR--Fameree-L--1972-."><span class="Hyperlink">Devriese</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 1972</span></a><span class="Body-text">). After this MRSA has been isolated from various species like dogs (</span><a href="#Pak-SI--Han-HR--Shimizu-A--1999-.-C"><span class="Hyperlink">Pak et al., 1999</span></a><span class="Body-text">), cats (</span><a href="#Scott-GM--Thomson-R--Malone-Lee-J--Ridgway-GL--1988-"><span class="Hyperlink">Scott et al., 1988</span></a><span class="Body-text">), sheep (</span><a href="#Goni-P--Vergara-Y--Ruiz-J--Albizu-I--Vila-J--Gomez-Lus-R--2004-."><span class="Hyperlink">Goni et al., 2004</span></a><span class="Body-text">), horses (</span><a href="#Seguin-JC--Walker-RD--Caron-JP--Kloos-WE--George-CG--Hollis-RJ--Pfaller-MA--1999"><span class="Hyperlink">Seguin et al., 1999</span></a><span class="Body-text">), pigs (</span><a href="#Voss-A--Loeffen-F--Bakker-J--Klaassen-C--Wulf-M--2005-."><span class="Hyperlink">Voss et al., 2005</span></a><span class="Body-text">) and chickens (</span><a href="#Lee-JH--2003-."><span class="Hyperlink">Lee, 2003</span></a><span class="Body-text">). Methicillin-resistant&#160;</span><span class="Body-text CharOverride-6">Staphylococcus aureus&#160;</span><span class="Body-text">(MRSA) is an important concern nowadays in pet animals for being a significant cause in nosocomial infections (</span><a href="#Weese-JS--2008b"><span class="Hyperlink">Weese, 2008b</span></a><span class="Body-text CharOverride-6">; </span><a href="#Faires-MC--Traverse-M--Tater-KC--Pearl-DL--Weese-JS--2010-"><span class="Hyperlink">Faires et al., 2010</span></a><span class="Body-text">; </span><a href="#Weese-JS--Finley-R--Reid-Smith-RR--Janecko-N--Rousseau-J--2010-."><span class="Hyperlink">Weese et al., 2010</span></a><span class="Body-text">) and also a threat of zoonoses to veterinary health care personnel&#160;(</span><a href="#Loeffler-A--Pfeiffer-DU--Lloyd-DH--Smith-H--Soares-Magalhaes-R--Lindsay-JA--2010"><span class="Hyperlink">Loeffler et al., 2010</span></a><span class="Body-text">; </span><a href="#Burstiner-LC--Faires-M--Weese-JS--2010-."><span class="Hyperlink">Burstiner</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">et al., 2010</span></a><span class="Body-text">) and horses may act as a reservoir of MRSA and serve as a source of infection to humans (</span><a href="#Weese-JS--Archambault-M--Willey-BM--Dick--2005a"><span class="Hyperlink">Weese et al., 2005</span></a><span class="Hyperlink">a</span><span class="Body-text">). Interestingly, various studies reported that MRSA isolated from companion animals like dogs and cats are found indistinguishable from MRSA isolated from human associated infections (</span><a href="#Baptiste-KE--Williams-K--Williams-NJ--Wattret...-2005"><span class="Hyperlink">Baptiste et al., 2005</span></a><span class="Body-text">, </span><a href="#Loeffler-A--Boag-AK--Sung-J--Lindsay-JA--Guardabassi-L--Dalsgaard-A--Lloyd-DH--2005-"><span class="Hyperlink">Loeffler et al., 2005</span></a><span class="Body-text">;  </span><a href="#O-Mahony-R--Abbott-Y--Leonard-FC--Markey-BK--Quinn-PJ--Pollock-PJ--Rossney-AS--2005-."><span class="Hyperlink">O’Mahony et al., 2005</span></a><span class="Body-text">; </span><a href="#Middleton-JR--Fales-WH--Luby-CD--Oaks-JL--Sanchez-S--Kinyon-JM--Hartmann-F--2005"><span class="Hyperlink">Middleton et al., 2005</span></a><span class="Body-text">;</span><span class="Body-text CharOverride-6"> </span><a href="#Rich-M--Roberts-L--Deighton-L--2005-"><span class="Hyperlink">Rich et al., 2005</span></a><span class="Body-text">; </span><a href="#Hanselman-B--Rousseau-J--Kruth-S--Weese-JS--2006-."><span class="Hyperlink">Hanselman et al., 2006</span></a><span class="Body-text">; </span><a href="#Malik-S--Peng-H--Barton-M--2006-"><span class="Hyperlink">Malik</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 2006</span></a><span class="Body-text">). The association was found out by various phenotypic typing and molecular typing methods like PFGE (</span><a href="#O-Mahony-R--Abbott-Y--Leonard-FC--Markey-BK--Quinn-PJ--Pollock-PJ--Rossney-AS--2005-."><span class="Hyperlink">O’Mahony et al., 2005</span></a><span class="Body-text">), SCCmec, MLST (</span><a href="#Enright-MC--Day-NP--Davies-CE--Peacock-SJ--Spratt-BG--2000-"><span class="Hyperlink">Enright et al., 2000</span></a><span class="Body-text">), spa typing (</span><a href="#Moodley-A--Stegger-M--Bagcigil-AF--Baptiste...-2006"><span class="Hyperlink">Moodley et al., 2006</span></a><span class="Body-text">). The data obtained through all these studies sturdily suggesting the bidirectional transmission of MRSA between companion animals and human (</span><a href="#Leonard-FC--Abbott-Y--Rossney-A--Quinn-PJ--O-Mahony-R--Markey-BK--2006-."><span class="Hyperlink">Leonard et al., 200</span></a><span class="Hyperlink">6</span><span class="Body-text">). Whereas with the assistance  of epidemiological typing it is proved that strains of MRSA isolated from horses and equine associated personnel are different (</span><a href="#Baptiste-KE--Williams-K--Williams-NJ--Wattret...-2005"><span class="Hyperlink">Baptiste et al., 2005</span></a><span class="Body-text">; </span><a href="#O-Mahony-R--Abbott-Y--Leonard-FC--Markey-BK--Quinn-PJ--Pollock-PJ--Rossney-AS--2005-."><span class="Hyperlink">O’Mahony et al., 2005</span></a><span class="Body-text">; </span><a href="#Weese-JS--Archambault-M--Willey-BM--Dick--2005a"><span class="Hyperlink">Weese et al., 2005a</span></a><span class="Body-text">; </span><a href="#Cuny-C--Kuemmerle-J--Stanek-C--Willey-B--Strommenger-B--Witte-W--2006-"><span class="Hyperlink">Cuny et al., 2006</span></a><span class="Body-text">). Outbreaks linking both horses and humans in veterinary hospitals were reported from the United States (</span><a href="#Seguin-JC--Walker-RD--Caron-JP--Kloos-WE--George-CG--Hollis-RJ--Pfaller-MA--1999"><span class="Hyperlink">Seguin et al., 1999</span></a><span class="Body-text">), Canada (</span><a href="#Weese-JS--Archambault-M--Willey-BM--Dick--2005a"><span class="Hyperlink">Weese et al., 2005</span></a><span class="Hyperlink">a</span><span class="Body-text">), Ireland (</span><a href="#O-Mahony-R--Abbott-Y--Leonard-FC--Markey-BK--Quinn-PJ--Pollock-PJ--Rossney-AS--2005-."><span class="Hyperlink">O’Mahony et al., 2005</span></a><span class="Body-text">), Austria (</span><a href="#Cuny-C--Kuemmerle-J--Stanek-C--Willey-B--Strommenger-B--Witte-W--2006-"><span class="Hyperlink">Cuny et al., 2006</span></a><span class="Body-text">, </span><a href="#Cuny-C--Strommenger-B--Witte-W--Stanek-C--2008"><span class="Hyperlink">2008</span></a><span class="Body-text">), the Netherlands (</span><a href="#van-Duijkeren-E--Moleman-M--Sloet-van-Oldruitenborgh-Oosterbaan-...-2010"><span class="Hyperlink">van Duijkeren et al., 2010</span></a><span class="Body-text">) Switzerland (</span><a href="#Sieber-S--Gerber-V--Jandova-V--Rossano-A--Evison-JM--Perreten-V--2011-"><span class="Hyperlink">Sieber et al., 2011</span></a><span class="Body-text">) and Israel (</span><a href="#Schwaber-MJ--Venezia-SN--Masarwa-S--Levy-...-2013"><span class="Hyperlink">Schwaber et al., 2013</span></a><span class="Body-text">). The typing studies revealed that the MRSA isolated from pigs (</span><a href="#Voss-A--Loeffen-F--Bakker-J--Klaassen-C--Wulf-M--2005-."><span class="Hyperlink">Voss et al., 2005</span></a><span class="Body-text">; </span><a href="#Van-Dijke-B--Koppen-H--Wannet-W--Huijsdens-X--de-Neeling-H--Voss-A--2006-."><span class="Hyperlink">Van Dijke</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 2006</span></a><span class="Body-text">) and cattle (</span><a href="#Kwon-NH--Park-KT--Moon-JS--Jung-WK--Kim-SH--Kim-JM--Hong-SK--Koo-HC--Joo-YS--Park-YH--2005"><span class="Hyperlink">Kwon</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 2005</span></a><span class="Body-text">) are distinct from MRSA of human lineage. Numerous studies have acknowledged the increasing MRSA infections in companion animals are coupled with  post-surgical infections and wounds (</span><a href="#Rich-M--Roberts-L--2004-."><span class="Hyperlink">Rich et al., 2004</span></a><span class="Body-text">; </span><a href="#Leonard-FC--Abbott-Y--Rossney-A--Quinn-PJ--O-Mahony-R--Markey-BK--2006-."><span class="Hyperlink">Leonard et al., 2006</span></a><span class="Body-text">) and indwelling devices and suture materials (</span><a href="#Leonard-FC--Abbott-Y--Rossney-A--Quinn-PJ--O-Mahony-R--Markey-BK--2006-."><span class="Hyperlink">Leonard et al., 2006</span></a><span class="Body-text">). </span><a href="#Smith-MM--Vasseur-PB--Saunders-HM--1989-."><span class="Hyperlink">Smith et al. (1989)</span></a><span class="Body-text"> accounted 38% isolation rate of bacteria in dogs from the orthopaedic implant fixation site soon after the removal following the union of the closed fracture (</span><a href="#Smith-MM--Vasseur-PB--Saunders-HM--1989-."><span class="Hyperlink">Smith et al., 1989</span></a><span class="Body-text">). The primary route of MRSA infection transmission in veterinary hospitals is through hands of healthcare personnel (</span><a href="#Leonard-FC--Abbott-Y--Rossney-A--Quinn-PJ--O-Mahony-R--Markey-BK--2006-."><span class="Hyperlink">Leonard et al., 200</span></a><span class="Hyperlink">6</span><span class="Body-text">). As far as public health is concerned many years ago likelihood of companion animals to act as the source for the zoonotic infections of </span><span class="Body-text CharOverride-6">Staphylococci</span><span class="Body-text">  is suggested (</span><a href="#Mann-P--1959-."><span class="Hyperlink">Mann, 1959</span></a><span class="Body-text">) and many reports have offered the suggestion that animals may act as reservoirs of MRSA infections to human. In one case a cat was involved as a MRSA source for nurses in geriatric care unit (</span><a href="#Scott-GM--Thomson-R--Malone-Lee-J--Ridgway-GL--1988-"><span class="Hyperlink">Scott et al., 1988</span></a><span class="Body-text">). In another case of two nurses, a dog was considered as a reservoir for the treatment failure for MRSA and reinfection (</span><a href="#Cefai-C--Ashurst-S--Owens-C--1994-.-H"><span class="Hyperlink">Cefai</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 1994</span></a><span class="Body-text">). Another interesting case of recurrent MRSA infection in a diabetic patient and his wife, the source was found out to be a dog after the sampling of dog’s nares which is colonized with identical PFGE type of MRSA from the couple and the infection was halted in the couple when the dog was treated completely for MRSA (</span><a href="#Manian-FA--2003"><span class="Hyperlink">Manian, 2003</span></a><span class="Body-text">). Some reports implies that swine farmers are at risk of </span><span class="Body-text CharOverride-6">S.aureus</span><span class="Body-text"> and MRSA colonization (</span><a href="#Armand-Lefevre-L--Ruimy-R--Andremont-A---2005-."><span class="Hyperlink">Armand-Lefevre et al., 2005</span></a><span class="Body-text">; </span><a href="#Voss-A--Loeffen-F--Bakker-J--Klaassen-C--Wulf-M--2005-."><span class="Hyperlink">Voss et al., 2005</span></a><span class="Body-text">). An attending pet surgeon who was an asymptomatic carrier of MRSA was found to be associated with postoperative wound infection of MRSA in five dogs (</span><a href="#Leonard-FC--Abbott-Y--Rossney-A--Quinn-PJ--O-Mahony-R--Markey-BK--2006-."><span class="Hyperlink">Leonard et al., 2006</span></a><span class="Body-text">). In a survey conducted in a referral hospital for small animals from the nasal and oral mucosae of hospital staff and animals, MRSA was isolated from four dogs and 14 staff (</span><a href="#Loeffler-A--Boag-AK--Sung-J--Lindsay-JA--Guardabassi-L--Dalsgaard-A--Lloyd-DH--2005-"><span class="Hyperlink">Loeffler et al., 2005</span></a><span class="Body-text">). The veterinary personnel working in veterinary hospitals are at greater risk of MRSA colonization and hence MRSA colonization is regarded as an occupational risk (</span><a href="#Hanselman-B--Rousseau-J--Kruth-S--Weese-JS--2006-."><span class="Hyperlink">Hanselman et al., 2006</span></a><span class="Body-text">; </span><a href="#Anderson-MEC--Lefebvre-SL--Weese-JS--2008-."><span class="Hyperlink">Anderson et al., 2008</span></a><span class="Body-text">; </span><a href="#van-Duijkeren-E--Moleman-M--Sloet-van-Oldruitenborgh-Oosterbaan-...-2010"><span class="Hyperlink">van Duijkeren et al., 2010</span></a><span class="Body-text">; </span><a href="#Jordan-D--Simon-J--Fury-S--Moss-S--Giffard-P--Maiwald...2011"><span class="Hyperlink">Jordan et al., 2011</span></a><span class="Body-text">). MRSA colonized personnel plays a vital task in the MRSA introduction and transmission in veterinary health care settings (</span><a href="#van-Duijkeren-E--Moleman-M--Sloet-van-Oldruitenborgh-Oosterbaan-...-2010"><span class="Hyperlink">van Duijkeren et al., 2010</span></a><span class="Body-text">; </span><a href="#Sieber-S--Gerber-V--Jandova-V--Rossano-A--Evison-JM--Perreten-V--2011-"><span class="Hyperlink">Sieber et al., 2011</span></a><span class="Body-text">) and besides this they spread the infection to other persons (</span><a href="#Anderson-MEC--Lefebvre-SL--Weese-JS--2008-."><span class="Hyperlink">Anderson et al., 2008</span></a><span class="Body-text">). An outbreak occurred at teaching veterinary hospital in Israel by an uncommon MRSA strain displayed the bidirectional spread between animal and humans (</span><a href="#Schwaber-MJ--Venezia-SN--Masarwa-S--Levy-...-2013"><span class="Hyperlink">Schwaber et al., 2013</span></a><span class="Body-text">). From animal health relevance methicillin-resistant&#160;</span><span class="Body-text CharOverride-6">Staphylococcus pseudintermedius</span><span class="Body-text"> (MRSP) is often associated with pyoderma</span><span class="Body-text"> and surgical site infections (</span><a href="#Weese-JS--2008"><span class="Hyperlink">Weese, 2008b</span></a><span class="Body-text">) has swiftly emerging as an opportunistic nosocomial infectious agent (</span><a href="#Laarhoven-LM--de-Heus-P--van-Luijn-J--Duim-B--Wagenaar-JA--van-Duijkeren-E--2011"><span class="Hyperlink">Laarhoven et al., 2011</span></a><span class="Body-text">). MRSP can be detected in apparently normal animals (</span><a href="#Murphy-C--Reid-Smith-RJ--Prescott-JF--Bonnett-BN--Poppe-C--Boerlin-P--Weese-JS--Janecko-N--McEwen-SA"><span class="Hyperlink">Murphy et al., 2009</span></a><span class="Body-text">) and in veterinary hospital environment (</span><a href="#Nienhoff-U--Kadlec-K--Chaberny-IF--Verspohl-J--Gerlach-GF--Kreienbrock-L--Schwarz-S--2011"><span class="Hyperlink">Nienhoff</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 2011</span></a><span class="Body-text">). A large outbreak was recorded in Finnish veterinary teaching hospital caused by MRSP (</span><a href="#Gronthal-T--Moodley-A--Nykasenoja-S--Junilla-J--Guardabassi-L--Thomson-K--Rantala-M--2014"><span class="Hyperlink">Gronthal et al., 2014</span></a><span class="Body-text">).</span></p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-1--Introduction----" lang="en-GB">&nbsp;</p>
		  <p class="Heading-1--Introduction----" lang="en-GB"><span class="Body-text CharOverride-15">Clostridium difficile</span></p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><span class="Body-text">Following the discovery of </span><span class="Body-text CharOverride-6">C. difficile</span><span class="Body-text"> in 1935, it was thought to be the normal faecal flora of the newborns rather than pathogenic (</span><a href="#Hall-IC--O-Toole-E--1935"><span class="Hyperlink">Hall and O’Toole, 1935</span></a><span class="Body-text">).  But the preamble of broad spectrum antibiotics prompted the emergence of pseudomembranous colitis and it is now considered one of the serious cause of nosocomial infections since it is emerging in the human community and food animals (</span><a href="#Rupnik-M--Wilcox-MH--Gerding-DN--2009-."><span class="Hyperlink">Rupnik et al., 2009</span></a><span class="Body-text">). </span><span class="Body-text CharOverride-6">Clostridium difficile</span><span class="Body-text"> is a gram positive, spore forming anaerobic bacterium. </span><span class="Body-text CharOverride-6">C. difficile</span><span class="Body-text"> spores are comparatively resistant to common disinfectants making </span><span class="Body-text CharOverride-6">C. difficile </span><span class="Body-text">a lasting environmental contaminant. Many studies have reported a strong association between nosocomial </span><span class="Body-text CharOverride-6">C. difficile </span><span class="Body-text">infection and antibiotic therapy in horses (</span><a href="#Madewell-BR--Tang-YJ--Jang-S--Madigan-JE--Hirsh-DC--Gumerlockm-PH--Silva-J--1995-."><span class="Hyperlink">Madewell et al., 1995</span></a><span class="Body-text">; </span><a href="#Ruby-R--Magdesian-KG--Kass-PH--2009-"><span class="Hyperlink">Ruby et al., 2009</span></a><span class="Body-text">; </span><a href="#Barr-BS--Waldridge-BM--Morresey-PR--Reed-SM--...-2013"><span class="Hyperlink">Barr et al., 2013</span></a><span class="Body-text">). In a Prospective study conducted in horses pre-treated with penicillin followed by experimental infection resulted in increased isolation of </span><span class="Body-text CharOverride-6">C. difficile</span><span class="Body-text"> from faecal samples, revealing the role of antimicrobials as a risk factor (</span><a href="#Gustafsson-A--Ba--verud-V--Gunnarsson-A--Pringle-J--Franklin-A--2004-."><span class="Hyperlink">Gustafsson et al., 2004</span></a><span class="Body-text">). Prevalence and distribution of </span><span class="Body-text CharOverride-6">C. difficile</span><span class="Body-text"> was studied in dogs and cats visiting Veterinary Hospitals and animal shelters (</span><a href="#Clooten-J--Kruth-S--Arroyo-L--Weese-JS---2008-."><span class="Hyperlink">Clooten et al., 2008</span></a><span class="Body-text">; </span><a href="#Schneeberg-A--Rupnik-M--Neubauer-H--Seyboldt-C--2012"><span class="Hyperlink">Schneeberg et al., 2012</span></a><span class="Body-text">). A study conducted in an animal shelter in Germany, reported  </span><span class="Body-text CharOverride-6">C</span><span class="Body-text">. </span><span class="Body-text CharOverride-6">difficile</span><span class="Body-text"> prevalence rate of 5.5% and 3.5% in dogs and cats respectively further the study acknowledged that dogs and cats kept in animal shelters act as a reservoir for&#160;C.&#160;difficile PCR ribotypes that can infect human (</span><a href="#Schneeberg-A--Rupnik-M--Neubauer-H--Seyboldt-C--2012"><span class="Hyperlink">Schneeberg et al., 2012</span></a><span class="Body-text">).</span><span class="Body-text CharOverride-16">&#160;</span><span class="Body-text">An another prospective study conducted in a veterinary teaching hospital reported that </span><span class="Body-text CharOverride-6">C. difficile</span><span class="Body-text"> could be isolated from 18% from dogs and cats and the study concluded that antibiotic administration  prior to admission and administration of immunosuppressive drugs during hospitalization were risk factors for the nosocomial colonization (</span><a href="#Clooten-J--Kruth-S--Arroyo-L--Weese-JS---2008-."><span class="Hyperlink">Clooten et al., 2008</span></a><span class="Body-text">). </span><span class="Body-text CharOverride-6">C. difficile</span><span class="Body-text"> Ribotype 001, which is very common in hospitalized patients in Ontario was also frequently encountered among dogs in Ontario (</span><a href="#Weese-JS--Duijkeren-EV--2010"><span class="Hyperlink">Weese et al., 2010</span></a><span class="Body-text">). A high environmental load of </span><span class="Body-text CharOverride-6">C</span><span class="Body-text">. </span><span class="Body-text CharOverride-6">difficile</span><span class="Body-text"> is present in veterinary hospitals (</span><a href="#Weese-JS--Staempfli-HR--Prescott-JF--2000"><span class="Hyperlink">Weese et al., 2000</span></a><span class="Body-text">). An environmental survey conducted in a teaching veterinary hospital for the presence of </span><span class="Body-text CharOverride-6">C. difficile</span><span class="Body-text"> documented an isolation rate of 6.3%. The places where </span><span class="Body-text CharOverride-6">C. difficile</span><span class="Body-text"> was isolated are places of high animal traffic and rough floor (spores persist in cracks) with more likelihood of faecal contamination (</span><a href="#Weese-JS--Staempfli-HR--Prescott-JF--2000"><span class="Hyperlink">Weese et al., 2000</span></a><span class="Body-text">).</span><span class="Body-text CharOverride-5"> </span><span class="Body-text">Similar type of ribotype was reported from various species like in piglets (</span><a href="#Keessen-EC--Hensgens-MP--Spigaglia-P--Barbanti-F--Sanders-IM--Kuijper-EJ--Lipman-LJ--2013"><span class="Hyperlink">Keessen et al., 2013</span></a><span class="Body-text">), calves (</span><a href="#Costa-MC--Stampfli-HR--Arroyo-LG--Pearl-DL--Weese-JS--2011-."><span class="Hyperlink">Costa et al., 2011</span></a><span class="Body-text">), humans (</span><a href="#Debast-SB--van-Leengoed-LA--Goorhuis-A--Harmanus-C--Kuijper-EJ--Bergwerff-AA--2009-."><span class="Hyperlink">Debast et al., 2009</span></a><span class="Body-text">) and other food animals (</span><a href="#Indra-A--Lassnig-H--Baliko-N--Much-P--Fiedler-A--Huhulescu-S--Allerberger-F--2009"><span class="Hyperlink">Indra et al., 2009</span></a><span class="Body-text">) and also in meat implicated in outbreaks (</span><a href="#Rodriguez-Palacios-A--Reid-Smith-RJ--Staempfli...2009"><span class="Hyperlink">Rodriguez-Palacios et al., 2009</span></a><span class="Body-text">). This paved way for making an assumption that </span><span class="Body-text CharOverride-6">C. difficile</span><span class="Body-text"> transmission from animals to human is likely to occur. An Austrian study concluded that animal reservoirs can be a possible source for human CDI infection through the food animals (</span><a href="#Indra-A--Lassnig-H--Baliko-N--Much-P--Fiedler-A--Huhulescu-S--Allerberger-F--2009"><span class="Hyperlink">Indra et al., 2009</span></a><span class="Body-text">). However frank zoonosis was not established, owing to the ubiquitous nature of the organism it may act as common source for both animals and human beings.</span></p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-1--Introduction----" lang="en-GB">&nbsp;</p>
		  <p class="Heading-1--Introduction----" lang="en-GB"><span class="Body-text">Multidrug-Resistant </span><span class="Body-text CharOverride-15">Escherichia coi </span><span class="Body-text">and other</span><span class="Body-text CharOverride-15"> Enterobacteriaceae</span></p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><span class="Body-text">Multidrug-resistant nosocomial infections is one of the big challenges in tertiary-care veterinary hospitals and have turned out to be endemic in the veterinary hospital environment (</span><a href="#Sanchez-S--Stevenson-MAM--Hudson-CR--Maier-M--Buffington-T--Dam-Q--Maurer-JJ--2002"><span class="Hyperlink">Sanchez et al., 2002</span></a><span class="Body-text">). Managing </span><span class="Body-text CharOverride-6">E. coli</span><span class="Body-text"> infections in veterinary hospitals has become more challenging task due to the emergence of multiple-antimicrobial-resistant </span><span class="Body-text CharOverride-6">E. coli </span><span class="Body-text">in food animals and pet animals (</span><a href="#Bischoff-KM--White-DG--McDermott-PF--Zhao-S--Gaines-S--Maurer-JJ--Nisbet-DJ--2001"><span class="Hyperlink">Bischoff</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 2001</span></a><span class="Body-text">; </span><a href="#Wagner-S--Gally-DL--Argyle-SA--2014-."><span class="Hyperlink">Wagner et al., 2014</span></a><span class="Body-text">; </span><a href="#Zhao-S--White-DG--McDermott-PF--Friedman-2001"><span class="Hyperlink">Zhao</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 2001</span></a><span class="Body-text">). The growing predominance of infections with organisms generating broad spectrum b-lactamses such as the ESBLs (mainly the CTX-M type), AmpC and carbapenemase enzymes are threatening the future of the b-lactam drug. Since b-lactams are inevitable to veterinary practice and the outlook of losing these drugs, warrants the necessity for defining the epidemiology of ESBL and carbapenemase producers in companion animals (</span><a href="#Rubin-JE--Pitout-JDD--2014-"><span class="Hyperlink">Rubin et al., 2014</span></a><span class="Body-text">). In the ICU of University of Georgia Veterinary Teaching Hospital, </span><span class="Body-text CharOverride-6">E.coli</span><span class="Body-text"> resistant to 12 antibiotics could be isolated from two dogs housed together, of which one dog died due to sudden septic shock. Followed by this incident 21 hospital-acquired </span><span class="Body-text CharOverride-6">E. coli </span><span class="Body-text">infections were reviewed and found out that the isolates had similar antibiotic resistance profiles (</span><a href="#Sanchez-S--Stevenson-MAM--Hudson-CR--Maier-M--Buffington-T--Dam-Q--Maurer-JJ--2002"><span class="Hyperlink">Sanchez et al., 2002</span></a><span class="Body-text">). Mostly </span><span class="Body-text CharOverride-6">E. coli</span><span class="Body-text"> isolates of nosocomial events were found to be resistant to cephalosporins, beta lactams and beta lactamase inhibitor clavlanic acid and this attributes to a common </span><span class="Body-text CharOverride-6">ampC </span><span class="Body-text">class of cephamycinases (</span><a href="#Oteo-J--Cercenado-E--Cuevas-O--Bautista-V--Delgado--...2010"><span class="Hyperlink">Oteo et al., 2010</span></a><span class="Body-text">). Especially, </span><span class="Body-text CharOverride-6">ampC</span><span class="Body-text">-like gene, </span><span class="Body-text CharOverride-6">bla</span><span class="Body-text">CMY2 was noticed in ceftriaxone-resistant </span><span class="Body-text CharOverride-6">E. coli </span><span class="Body-text">isolates of animal origin (</span><a href="#Zhao-S--White-DG--McDermott-PF--Friedman-2001"><span class="Hyperlink">Zhao et al., 2001</span></a><span class="Body-text">). Carriage of ESBL and AmpC-producing </span><span class="Body-text CharOverride-6">E. coli</span><span class="Body-text"> has been acknowledged in many species (</span><a href="#Bortolaia-V--Larsen-J--Damborg-P--Guardabassi-L--2011-"><span class="Hyperlink">Bortolaia et al., 2011</span></a><span class="Body-text">). ESBL </span><span class="Body-text CharOverride-6">E. coli</span><span class="Body-text"> (O’Keefe et al., 2010) and AmpC producing </span><span class="Body-text CharOverride-6">E. coli</span><span class="Body-text"> (</span><a href="#Oteo-J--Cercenado-E--Cuevas-O--Bautista-V--Delgado--...2010"><span class="Hyperlink">Oteo et al., 2010</span></a><span class="Body-text">) are the emerging problems. ESBL </span><span class="Body-text CharOverride-6">E. coli</span><span class="Body-text"> are linked to range of clinical diseases like urinary tract infections, neonatal septicaemia and wound infections (</span><a href="#Pitout-JDD--2010-"><span class="Hyperlink">Pitout, 2010</span></a><span class="Body-text">; </span><a href="#Ewers-C--Stamm-I--Pfeifer-Y--Wieler-LH---Kopp-PA---Sch-nning-K--2014-."><span class="Hyperlink">Ewers et al., 2014</span></a><span class="Body-text">) and reported from canine clinical isolates (</span><a href="#Sanchez-S--Stevenson-MAM--Hudson-CR--Maier-M--Buffington-T--Dam-Q--Maurer-JJ--2002"><span class="Hyperlink">Sanchez et al., 2002</span></a><span class="Body-text">; </span><a href="#Shaheen-BW--Nayak-R--Foley-SL--Kweon-O--Deck-J--Park-M--Rafii-F--Boothe-DM--2011-."><span class="Hyperlink">Shaheen et al., 2011</span></a><span class="Body-text">). ESBL-producing uropathogenic </span><span class="Body-text CharOverride-6">Escherichia coli</span><span class="Body-text"> (CTX-M-15) were isolated from 5% dogs and 3.3% cats in Switzerland (</span><a href="#Huber-H--Zweifel-C--Wittenbrink-MM--Stephan-R--2013"><span class="Hyperlink">Huber et al., 2013</span></a><span class="Body-text">). A survey carried out in Netherlands in companion animals and horses demonstrated a 2% prevalence of ESBL and AmpC-producing isolates. The same study identified, ESBL producing </span><span class="Body-text CharOverride-6">S. enterica, Proteus miriabilis</span><span class="Body-text"> and </span><span class="Body-text CharOverride-6">Enterobacter cloaceae</span><span class="Body-text"> from urinary, wound, respiratory, abdominal and bone infections (</span><a href="#Dierikx-CM--van-Duijkeren-E--Schoormans-AH--van-Essen-Zandbergen-...-2012"><span class="Hyperlink">Dierikx et al., 2012</span></a><span class="Body-text">). In Germany from six nosocomially infected dogs, OXA-48 type Carbopenamases  producing </span><span class="Body-text CharOverride-6">E. coli</span><span class="Body-text"> and </span><span class="Body-text CharOverride-6">K. pneumonia</span><span class="Body-text"> were isolated (</span><a href="#Stolle-I--Prenger-Berninghoff-E--Stamm-I--Scheufen...2013"><span class="Hyperlink">Stolle</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 2013</span></a><span class="Body-text">) and in France CTX-M-15 generating  </span><span class="Body-text CharOverride-6">K. pneumoniae</span><span class="Body-text"> have been detected from urinary tract infections of dogs and cats (</span><a href="#Haenni-M--Ponsin-C--Metayer-V--Medaille-C--Madec-JY--2012-"><span class="Hyperlink">Haenni et al., 2012</span></a><span class="Body-text">). Clinical samples from urinary, wound infections etc. from Germany and European countries were investigated for ESBL producing </span><span class="Body-text CharOverride-6">K. pneumoniae</span><span class="Body-text"> from horses and companion animals. MLST and PFGE were performed for comparing with human isolates. About 75.8% of the strains possess ST15-CTX-M-15, which is a clonal group that emerged in humans in recent times and this strain shared PFGE clusters with human isolates, signifying the dissemination of this clonal group between human and animal populations (</span><a href="#Ewers-C--Stamm-I--Pfeifer-Y--Wieler-LH---Kopp-PA---Sch-nning-K--2014-."><span class="Hyperlink">Ewers et al., 2014</span></a><span class="Body-text">).There are reports of ESBL in other </span><span class="Body-text CharOverride-6">Enterobacteriaceae</span><span class="Body-text"> members like </span><span class="Body-text CharOverride-6">Enterobacter</span><span class="Body-text"> sp., </span><span class="Body-text CharOverride-6">K. pneumoniae</span><span class="Body-text">, </span><span class="Body-text CharOverride-6">Citrobacter</span><span class="Body-text"> sp. and </span><span class="Body-text CharOverride-6">Salmonella enterica</span><span class="Body-text"> serovar Newport (</span><a href="#Haenni-M--Ponsin-C--Metayer-V--Medaille-C--Madec-JY--2012-"><span class="Hyperlink">Haenni et al., 2012</span></a><span class="Body-text">; </span><a href="#Ma-J--Zeng-Z--Chen-Z--Xu-X--Wang-X--Deng-Y--Lu-D--Huang-L--Zhang-Y--Liu-J--Wang-M--2009"><span class="Hyperlink">Ma et al., 2009</span></a><span class="Body-text">). A recent study conducted in Netherlands reported a high prevalence of faecal carriage of </span><span class="Body-text CharOverride-6">Enterobacteriaceae </span><span class="Body-text">resistant to third-generation cephalosporins in cats and dogs (</span><a href="#Hordijk-J--Schoormans-A--Kwakernaak-M--Duim-B--Broens-E--Dierikx-C--Mevius-D--Wagenaar-JA--2013"><span class="Hyperlink">Hordijk et al., 2013</span></a><span class="Body-text">). Various risk-based case control studies reported that hospitalization is a major risk associated with the dogs to become multi-drug resistant (MDR)&#160;</span><span class="Body-text">E. coli&#160;rectal carriers (</span><a href="#Gibson-JS--Morton-JM--Cobbold-RN--Filippich-LJ--Trott-DJ--2011-"><span class="Hyperlink">Gibson et al., 2011</span></a><span class="Body-text">; </span><a href="#Hamilton-E--Kruger-JM--Schall-W--Beal-M--Manning-SD--2013-"><span class="Hyperlink">Hamilton et al., 2013</span></a><span class="Body-text">). </span><span class="Body-text CharOverride-6">Enterobacter cloacae</span><span class="Body-text">, also a nosocomial agent and particularly the multidrug resistant strains, are concerning (</span><a href="#Wilberger-MS--Anthony-KE--Rose-S--McClain-M--Bermudez-LE--2012-"><span class="Hyperlink">Wilberger et al., 2012</span></a><span class="Body-text">). </span></p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-2--History-in-MM-" lang="en-GB"><span class="Body-text">Acinetobacter baumannii</span></p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><span class="Body-text CharOverride-6">Acinetobacter</span><span class="Body-text"> spp. is environmental bacteria and normal flora of skin and mucous membrane in humans and animals and often associated with opportunistic infections in animals (</span><a href="#Clemetson-LL--Ward-AC--1990-."><span class="Hyperlink">Clemetson and Ward, 1990</span></a><span class="Body-text">). </span><span class="Body-text CharOverride-6">Acinetobacter baumannii</span><span class="Body-text"> has emerged over the last decade as a cause of nosocomial infections and the pathogenicity is mainly due to multidrug resistance and biofilm formation. Its ability to acquire the resistance easily making it as one of the ominous agent to the existing antibiotic era (</span><a href="#Kempf-M.--Rolain-J.M--2012-"><span class="Hyperlink">Kempf and Rolain, 2012</span></a><span class="Body-text">). Outbreaks have been recorded in hospitalized animals (</span><a href="#Francey-T--Gaschen-F--Nicolet-J--Burnens-AP--2000-."><span class="Hyperlink">Francey et al., 2000</span></a><span class="Body-text">) and associated with indwelling vascular catheter infection in horses (</span><a href="#Vaneechoutte-M--Devriese-LA--Dijkshoorn-L--2000-"><span class="Hyperlink">Vaneechoutte et al., 2000</span></a><span class="Body-text">). </span><span class="Body-text CharOverride-6">A. baumannii</span><span class="Body-text"> have been isolated from the clinical samples of companion animals (</span><a href="#Francey-T--Gaschen-F--Nicolet-J--Burnens-AP--2000-."><span class="Hyperlink">Francey et al., 2000</span></a><span class="Body-text">; </span><a href="#Zordan-S--Prenger-Berninghoff-E--Weiss-R--van-der-Reijden-T--van-den-Broek-P--Baljer-G--Dijkshoorn-L"><span class="Hyperlink">Zordan et al., 2011</span></a><span class="Body-text">). It is evident that companion animals can be reservoirs of antimicrobial resistant bacteria and the role of pets in the dissemination of antimicrobial resistance is well understood (</span><a href="#Guardabassi-L--Schwarz-S--Lloyd-DH--2004-."><span class="Hyperlink">Guardabassi et al., 2004</span></a><span class="Body-text">). The spread of multiresistant </span><span class="Body-text CharOverride-6">A. baumannii</span><span class="Body-text"> from a companion animal clinic to a horse clinic was recorded and the reason behind the transmission was believed to be the hands of staff personnel and students working simultaneously in both the clinics (</span><a href="#Boerlin-P--Eugster-S--Gaschen-F--Straub-R--Schwalder-P--2001-."><span class="Hyperlink">Boerlin et al., 2001</span></a><span class="Body-text">). Majority of the </span><span class="Body-text CharOverride-6">Acinetobacter baumannii</span><span class="Body-text"> isolates belong to ST25, where ST is an emergent clonal lineage which includes Carbapenemases including oxacillinases (OXA-58 and OXA-72), metallo-ß-lactamases (NDM-1) (</span><a href="#Zarrilli-R--Pournaras-S--Giannouli-M--Tsakris-A--2013-"><span class="Hyperlink">Zarrilli et al., 2013</span></a><span class="Body-text">) and recently for the first time OXA-23 mediated Carbapenem resistance in sequence type 2 multidrug-resistant </span><span class="Body-text CharOverride-6">Acinetobacter baumannii</span><span class="Body-text">&#160;was recorded from a cat with urinary tract infection. A recent study demonstrated increased resistance of </span><span class="Body-text CharOverride-6">A. baumannii</span><span class="Body-text"> towards dessication and its biofilm forming ability on abiotic surfaces which facilitates its persistence in hospital environment (</span><a href="#Giannouli-M--Antunes-LCS--Marchetti-V--Triassi-M--Visca-P--Zarrilli-R--2013-"><span class="Hyperlink">Giannouli et al. 2013</span></a><span class="Body-text">), one more study revealed the isolation of carbapenem-resistant </span><span class="Body-text CharOverride-6">A. baumannii</span><span class="Body-text"> from hospital sewges in Beijing (</span><a href="#Zhang-C--Qiu-S--Wang-Y--Qi-L--Hao-R--Liu-X--Shi-Y--Hu-X--An-D--Li-Z---2013"><span class="Hyperlink">Zhang et al., 2013</span></a><span class="Body-text">). A multicentre cross-sectional study conducted to detect the carriage of </span><span class="Body-text CharOverride-6">Acinetobacter baumannii</span><span class="Body-text"> in pets revealed a carriage prevalence of 6.5% and nine carriers were identified from four veterinary clinics. Hospitalization and recent antibiotic therapy was notably associated with the carriage of </span><span class="Body-text CharOverride-6">A. baumannii</span><span class="Body-text"> (</span><a href="#Belmonte-O---Pailhories-H--Kempf-M---Gaultier-MP--Lemarie..-2014"><span class="Hyperlink">Belmonte et al., 2014</span></a><span class="Body-text">).</span></p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-2--History-in-MM-" lang="en-GB"><span class="Body-text">Multidrug-Resistant </span><span class="Body-text CharOverride-15">Enterococci</span></p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><span class="Body-text CharOverride-6">Enterococci</span><span class="Body-text"> are saprophytic, Gram-positive, facultative anaerobes inhabitating the intestinal tract of humans and animals as a commensal. But now </span><span class="Body-text CharOverride-6">Enterococci</span><span class="Body-text"> has been emerged as an important nosocomial agent , particularly multiple drug resistance species of </span><span class="Body-text CharOverride-6">Enterococci</span><span class="Body-text"> (</span><a href="#Poeta-P--Costa-D--Rodrigues-J--Torres-C.--2006-."><span class="Hyperlink">Poeta et al., 2006</span></a><span class="Body-text">) and the development of multiple drug resistance among </span><span class="Body-text CharOverride-6">Enterococci</span><span class="Body-text"> species rose as a significant public health issue due to abuse and over exploitation of antibiotics in human and veterinary practices. It can also thrive well in dry hospital surfaces, medical instruments and resistant to heat, alcohol and chlorine (</span><a href="#Fisher-K--Phillips-C--2009-"><span class="Hyperlink">Fisher et al., 2009</span></a><span class="Body-text">; </span><a href="#Giraffa-G--2002-"><span class="Hyperlink">Giraffa, 2002</span></a><span class="Body-text">). In Europe </span><span class="Body-text CharOverride-6">Enterococci</span><span class="Body-text"> are ranked second most hazardous pathogen among intensive care unit-acquired bloodstream infections (</span><a href="#Bohme-H--Konigsmark-C--Klare-I--Zischka-M--Werner-G--2012-."><span class="Hyperlink">Bohme et al., 2012</span></a><span class="Body-text">). In the USA around 12% of the nosocomial infections are due to </span><span class="Body-text CharOverride-6">Enterococcus</span><span class="Body-text"> species. </span><span class="Body-text CharOverride-6">E. faecalis</span><span class="Body-text"> is the predominant species responsible for clinical infection whereas </span><span class="Body-text CharOverride-6">E. faecium </span><span class="Body-text">claims the higher antibiotic resistance (</span><a href="#Giraffa-G--2002-"><span class="Hyperlink">Giraffa, 2002</span></a><span class="Body-text">). Globally multiresistant </span><span class="Body-text CharOverride-6">E. faecium</span><span class="Body-text"> causing increasing number of hospital associated infections (</span><a href="#Willems-RJ--Top-J--VanSchaik-W--Leavis-H--Bonten-M--Siren-J--2012-"><span class="Hyperlink">Willems et al., 2012</span></a><span class="Body-text">) and embodies upto to one third of Enterococcal infections (</span><a href="#Willems-RJ--VanSchaik-W--2009-."><span class="Hyperlink">Willems and VanSchaik, 2009</span></a><span class="Body-text">). In 1972, Vancomycin was first used and first vancomycin-resistant </span><span class="Body-text CharOverride-6">Enterococci</span><span class="Body-text"> (VRE) were documented   15 years later and  NNIS accounted increase of 7.6% in Vancomycin resistant </span><span class="Body-text CharOverride-6">Enterococci</span><span class="Body-text">  between 1989 and 1993 (</span><a href="#Metan-G--Zarakolu-P--Unal-S--2005-."><span class="Hyperlink">Metan et al., 2005</span></a><span class="Body-text">). In a study conducted in Korea to investigate the possibility of MDR </span><span class="Body-text CharOverride-6">Enterococcus </span><span class="Body-text">cross transmission, </span><span class="Body-text CharOverride-6">Enterococcus</span><span class="Body-text"> species was isolated from dogs, dog owners, veterinary personnel and five veterinary hospital environment  and the study demonstrated a high prevalence of 62.5% of MDR </span><span class="Body-text CharOverride-6">E. faecalis</span><span class="Body-text">  and 75% of MDR </span><span class="Body-text CharOverride-6">E. faecium</span><span class="Body-text"> (</span><a href="#Chung-YS--Kwon-KH--Shin-S--Kim-JH--Park-YH--Yoon-JW--2014-"><span class="Hyperlink">Chung  et al., 2014</span></a><span class="Body-text">). In a study conducted in veterinary teaching hospital in Switzerland, two multiresistant </span><span class="Body-text CharOverride-6">E. faecium</span><span class="Body-text"> isolates with similar antibiotic resistant and PFGE profiles was recovered from two different cats with less than one month interval suggesting the persistence in hospital environment and nosocomial transmission (</span><a href="#Boerlin-P--Eugster-S--Gaschen-F--Straub-R--Schwalder-P--2001-."><span class="Hyperlink">Boerlin et al., 2001</span></a><span class="Body-text">). In the early 1980’s the emergence of Hospital associated Ampicillin resistant </span><span class="Body-text CharOverride-6">Enterococci</span><span class="Body-text"> (ARE) in USA preceded rise of vancomycin resistance in </span><span class="Body-text CharOverride-6">enterococci,</span><span class="Body-text"> which happend in the 1990s, is the reason  why virtually all VRE of nosocomial infections in humans are also ampicillin resistant (</span><a href="#Grayson-ML--Eliopoulos-GM--Wennersten-CB--Ruoff-KL--De-Girolami-PC--Ferraro-MJ--1991-"><span class="Hyperlink">Grayson</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 1991</span></a><span class="Body-text">) but ARE associated with human infections remain vancomycin susceptible (</span><a href="#Tremblay-CL--Charlebois-A--Masson-L--Archambault-M--2013"><span class="Hyperlink">Tremblay et al., 2013</span></a><span class="Body-text">). The hospital associated </span>ARE have been recovered from dogs suffering from urinary tract infections in US (<a href="#Simjee-S--White-DG--McDermott-PF--Wagner-DD--Zervos-MJ--Donabedian-SM--2002-."><span class="Hyperlink">Simjee et al., 2002</span></a>), Denmark (<a href="#Damborg-P--Top-J--Hendrickx-AP--Dawson-S--Willems-RJ--Guardabassi-L--2009-."><span class="Hyperlink">Damborg et al., 2009</span></a>), Korea (<a href="#Kwon-KH--Moon-BY--Hwang-SY--Park-YH--2012"><span class="Hyperlink">Kwon et al., 2012</span></a>) and also from the faeces of dogs departing the intensive care unit of an American veterinary medicine teaching hospital (<a href="#Ghosh-A--Dowd-SE--Zurek-L--2011-."><span class="Hyperlink">Ghosh et al., 2011</span></a>). In a study conducted in veterinary teaching hospital of Canada with the objective of characterizing the ARE strains of dogs and human revealed the cross-transmission between humans and dogs and further supports the significance of antibiotic stewardship to avoid zoonotic spread of canine ARE (<a href="#Tremblay-CL--Charlebois-A--Masson-L--Archambault-M--2013"><span class="Hyperlink">Tremblay et al., 2013</span></a>).</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-2--History-in-MM-" lang="en-GB"><span class="CharOverride-15">Salmonella</span></p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><span class="CharOverride-6">Salmonella enterica</span> was found out to be a most common agent associated with nosocomial outbreaks in veterinary teaching hospitals through a survey conducted by the biosecurity experts (<a href="#Benedict-KM--Morley-PS--Van-Metre-DC--2008-."><span class="Hyperlink">Benedict et al., 2008</span></a>). Many outbreaks of nosocomial salmonellosis have been reported from different large animal hospitals especially among horses (<a href="#Steneroden-KK--Van-Metre-DC--Jackson-C--Morle-PS--2010-."><span class="Hyperlink">Steneroden et al., 2010</span></a>; <a href="#Tillotson-K--Savage-CJ--Salman-MD--Gentry-Weeks-C--Rice-D--Fedorka-Cray-PJ--Traub-Dargatz-JL--1997-"><span class="Hyperlink">Tillotson et al., 1997</span></a>; <a href="#Dallap-Schaer-BL--Aceto-H--Rankin-SC--2010-."><span class="Hyperlink">Dallap et al., 2010</span></a>; <a href="#Schott-HC--Ewart-SL--Walker-RD--Dwyer-RM--Dietrich-S--Eberhart-SW--Derksen-FJ--2001-."><span class="Hyperlink">Schott et al., 20</span></a><span class="Hyperlink">01</span>). In horses <span class="CharOverride-6">Salmonella </span>spp. can cause enterocolitis but the organism also present in the absence of the disease making the horse, a transient, sub-clinical shedders of <span class="CharOverride-6">Salmonella</span> (<a href="#Jones-SL--2008-."><span class="Hyperlink">Jones, 2008</span></a>). Studies have reported 1% to 5% prevalence of the sub-clinical shedding of <span class="CharOverride-6">Salmonella </span>by horses entering veterinary clinics (<a href="#Roberts-MC--O-Boyle-DA--1981-.-T"><span class="Hyperlink">Roberts and O’Boyle, 1981</span></a>). Persistence of <span class="CharOverride-6">Salmonella </span>in the hospital environment has been often reported to be associated with nosocomial outbreaks (<a href="#Steneroden-KK--Van-Metre-DC--Jackson-C--Morle-PS--2010-."><span class="Hyperlink">Steneroden et al., 2010</span></a>; <a href="#Schott-HC--Ewart-SL--Walker-RD--Dwyer-RM--Dietrich-S--Eberhart-SW--Derksen-FJ--2001-."><span class="Hyperlink">Schott et al., 2001</span></a>) and environmental contamination with <span class="CharOverride-6">S. enterica </span>in veterinary hospitals are identified as a hazard related to the nosocomial infections (<a href="#Pandya-M--Wittum-T--Tadesse-DA--Gebreyes-W--Hoet-A--2009"><span class="Hyperlink">Pandya et al., 2009</span></a>; <a href="#Ewart-SL--Schott-HC--Robison-RL--Dwyer-RM--Eberhart-SW-Walker-RD--2001-."><span class="Hyperlink">Ewart et al., 2001</span></a>). In fact, many nosocomial outbreaks recorded in equine veterinary hospitals have been associated with multi drug resistant strains (<a href="#Table-1-"><span class="Hyperlink">Table 1</span></a>).</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Body-Text" lang="en-GB">MDR <span class="CharOverride-6">Salmonella</span> <span class="CharOverride-6">Typhimurium</span> have been reported from companion animals (<a href="#Cherry-B--Burns-A--Johnson-GS--Pfeiffer-H--Dumas-N--Barrett-D--McDonough-PL--Eidson-M--2004-."><span class="Hyperlink">Cherry et al., 2004</span></a>; <a href="#Low-JC--Tennant-B--Munro-D--1996-"><span class="Hyperlink">Low et al., 1996</span></a>; <a href="#Wall-PG--Threllfall-EJ--Ward-LR--Rowe-B--1996-"><span class="Hyperlink">Wall et al., 1996</span></a>). In an outbreak occurred in a small animal hospital of US, two cats, one dog,  3 pet owners and two technicians were affected from a same strain of <span class="CharOverride-6">Salmonella enterica </span>serovar <span class="CharOverride-6">Typhi-</span><span class="Body-Text ParaOverride-1"><span class="CharOverride-6">murium</span> (<a href="#Cherry-B--Burns-A--Johnson-GS--Pfeiffer-H--Dumas-N--Barrett-D--McDonough-PL--Eidson-M--2004-."><span class="Hyperlink">Cherry et al., 2004</span></a>). A report documented multi-drug resistant <span class="CharOverride-6">Salmonella</span> <span class="CharOverride-6">Typhimurium</span> in four veterinary health care centres described that Pet care centres can act as a foci of <span class="CharOverride-6">Salmonella</span> transmission between animals and humans, if necessary precautions are not followed (<a href="#Wright-JG--Tengelsen-LA--Smith-KE--Bender-JB--Frank-RK--Grendon-JH--Angulo-FJ--2005-."><span class="Hyperlink">Wright et al., 2005</span></a>).</span></p>
		  <p class="Body-Text" lang="en-GB">&nbsp;</p>
			<p class="Figure--and-Table-Heading" lang="en-GB"><span class="CharOverride-5"><a id="Table-1-"></a>Table 1: </span>MDR <span class="CharOverride-6">Salmonella </span>strains of nosocomial outbreaks in horses</p>
			<table width="657" height="278" class="Table-Style-1" id="table-1">
				<colgroup>
					<col class="_idGenTableRowColumn-1" />
					<col class="_idGenTableRowColumn-2" />
					<col class="_idGenTableRowColumn-3" />
				</colgroup>
				<tbody>
					<tr class="_idGenTableRowColumn-4">
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB"><span class="CharOverride-5">Serial no.</span></p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB"><span class="CharOverride-5">MDR </span><span class="CharOverride-15">Salmonella</span><span class="CharOverride-5"> strains of nosocomial outbreaks - Horses</span></p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB"><span class="CharOverride-5">References</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-5">
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB">1</p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB"><span class="CharOverride-6">S. Infantis</span></p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB">Tillotson et al., 1997; Dunowska et al., 2007</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-6">
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB">2</p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB"><span class="CharOverride-6">S. Anatum</span></p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-1" lang="en-GB">Hartmann, 1995; Hartmann et al., 1996; Castor et al., 1989</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-5">
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB">3</p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB"><span class="CharOverride-6">S</span><span class="CharOverride-6">. Heidelberg</span></p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB">Amavisit et al., 2001</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-7">
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB">4</p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB"><span class="CharOverride-6">S Agona</span></p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB">Donahue et al., 1986; Castor et al., 1989</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-5">
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB">5</p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB"><span class="CharOverride-6">S Krefeld</span></p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB">Ikeda et al., 1985</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-7">
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB">6</p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB"><span class="CharOverride-6">S Saintpaul</span></p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB">Ikeda et al., 1985; Hird et al., 1986</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-5">
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB">7</p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB"><span class="CharOverride-6">S Newport</span></p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB">Castor et al., 1989; Dallap et al., 2010</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-7">
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB">8</p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB"><span class="CharOverride-6">S. Oranienburg</span></p>
						</td>
						<td>
							<p class="Body-Text ParaOverride-2" lang="en-GB">Kevin et al., 2014</p>
						</td>
					</tr>
				</tbody>
			</table>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-1--Introduction----" lang="en-GB">Others</p>
		  <p class="Heading-1--Introduction----" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">Nosocomial transmission of <span class="CharOverride-6">Cryptosporidium</span> was documented in a veterinary hospital through an outbreak involving multiple species, which originated from an infected dairy calf (<a href="#Konkle-DM--Nelson-KM--Lunn-DP--1997-"><span class="Hyperlink">Konkle et al., 1997</span></a>). Biofilms are group of adherent microorganisms encased in a self-produced extracellular polymeric substance or slime, formed in both biotic and abiotic surfaces. They are often associated with a number of persistent infections that poorly respond to antibiotics (<a href="#Hall-IC--O-Toole-E--1935"><span class="Hyperlink">Hall-Stoodley, 2004</span></a>). Nosocomial spread of <span class="CharOverride-6">Mycobacterium bovis</span> between cats was recorded in a veterinary clinic in Ireland (<a href="#Murray-A--Dineen-A--Kelly-P--McGoey-K--Madigan-G--Nighallchoir-E--Gunn-Moore-DA--2014-."><span class="Hyperlink">Murray et al., 2014</span></a>). In Hospital settings biofilm formation in indwelling medical devices like i.v catheter can harbour numerous potentially infectious pathogens resulting in elevated morbidity, mortality and propagation of antimicrobial resistance. The main pathogen for i.v catheter, urethral catheter and endotracheal tubes are coagulase negative <span class="CharOverride-6">Staphylococci</span>, <span class="CharOverride-6">E. coli</span> and enteric gram negative bacilli respectively. The other common pathogens forming biofilms are <span class="CharOverride-6">S. aureus</span>, <span class="CharOverride-6">K. pneumonia, P. mirabilis, E. faecalis, P. aeruginosa, Streptococcus </span>spp,<span class="CharOverride-6"> Candida </span>spp (<a href="#Lynch-AS--Robertson-GT--2008-"><span class="Hyperlink">Lynch and Robertson, 2008</span></a>). The nosocomial outbreak of canine parainfluenza infection was recorded in a veterinary referral hospital among dogs (<a href="#Weese-JS--Stull-J--2013-"><span class="Hyperlink">Weese and Stull, 2013</span></a>).</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-2--History-in-MM-" lang="en-GB">Surveillance in veterinary hospitals</p>
		  <p class="Heading-2--History-in-MM-" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">Even though loads of recommendations for prevention and control of nosocomial infection is available out of the lesson learnt from previous experiences (<a href="#Hartmann-FA--Callan-RJ--McGuirk-SM--West-SE--1996-."><span class="Hyperlink">Hartmann et al</span><span class="Hyperlink CharOverride-6">.</span><span class="Hyperlink">, 1996</span></a>; <a href="#Schott-HC--Ewart-SL--Walker-RD--Dwyer-RM--Dietrich-S--Eberhart-SW--Derksen-FJ--2001-."><span class="Hyperlink">Schott et al</span><span class="Hyperlink CharOverride-6">., </span><span class="Hyperlink">2001</span></a>; <a href="#Wright-JG--Tengelsen-LA--Smith-KE--Bender-JB--Frank-RK--Grendon-JH--Angulo-FJ--2005-."><span class="Hyperlink">Wright et al., 2005</span></a>; <a href="#Dallap-Schaer-BL--Aceto-H--Rankin-SC--2010-."><span class="Hyperlink">Dallap et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">2010</span></a>; <a href="#Goehring-LS--Landolt-GS--Morley-PS--2010-."><span class="Hyperlink">Goehring et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">2010</span></a>; <a href="#Steneroden-KK--Van-Metre-DC--Jackson-C--Morle-PS--2010-."><span class="Hyperlink">Steneroden et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">2010</span></a>). Presently there is no recognized or  published principles or standards for surveillance and control of infection in veterinary hospitals, which makes the system weak to determine rates and fraction of nosocomial and preventable infections respectively (<a href="#Morley-PS--2002"><span class="Hyperlink">Morley, 2002</span></a>, <a href="#Morley-PS--2004-."><span class="Hyperlink">2004</span></a>; <a href="#Benedict-KM--Morley-PS--Van-Metre-DC--2008-."><span class="Hyperlink">Benedict et al., 2008</span></a>; <a href="#Morley-PS--Weese-JS--2008-."><span class="Hyperlink">Morley and Weese, 2008</span></a>).</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">The surveillance is broadly classified into Hospital wide surveillance and Targeted surveillance. The Hospital wide surveillance are very expensive, time consuming, laborious and tend to detect more infections which cannot be prevented (<a href="#Pottinger--JM--Herwaldt-LA--Perl-TM--1997-."><span class="Hyperlink">Pottinger et al., 1997</span></a>).<span class="CharOverride-5"> </span>A study conducted for understanding the trends in nosocomial infections in University of Virginia Hospital for the period of eight years revealed that nosocomial infection rates are 4 times greater in intensive care units than in general wards (<a href="#Landry-SL--Donowitz-LG--Wenzel-RP--1982-."><span class="Hyperlink">Landry et al., 1982</span></a>)<span class="CharOverride-6">,</span> and during the study period there were seven infectious disease outbreaks and interestingly all the seven were in critical care units. One more study conducted on the same hospital exposed that the competence of surveillance systems for spotting nosocomial infection was maximum when it is focused in intensive care units rather than hospital wide surveillance (<a href="#Wenzel-RP--Osterman-CA--Donowitz-LG--Hoyt-JW--Sande-MA--Martone-WJ--Miller-GB--1981-"><span class="Hyperlink">Wenzel</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 1981</span></a>). An additional study performed in German hospital exclusively in an intensive care unit revealed that only a minimum difference in the sensitivity and specificity when there is a targeted approach when compared to entire hospital wide surveillance (<a href="#Dettenkofer-M--Ebner-W--Els-T--Babikir-R--L-cking-C--Pelz-K--Daschner-F--2001-.-S"><span class="Hyperlink">Dettenkofer et al., 2001</span></a>). By another study researcher found that narrowing the population under surveillance, like targeting the hospitalized patients with increased risk of developing nosocomial infections may increase the sensitivity and reduce the labour, money and time consumption (<a href="#Brusaferro-S--Regattin-L--Faruzzo-A--Grasso-A--Basile-M--Calligaris-L--Scudeller-L--Viale-P--2006-."><span class="Hyperlink">Brusaferro et al., 2006</span></a>).<span class="CharOverride-5"> </span>Targeted surveillance is efficient and less time, money and labour consuming than hospital wide surveillance which requires more cost and effort for data collection (<a href="#Morley-PS--2004-."><span class="Hyperlink">Morley, 2004</span></a>).<span class="CharOverride-5"> </span>The only drawback of this approach is missing out of nosocomial infections in general ward and other area patients.</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-2--History-in-MM-" lang="en-GB">Different methods of Targeted surveillance</p>
			<p class="Heading-2--History-in-MM-" lang="en-GB">&nbsp;</p>
			<ul>
			  <li class="Body-Text ParaOverride-3" lang="en-GB">Device associated infection surveillance</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Specific etiological agent surveillance</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Syndromie based  surveillance </li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Environmental based surveillance</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Laboratory based surveillance</li>
			</ul>
			<p class="Heading-2--History-in-MM-" lang="en-GB">&nbsp;</p>
			<p class="Heading-2--History-in-MM-" lang="en-GB">Device associated infection surveillance</p>
		  <p class="Heading-2--History-in-MM-" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">Most of the device associated infections that had been published are restricted to dogs with urinary catheter (<a href="#Wise-LA--Jones-RL--Reif-JS--1990-."><span class="Hyperlink">Wise et al., 1990</span></a>). A prospective study done with 18 male cats to evaluate the incidence of catheter-associated urinary tract infections by collecting urine samples three times, i.e. straight away after catheterization, 24 hours after and before removal. The bacterial culture of the urine samples detected that six cats (33.3%) developed bacteriuria, 5 cats with <span class="Emphasis">Escherichia coli, Staphylococcus</span><span class="apple-converted-space CharOverride-17">&#160;</span>species, one cat with <span class="Emphasis">Streptococcus bovis</span><span class="apple-converted-space CharOverride-17"> and one more cat developed </span>fungal infection (<a href="#Hugonnard-M--Chalvet-Monfray-K--Dernis-J--Pouzot-Nevoret-C--Barth-l-my-A--Vialard-J--Goy-Thollot-I--"><span class="Hyperlink">Hugonnard et al., 2013</span></a>). A prospective study conducted by <a href="#Smarick-SD--Haskins-SC.--Aldrich-J--Foley-JE--Kass-PH--Fudge-M--Ling-GV--2004-."><span class="Hyperlink">Smarick</span></a> and others in <a href="#Smarick-SD--Haskins-SC.--Aldrich-J--Foley-JE--Kass-PH--Fudge-M--Ling-GV--2004-."><span class="Hyperlink">2004</span></a> reported 10.3% of healthy catheterized dogs of both sex developed urinary tract infection. Furthermore this study revealed that female dogs are more susceptible to develop the urinary tract infection (<a href="#Smarick-SD--Haskins-SC.--Aldrich-J--Foley-JE--Kass-PH--Fudge-M--Ling-GV--2004-."><span class="Hyperlink">Smarick et al., 2004</span></a>).<span class="CharOverride-5"> </span>A randomized clinical trial was performed with dogs underwent intervertebral disk correction surgery. Based on sex, the dogs were stratified and assigned randomly with three different urinary bladder managing methods, <span class="CharOverride-6">viz.</span> manual expulsion, intermittent catheterization or catheter insitu. The proportion of urinary tract infection was higher in dogs with indwelling catheter and 32% showed noticeable growth of minimum one bacterial species (<a href="#Bubenik-L--Hosgood-G--2008-."><span class="Hyperlink">Bubenik and Hosgood, 2008</span></a>). The other device always associated with nosocomial infection in animal is intravenous catheter (<a href="#Marsh-Ng-ML--Burney-DP--Garcia-J--2007-."><span class="Hyperlink">Marsh-Ng et al., 2007</span></a>) and it is due to the contamination of the catheter (<a href="#Johnson-JA--2002"><span class="Hyperlink">Johnson, 2002</span></a>). Number of studies have been conducted to estimate the prevalence of contamination of intravenous catheter in veterinary hospitals.<span class="CharOverride-5"> </span>In a study conducted for one year period at intensive care unit Ontario Veterinary College, they collected all the intravenous catheters from dogs and cats and cultured and found out the bacterial contamination rate of 10.7% (<a href="#Mathews-KA--Brooks-MJ--Valliant-AE--1996-."><span class="Hyperlink">Mathews et al., 1996</span></a>). With another study the bacterial contamination rate of intravenous catheter from 100 dogs was found out to be 22% and the bacteria isolated were often found to be of gastrointestinal and environmental origin (<a href="#Lobetti-RG--Joubert-KE--Picard-J--Carstens-J--Pretorius-E--2002-."><span class="Hyperlink">Lobetti et al., 2002</span></a>). Other studies reported 24.5% (<a href="#Marsh-Ng-ML--Burney-DP--Garcia-J--2007-."><span class="Hyperlink">Marsh-Ng et al., 2007</span></a>) and 23.2% (<a href="#Jones-ID--Case-AM--Stevens-KB--Boag-A--Rycroft-AN--2009"><span class="Hyperlink">Jones et al., 2009</span></a>) of bacterial contamination rates due to intravenous catheters in dogs and cats.</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-2--History-in-MM-" lang="en-GB">Specific etiological agent surveillance</p>
			<p class="Heading-2--History-in-MM-" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">Some hospitals are performing surveillance based on specific etiological agents which are associated with nosocomial infections. In 2008, <a href="#Benedict-KM--Morley-PS--Van-Metre-DC--2008-."><span class="Hyperlink">Benedict et al. (2008)</span></a><span class="CharOverride-6"> </span>conducted a study in US veterinary teaching hospitals and reported that 53% of hospitals are collecting samples for detecting the specific pathogen and it is their one of the element of infection control practices. One of the specific contagious pathogen often encountered in veterinary nosocomial outbreaks and also incorporated in hospital surveillance is <span class="CharOverride-6">Salmonella </span>(<a href="#Schott-HC--Ewart-SL--Walker-RD--Dwyer-RM--Dietrich-S--Eberhart-SW--Derksen-FJ--2001-."><span class="Hyperlink">Schott et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">2001</span></a>; <a href="#Cherry-B--Burns-A--Johnson-GS--Pfeiffer-H--Dumas-N--Barrett-D--McDonough-PL--Eidson-M--2004-."><span class="Hyperlink">Cherry et al., 2004</span></a>; <a href="#Benedict-KM--Morley-PS--Van-Metre-DC--2008-."><span class="Hyperlink">Benedict et al., 2008</span></a>; <a href="#Steneroden-KK--Van-Metre-DC--Jackson-C--Morle-PS--2010-."><span class="Hyperlink">Steneroden et al., 2010</span></a>). Patient who are under greater risk of shedding <span class="CharOverride-6">Salmonella</span> are included in the surveillance (<a href="#Morley-PS--2002"><span class="Hyperlink">Morley, 2002</span></a>, <a href="#Morley-PS--2004-."><span class="Hyperlink">2004</span></a>; <a href="#Morley-PS--Weese-JS--2008-."><span class="Hyperlink">Morley and Weese, 2008</span></a>; <a href="#Ekiri-AB--Morton-AJ--Long-MT--MacKay-RJ--Hernandez-JA--2010-."><span class="Hyperlink">Ekiri et al., 2010</span></a>). The sampling plan includes faecal sampling at the time of admittance and then at regular intervals during the hospital stay (<a href="#Morley-PS--2002"><span class="Hyperlink">Morley, 2002</span></a>; <a href="#Ekiri-AB--Morton-AJ--Long-MT--MacKay-RJ--Hernandez-JA--2010-."><span class="Hyperlink">Ekiri et al., 2010</span></a>). If <span class="CharOverride-6">Salmonella</span> was not present at the time of admittance and detected during subsequent sampling, which of similar serotype and antibiogram pattern as other isolates in the patients, then the Salmonellosis is considered to be of nosocomial origin (<a href="#Ekiri-AB--Morton-AJ--Long-MT--MacKay-RJ--Hernandez-JA--2010-."><span class="Hyperlink">Ekiri et al., 2010</span></a>). A study conducted for<span class="CharOverride-6"> Salmonella </span>surveillance in 246 hospitalized colic horses reported positive result in 9% of the faecal sample (<a href="#Kim-LM--Morley-PS--Traub-Dargatz-JL--Salman-MD--Gentry-Weeks-C--2001-"><span class="Hyperlink">Kim et al., 2001</span></a>). In Human medicine one of the most significant nosocomial pathogen is Methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus </span>(MRSA) and in all probability it is one of the emerging multiple drug resistant bacteria in veterinary health settings (<a href="#Beard-LA--2010-.-M"><span class="Hyperlink">Beard, 2010</span></a>). In a survey conducted in seven teaching veterinary hospitals in the United States regarding the <span class="CharOverride-6">S.aureus </span>isolated from hospitalized patients revealed that 14% of animals were infected with Methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus </span>and the highest prevalence was estimated in horses and dogs (<a href="#Middleton-JR--Fales-WH--Luby-CD--Oaks-JL--Sanchez-S--Kinyon-JM--Hartmann-F--2005"><span class="Hyperlink">Middleton et al., 2005</span></a>). In an attempt to determine the prevalence rate of MRSA, an emerging equine pathogen, a screening program was organized, in which nasal swab was collected from all horses during admission, hospitalization and discharge. MRSA was isolated from 5.3% of horses and the incidence rate of overall nosocomial MRSA was found to be 23/1000 admissions (<a href="#Weese-JS--Rousseau-J--Willey-BM--Archambault-M--McGeer-A--Low-DE--2006b"><span class="Hyperlink">Weese et al., 2006b</span></a>). A study conducted in a small animal hospital revealed MRSA prevalence of 9% in dogs (<a href="#Loeffler-A--Boag-AK--Sung-J--Lindsay-JA--Guardabassi-L--Dalsgaard-A--Lloyd-DH--2005-"><span class="Hyperlink">Loeffler et al., 2005</span></a>). Various studies have also documented clear rise in the MRSA infections on surgical sites of companion animals (<a href="#Boag-A--Loeffler-A--Lloyd-DH--2004-.-M"><span class="Hyperlink">Boag et al., 2004</span></a>; <a href="#O-Mahony-R--Abbott-Y--Leonard-FC--Markey-BK--Quinn-PJ--Pollock-PJ--Rossney-AS--2005-."><span class="Hyperlink">O’Mahony et al., 2005</span></a>). A retrospective study with the faecal culture data conducted in a teaching veterinary hospital following an outbreak of salmonellosis with high percentage of cases within 24 hours of admission revealed the etiological agent was <span class="CharOverride-6">Salmonella enterica</span><span class="apple-converted-space CharOverride-17">&#160;</span>serovar Oranienburg. Severe scrutiny of their medical records exposed the concealed epidemiological association to the veterinary hospital following the index case (<a href="#Cummings-KJ--Rodriguez-Rivera-LD--Katharyn-JM--Karin-H--Martin...-2014"><span class="Hyperlink">Cummings</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 2014</span></a>).</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-2--History-in-MM-" lang="en-GB">Syndrome based surveillance </p>
		  <p class="Heading-2--History-in-MM-" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">Syndrome based surveillance means detecting simple adverse conditions (pyrexia of unknown origin) in hospitalized patients or distinct signs and symptoms of any infection (<a href="#Mostashari-F--Hartman-J--2003-."><span class="Hyperlink">Mostashari and Hartman, 2003</span></a>). This system can be used based on the monitoring of clinical datas (flu-like symptoms) and nonclinical datas (sale of over-the-counter drugs or school absenteeism) (<a href="#Lombardo-J--Burkom-H--Elbert-E--Magruder-S--Lewis-SH--Loschen-W--Pavlin-J--2003"><span class="Hyperlink">Lombardo et al., 2003</span></a>; <a href="#Mostashari-F--Hartman-J--2003-."><span class="Hyperlink">Mostashari and Hartman, 2003</span></a>). On an added advantage, to make an evidence-based veterinary practices, the Syndromic surveillance in veterinary hospitals can be used concurrently to collect information about prevalene, incidence and various risk factors prevailing in the animal population (<a href="#Stone-AB--Hautala-JA--2008-"><span class="Hyperlink">Stone and Hautala, 2008</span></a>). Various studies has been conducted with syndromic surveillance in veterinary hospitals (<a href="#Nicholson-M--Beal-M--Shofer-F--Brown-DC--2002-"><span class="Hyperlink">Nicholson et al., 2002</span></a>; <a href="#Eugster-S--Schawalder-P--Gaschen-F--Boerlin-P--2004-."><span class="Hyperlink">Eugster et al., 2004</span></a>; <a href="#Ahern-BJ--Richardson-DW--Boston-RC--Schaer-TP--2010-"><span class="Hyperlink">Ahern et al., 2010</span></a>; <a href="#Ruple-Czerniak-AA--Aceto-HW--Bender-JB--Paradis-...-2014"><span class="Hyperlink">Ruple-Czerniak et al., 2014</span></a>). A syndromic surveillance for evaluating the occurrence of healthcare-associated infections in Critical Care Units of Small Animal Referral Hospitals reported that 16.3% of dogs and 12% of cats had ≥1 nosocomial syndrome during hospitalization (<a href="#Ruple-Czerniak-A--Aceto-HW--Bender-JB--Paradis...2013"><span class="Hyperlink">Ruple-Czerniak et al., 2013</span></a>). Another Syndromic surveillance used to estimate the rate of nosocomial infections in   equine hospitals reported that  19.7% of the study population had at least one nosocomial event during hospital stay and the most commonly observed nosocomial syndromes were surgical site inflammation and intra-venous catheter site inflammation (<a href="#Ruple-Czerniak-AA--Aceto-HW--Bender-JB--Paradis-...-2014"><span class="Hyperlink">Ruple-Czerniak et al., 2014</span></a>). Though the specificity of this system is low in outbreak surveillance, the sensitivity is high by guaranteeing the pertinent markers of disease (<a href="#Van-Metre-DC--Barkey-DQ--Salman-MD--Morley-PS--2009"><span class="Hyperlink">Van Metre et al., 2009</span></a>). Some of the relevant markers used in the surveillance are:</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><span class="CharOverride-5">Acute respiratory tract disorders:</span> evidence of coughing, abnormal lung sounds, dyspnoea or tachypnea, sneezing, nasal discharges. </p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><span class="CharOverride-5">Acute infectious gastrointestinal disorders:</span> diarrhoea, vomiting, abdominal pain or discomfort.</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><span class="CharOverride-5">Pyrexia of unknown origin:</span> temperature more than 102.0ºF in horses or more than 102.5ºF in dogs and cats. </p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><span class="CharOverride-5">Septicemia:</span> clinical or microbiological confirmation of septicemia</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB"><span class="CharOverride-5">Surgical wound analysis:</span> inflammation, infection or discharges.</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-2--History-in-MM-" lang="en-GB">Environmental based surveillance</p>
			<p class="Heading-2--History-in-MM-" lang="en-GB">&nbsp;</p>
			<p class="Body-Text" lang="en-GB">In Environment based surveillance the hospital should submit the hospital environment sample for routine culture. Many studies has been published stating that hospital equipment and fomites harbouring potential nosocomial infectious agents and act as a reservoir such as sponge pots with benzalkonium chloride (<a href="#Fox-JG--Beaucage-CM--Folta-CA--Thornton-GW--1981-"><span class="Hyperlink">Fox et al., 1981</span></a>), stethoscopes (<a href="#Fujita-H--Hansen-B--Hanel-R--2013-."><span class="Hyperlink">Fujita et al., 2013</span></a>), thermometers (<a href="#Van-den-Berg-RWA--Claahsen-HL--Niessen-M--Muytjens-HL--Liem-K--Voss-A--2000"><span class="Hyperlink">Van den Berg et al., 2000</span></a>; <a href="#Weese-JS--Staempfli-HR--Prescott-JF--2000"><span class="Hyperlink">Weese et al., 2000</span></a>), Faucet handles and computer keyboards (<a href="#Bures-S--Fishbain-JT--Uyehara-CFT--Parker-JM--Berg-BW--2000-."><span class="Hyperlink">Bures et al., 2000</span></a>), endoscopes (<a href="#Schelenz-S--French-G--2000-"><span class="Hyperlink">Schelenz and French, 2000</span></a>; <a href="#Cowen-AE--2001-"><span class="Hyperlink">Cowen, 2001</span></a>), multiple-dose vials (<a href="#Sabino-CV--Weese-JS--2006-"><span class="Hyperlink">Sabino and Weese, 2006</span></a>), Cellular phones (<a href="#Brady-RR--Fraser-SF--Dunlop-MG--Brown-SP--Gibb-AP--2007-."><span class="Hyperlink">Brady et al., 2007</span></a>; <a href="#Julian-T--Singh-A--Rousseau-J--Weese-JS--2012-."><span class="Hyperlink">Julian et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">2012</span></a>), white coats and surgical scrubs (<a href="#Singh-A--Walker-M--Rousseau-J--Monteith-GJ--Weese-JS--2013-"><span class="Hyperlink">Singh et al., 2013</span></a>). Examination tables, floors and doors (<a href="#Van-den-Berg-RWA--Claahsen-HL--Niessen-M--Muytjens-HL--Liem-K--Voss-A--2000"><span class="Hyperlink">van Balen et al., 2013</span></a>). In <a href="#Burgess-BA--Morley-PS--Hyatt-DR--2004-."><span class="Hyperlink">2004, Burgess et al.,</span></a> reported that the nosocomial infectious agents are often encountered in the environment whenever the nosocomial rates are increased (<a href="#Burgess-BA--Morley-PS--Hyatt-DR--2004-."><span class="Hyperlink">Burgess et al., 2004</span></a>). And it has been reported that contamination of veter<span class="Body-Text ParaOverride-1">inary hospital environment was responsible for many nosocomial infection outbreaks (<a href="#Castor-ML--Wooley-RE--Shotts-EB--Brown-J--Payeur-JB--1989-."><span class="Hyperlink">Castor et al., 1989</span></a>; <a href="#Hartmann-FA--Callan-RJ--McGuirk-SM--West-SE--1996-."><span class="Hyperlink">Hartmann et al., 1996</span></a>; <a href="#Tillotson-K--Savage-CJ--Salman-MD--Gentry-Weeks-C--Rice-D--Fedorka-Cray-PJ--Traub-Dargatz-JL--1997-"><span class="Hyperlink">Tillotson et al., 1997</span></a>; <a href="#Schott-HC--Ewart-SL--Walker-RD--Dwyer-RM--Dietrich-S--Eberhart-SW--Derksen-FJ--2001-."><span class="Hyperlink">Schott et al., 2001</span></a>; <a href="#Weese-JS-Armstrong-J--2003-"><span class="Hyperlink">Weese and Armstrong, 2003</span></a>; <a href="#Wright-JG--Tengelsen-LA--Smith-KE--Bender-JB--Frank-RK--Grendon-JH--Angulo-FJ--2005-."><span class="Hyperlink">Wright et al., 2005</span></a>; <a href="#Dallap-Schaer-BL--Aceto-H--Rankin-SC--2010-."><span class="Hyperlink">Dallap et al., 2010</span></a>; <a href="#Steneroden-KK--Van-Metre-DC--Jackson-C--Morle-PS--2010-."><span class="Hyperlink">Steneroden et al., 2010</span></a>).  The percentage recovery of nosocomial agents in environmental survey of hospitals is depicted in <a href="#Table-2--P"><span class="Hyperlink">table 2</span></a>.</span></p>
		  <p class="Body-Text" lang="en-GB">&nbsp;</p>
			<p class="Figure--and-Table-Heading" lang="en-GB"><span class="CharOverride-5"><a id="Table-2--P"></a>Table 2: </span>Percentage recovery of nosocomial agents in environmental survey of hospitals</p>
			<table width="557" height="180" class="Table-Style-1" id="table-2">
				<colgroup>
					<col class="_idGenTableRowColumn-8" />
					<col class="_idGenTableRowColumn-9" />
					<col class="_idGenTableRowColumn-10" />
					<col class="_idGenTableRowColumn-11" />
				</colgroup>
				<tbody>
					<tr class="_idGenTableRowColumn-12">
						<td class="CellOverride-1">
							<p class="Default ParaOverride-1"><span class="CharOverride-18" lang="en-GB">S.no</span></p>
						</td>
						<td class="CellOverride-1">
							<p class="Default ParaOverride-1"><span class="CharOverride-18" lang="en-GB">Nosocomial agent</span></p>
						</td>
						<td class="CellOverride-1">
							<p class="Default"><span class="CharOverride-18" lang="en-GB">Percentage  recovery in environmental survey of hospitals</span></p>
						</td>
						<td class="CellOverride-1">
							<p class="Default ParaOverride-1"><span class="CharOverride-18" lang="en-GB">Reference</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-13">
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">1</span></p>
						</td>
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-19" lang="en-GB">Salmonella </span><span class="CharOverride-17" lang="en-GB">spp</span></p>
						</td>
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">2.1%</span></p>
						</td>
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">(Alinovi et al., 2003)</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-14">
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">2</span></p>
						</td>
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-19" lang="en-GB">Salmonella </span><span class="CharOverride-17" lang="en-GB">spp</span></p>
						</td>
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">11.9%</span></p>
						</td>
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">(Burgess et al., 2004)</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-13">
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">3</span></p>
						</td>
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-19" lang="en-GB">Clostridium difficile</span></p>
						</td>
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">6.3%</span></p>
						</td>
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">(Weese et al., 2000)</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-14">
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">4</span></p>
						</td>
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">MRSA</span></p>
						</td>
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">9.6%</span></p>
						</td>
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">(Weese et al., 2004)</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-15">
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">5</span></p>
						</td>
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-19" lang="en-GB">Staphylococci</span><span class="CharOverride-17" lang="en-GB"> count</span></p>
						</td>
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">55.9% of sample contain ≥2.5 cfu/cm2</span></p>
						</td>
						<td class="CellOverride-2">
							<p class="Default ParaOverride-1"><span class="CharOverride-17" lang="en-GB">(Aksoy et al., 2010).</span></p>
						</td>
					</tr>
				</tbody>
			</table>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-2--History-in-MM-" lang="en-GB">Laboratory based surveillance</p>
		  <p class="Heading-2--History-in-MM-" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">The Surveillance system used in human health care centres includes laboratory diagnosis (<a href="#Emori-TG--Gaynes-RP--1993"><span class="Hyperlink">Emori and Gaynes, 1993</span></a>; <a href="#Brossette-SE--Hacek-DM--Gavin-PJ--Kamdar-MA--Gadbois-KD--Fisher-AG--Peterson-LR--2006-"><span class="Hyperlink">Brossette et al., 2006</span></a>). Many researchers in veterinary nosocomial infections also included laboratory diagnosis for confirmation (<a href="#Biertuempfel--P.-H.--Ling--G.-V.--and-Ling--G.-A.--1981-."><span class="Hyperlink">Biertuempfel et al., 1981</span></a>; <a href="#Mathews-KA--Brooks-MJ--Valliant-AE--1996-."><span class="Hyperlink">Mathews et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">1996</span></a>; <a href="#Lobetti-RG--Joubert-KE--Picard-J--Carstens-J--Pretorius-E--2002-."><span class="Hyperlink">Lobetti</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 2002</span></a>; <a href="#Smarick-SD--Haskins-SC.--Aldrich-J--Foley-JE--Kass-PH--Fudge-M--Ling-GV--2004-."><span class="Hyperlink">Smarick et al., 2004</span></a>; <a href="#Marsh-Ng-ML--Burney-DP--Garcia-J--2007-."><span class="Hyperlink">Marsh-Ng et al., 2007</span></a>; <a href="#Bubenik-L--Hosgood-G--2008-."><span class="Hyperlink">Bubenik and Hosgood, 2008</span></a>; <a href="#Jones-ID--Case-AM--Stevens-KB--Boag-A--Rycroft-AN--2009"><span class="Hyperlink">Jones et al., 2009</span></a>) and some researchers have not included laboratory confirmation (<a href="#Johnson-JA--2002"><span class="Hyperlink">Nicholson, 2002</span></a>; <a href="#Eugster-S--Schawalder-P--Gaschen-F--Boerlin-P--2004-."><span class="Hyperlink">Eugster et al., 2004</span></a>; <a href="#Ahern-BJ--Richardson-DW--Boston-RC--Schaer-TP--2010-"><span class="Hyperlink">Ahern et al., 2010</span></a>). Committing laboratory confirmation is not cost effective and also more time consuming which prevents immediate action during outbreaks. In other way laboratory diagnosis can be used as a passive surveillance in regular basis. Passive surveillance means collecting data for other purposes, like samples which are regularly collected from patients can be tested for nosocomial infectious agents and Active surveillance means data collection for the specific purpose, and these are the types based on data collection (<a href="#Morley-PS--2004-."><span class="Hyperlink">Morley, 2004</span></a>). But the sensitivity of active surveillance is greater than the passive surveillance (<a href="#Brachman-PS--1993-."><span class="Hyperlink">Brachman, 1993</span></a>). </p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-2--History-in-MM-" lang="en-GB">Methods in Data Collection and Comparsion</p>
		  <p class="Heading-2--History-in-MM-" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">The data collection may be either Prospective or Retrospective. Data collection by monitoring the patient during hospitalization is Prospective and data collection by reviewing the hospital records after the patient has been discharged is Retrospective (<a href="#Abrutyn-E--Talbot--GH--1987-."><span class="Hyperlink">Abrutyn and Talbot, 1987</span></a>). Eventhough the Prospective data collection is gold standard there is a possibility of missing out of nosocomial infections after the patient is discharged (<a href="#Freeman-J--McGowan-JE--1981-."><span class="Hyperlink">Freeman and McGowan, 1981</span></a>) however it is wise to follow prospective surveillance during outbreaks of nosocomial infections (<a href="#Wenzel-RP--Osterman-CA--Hunting-KJ--Gwaltney-JM--1976-."><span class="Hyperlink">Wenzel</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 1976</span></a>). But retrospective method is used in hospital readmissions for infections (<a href="#Pottinger--JM--Herwaldt-LA--Perl-TM--1997-."><span class="Hyperlink">Pottinger et al., 1997</span></a>). Lot of studies has been conducted to illustrate the magnitude of nosocomial infections occurring after discharge from hospitals especially post-surgical infections (<a href="#Brown-RB--Bradley-S--Opitz-E--Cipriani-D--Pieczarka-R--Sands-M--1987-."><span class="Hyperlink">Brown et al.,</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">1987</span></a>; <a href="#Delgado-Rodriguez-M--G-mez-Ortega-A--Sillero-Arenas-M--Llorca-J--2001-."><span class="Hyperlink">Delgado-Rodriguez et al., 2001</span></a>; <a href="#Eugster-S--Schawalder-P--Gaschen-F--Boerlin-P--2004-."><span class="Hyperlink">Eugster et al., 2004</span></a>). There are two methods in prospective data collection i.e patient-based collection methods by nurse or physician while attending the patient (<a href="#Abrutyn-E--Talbot--GH--1987-."><span class="Hyperlink">Abrutyn and Talbot, 1987</span></a>; <a href="#Pottinger--JM--Herwaldt-LA--Perl-TM--1997-."><span class="Hyperlink">Pottinger et al., 1997</span></a>) and diagnostic laboratory-based data collection which is time consuming, lacking in clinical data and with more false positive and false nagatives (<a href="#Abrutyn-E--Talbot--GH--1987-."><span class="Hyperlink">Abrutyn and Talbot, 1987</span></a>).</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">Inter-hospital comparison of data of nosocomial infections will facilitate the effective surveillance and for this nosocomial infection rates should be determined in each hospital (<a href="#Gaynes-RP--1997-."><span class="Hyperlink">Gaynes, 1997</span></a>). But the crude rates cannot be compared since it varies with the patient number, hospital size, facilities, case load, underlying illness and severity of disease (<a href="#Pottinger--JM--Herwaldt-LA--Perl-TM--1997-."><span class="Hyperlink">Pottinger et al., 1997</span></a>; <a href="#Sax-H--Pittet-D--and-the-Swiss-NOSO-network--2002-"><span class="Hyperlink">Sax et al., 2002</span></a>). For effective comparison it must be standardized like, which risk factors should be taken into account like length of hospital stay, exposure to invasive devices and intrinsic factors of patient (<a href="#Pottinger--JM--Herwaldt-LA--Perl-TM--1997-."><span class="Hyperlink">Pottinger et al., 1997</span></a>).</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-1--Introduction----" lang="en-GB">Prevention and control of Nosocomial Infections: Best to be proactive rather than reactive</p>
		  <p class="Heading-1--Introduction----" lang="en-GB">&nbsp;</p>
			
			  <li class="Body-Text ParaOverride-3" lang="en-GB">Hand hygiene is the easiest, cost effective and most underused measure (<a href="#Sax-H--Uckay-I--Richet-H--Allegranzi-B--Pittet-D--2007-."><span class="Hyperlink">Sax et al., 2007</span></a>). Hand washing with plain soaps failed to remove pathogens (<a href="#Ehrenkranz-NJ--Alfonso-BC--1991-.-F"><span class="Hyperlink">Ehrenkranz et al., 1991</span></a>) and also there are ironical reports stating that hand washing with plain soaps increases the bacterial counts on the skin (<a href="#Larson-EL--Leyden-JJ--McGinley-KJ--Grove-GL--Talbot-GH--1986"><span class="Hyperlink">Larson et al., 1986</span></a>; <a href="#Winnefeld-M--Richard-MA--Drancourt-M--Grubb-JJ--2000-."><span class="Hyperlink">Winnefeld et al., 2000</span></a>). Proper hand hygiene (<a href="#Sax-H--Uckay-I--Richet-H--Allegranzi-B--Pittet-D--2007-."><span class="Hyperlink">Sax et al., 2007</span></a>) and 70% alcohol gel based hand sanitizers should be placed throughout the hospitals (<a href="#Kampf-G--Rudolf-M--Labadie-JC--Barrett-SP--2002-."><span class="Hyperlink">Kampf et al., 2002</span></a>; <a href="#Leonard-FC--Markey-BK--2008-."><span class="Hyperlink">Leonard et al., 2008</span></a>). The alcohol based hand sanitizers have increased antimicrobial activity and reduces the cross contamination from taps and paper towel dispensers (<a href="#Harrison-WA--Grifith-CJ--Ayers-T--Michaels-B--2003-"><span class="Hyperlink">Harrison et al., 2003</span></a>). Hand washing should be done– i) before and after contact with a patient, ii) before and after contact with objects in the animals environment, iii) after contact with potentially infective biological specimen or discharges and iv) before and after wearing gloves is necessary (<a href="#CCAR.-Infection-preven"><span class="Hyperlink">CCAR, 2008</span></a>).</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Preliminary screening of all patients for signs of contagious disease before admission to the hospital and separate isolation facility for the contagious disease infected animals (<a href="#Traub-Dargatz-JL--Dargatz-DA--Morley-PS--Dunowska-M--2004"><span class="Hyperlink">Traub-Dargatz et al., 2004</span></a>).</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">If environmental contamination is suspected, regular monitoring and intervention is required with periodic spot checks of environment (<a href="#Traub-Dargatz-JL--Dargatz-DA--Morley-PS--Dunowska-M--2004"><span class="Hyperlink">Traub-Dargatz et al., 2004</span></a>).</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Veterinary health care personnel should take necessary occupational health measures like personal protective equipment, vaccination while handling infected materials like discharges, blood and sharps (<a href="#Mielke-M--2010-"><span class="Hyperlink">Mielke, 2010</span></a>).</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">The outerwear should be changed frequently since gross contamination does not need for pathogen to be present and attached laundry services may be provided.</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Cover skin lesions and open wounds. Strict asepsis in surgery with autoclaved surgical instruments and thoroughly cleaned endotracheal tubes (<a href="#CCAR.-Infection-preven"><span class="Hyperlink">CCAR, 2008</span></a>).</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Removal of implants and appropriate antibiotic treatment based on antibiogram (<a href="#Leonard-FC--Abbott-Y--Rossney-A--Quinn-PJ--O-Mahony-R--Markey-BK--2006-."><span class="Hyperlink">Leonard et al., 2006</span></a>).</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Animals with suspected clinical signs of any infectious diseases should not be admitted for any elective procedures (<a href="#CCAR.-Infection-preven"><span class="Hyperlink">CCAR, 2008</span></a>).</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Animals belonging to hospital workers should be screened (<a href="#Leonard-FC--Markey-BK--2008-."><span class="Hyperlink">Leonard et al., 2008</span></a>)</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Animals with multi-drug resistant infections should be handled with great precautions since the body sites like nose, rectum could be colonized with those pathogens (<a href="#CCAR.-Infection-preven"><span class="Hyperlink">CCAR, 2008</span></a>).</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Ensure appropriate handling of sterile medical devices particularly indwelling devices like urinary catheter and drugs for parental administration. Invasive procedures should only be performed if mandatory.</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Regular collection of Laboratory samples as a part of comprehensive monitoring programme. For example, Faeces can be collected for culture to detect salmonella from all the animals admitted for colic. If a particular nosocomial agent has been a problem in the past, there should be a readymade programmed action plan (<a href="#Traub-Dargatz-JL--Dargatz-DA--Morley-PS--Dunowska-M--2004"><span class="Hyperlink">Traub-Dargatz et al, 2004</span></a>).</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Special precautions on re-dispensation of medical products by proper disinfection and sterilization and disinfection of hand touch surfaces. Touching clean items like telephone or microscope while handling potential infectious material like swabs should be avoided.</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Ensure healthy patient environment and waste disposal (<a href="#Mielke-M--2010-"><span class="Hyperlink">Mielke, 2010</span></a>).</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Monitoring of antibiotic drugs consumption and development of resistance. Ensure antibiotic stewardship.</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">Adequate education and training for staff on infection control and occupational health supervision and Education of veterinary graduates and personnel about nosocomial infections and the significance of infection control measures (<a href="#Schwaber-MJ--Venezia-SN--Masarwa-S--Levy-...-2013"><span class="Hyperlink">Schwaber</span><span class="Hyperlink CharOverride-5"> </span><span class="Hyperlink">et al., 2013</span></a>). </li>
		  <li class="Body-Text ParaOverride-3" lang="en-GB">Client education particularly about zoonosis if the veterinarian has a reasonable suspicion of any zoonotic infectious disease.</li>
				<li class="Body-Text ParaOverride-3" lang="en-GB">The surveillance of nosocomial infections should be accomplished by creating nationwide reference data which will facilitate the quick reporting about infection clusters, outbreak and thereby makes evidence based preventive and control measures (<a href="#Mielke-M--2010-"><span class="Hyperlink">Mielke, 2010</span></a>).</li>
                <p>&nbsp;</p>
          <p>&nbsp;</p>
			
			<p class="Heading-1--Introduction----" lang="en-GB">Conclusions</p>
		  <p class="Heading-1--Introduction----" lang="en-GB">&nbsp;</p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">Nosocomial infections are preventable yet it is more neglected area of veterinary practice since it warrants some added tasks which do not fetch money. Unfortunately it will influence the success of the treatment and care provided so it cannot be ignored any longer. The mandate elements for providing patient safety and to prevent nosocomial infections are clean hospital environment, clean equipment and clean procedures or practices. Further in broader sense proactive policies, health worker education, safe use of medicines and surveillance system can strengthen patient safety, curtail dissemination of antibiotic resistance and zoonotic diseases. </p>
			<p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1" lang="en-GB">&nbsp;</p>
			<p class="Heading-1--Introduction----" lang="en-GB">Reference</p>
			
				<li class="References ParaOverride-5"><a id="Abraham-S--Wong-HS--Turnidge-J--Johnson-JR--Trott-DJ--2014-"></a>Abraham S, Wong HS, Turnidge J, Johnson JR, Trott DJ (2014). Carbapenemase-producing bacteria in companion animals: a public health concern on the horizon. J. Antimicrobial. Chemo. 69(5): 1155-1157. <a href="http://dx.doi.org/10.1093/jac/dkt518"><span class="Hyperlink">http://dx.doi.org/10.1093/jac/dkt518</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Abrutyn-E--Talbot--GH--1987-."></a>Abrutyn E, Talbot, GH (1987). Surveillance strategies: a primer. Infect. Control<span class="CharOverride-6">. </span>8(11):  459-464.  </li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Ahern-BJ--Richardson-DW--Boston-RC--Schaer-TP--2010-"></a>Ahern BJ, Richardson DW, Boston RC, Schaer TP (2010). Orthopedic infections in equine long bone fractures and arthrodeses treated by internal fixation: 192 cases (1990-2006). Vet. Surg.  39(5): 588-593. <a href="http://dx.doi.org/10.1111/j.1532-950X.2010.00705.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1532-950X.2010.00705.x</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Ahmed-MO--Williams-NJ--Clegg-PD--van-Velkinburgh-JC--Baptiste-KE--2012-"></a>Ahmed MO, Williams NJ, Clegg PD, van Velkinburgh JC, Baptiste KE (2012). Analysis of risk factors associated with antibiotic-resistant <span class="CharOverride-6">Escherichia coli</span>. Microb. Drug Resist. 18 (2): 161–168.<span class="CharOverride-17">&#160;</span><a href="http://dx.doi.org/10.1089/mdr.2011.0213"><span class="Hyperlink">http://dx.doi.org/10.1089/mdr.2011.0213</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Aksoy-E--Boag-A--Brodbelt-D--Grierson-J--2010-."></a>Aksoy E, Boag A, Brodbelt D, Grierson J (2010). Evaluation of surface contamination with <span class="CharOverride-6">Staphylococci</span> in a veterinary hospital using a quantitative microbiological method. J. Small Anim. Pract. 51(11): 574-580. <a href="http://dx.doi.org/10.1111/j.1748-5827.2010.00994.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1748-5827.2010.00994.x</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Alinovi-CA--Ward-MP--Cou-til-LL--Wu-CC--2003-."></a>Alinovi CA, Ward MP, Couëtil LL, Wu CC (2003). Detection of <span class="CharOverride-6">Salmonella </span>organisms and assessment of a protocol for removal of contamination in horse stalls at a veterinary teaching hospital. J. Am. Vet. Med. Assoc. 223(11): 1640-1644. <a href="http://dx.doi.org/10.2460/javma.2003.223.1640"><span class="Hyperlink">http://dx.doi.org/10.2460/javma.2003.223.1640</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Amavisit-P--Markham-PF--Lightfoot-D--Whithear-KG--Browning-GF--2001-"></a>Amavisit P, Markham PF, Lightfoot D, Whithear KG, Browning GF (2001). Molecular epidemiology of<span class="CharOverride-6"> Salmonella </span>Heidelberg in an equine hospital. Vet. Microbiol. 80(1): 85–98. <a href="http://dx.doi.org/10.1016/S0378-1135(00)00373-4"><span class="Hyperlink">http://dx.doi.org/10.1016/S0378-1135(00)00373-4</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Anderson-MEC--Lefebvre-SL--Weese-JS--2008-."></a>Anderson MEC, Lefebvre SL, Weese JS (2008). Evaluation of prevalence and risk factors for methicillin-resistant <span class="CharOverride-6">S. aureus</span> colonization in veterinary personnel attending an international equine veterinary conference. Vet. Microbiol. 129 (3-4): 410–417. <a href="http://dx.doi.org/10.1016/j.vetmic.2007.11.031"><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2007.11.031</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Armand-Lefevre-L--Ruimy-R--Andremont-A---2005-."></a>Armand-Lefevre L, Ruimy R, Andremont A (2005). Clonal comparison of <span class="CharOverride-6">Staphylococcus aureus</span> isolates from healthy pig farmers, human control and pigs. Emerg. Infect. Dis. 11(5): 711–714. <a href="http://dx.doi.org/10.3201/eid1105.040866"><span class="Hyperlink">http://dx.doi.org/10.3201/eid1105.040866</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Ayliffe-GA--1997"></a>Ayliffe GA (1997). The progressive intercontinental spread of methicillinresistant <span class="CharOverride-6">Staphylococcus aureus</span>. Clin. Infect. Dis. 24 (Suppl.1): S74–S79. <a href="http://dx.doi.org/10.1093/clinids/24.Supplement_1.S74"><span class="Hyperlink">http://dx.doi.org/10.1093/clinids/24.Supplement_1.S74</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Baptiste-KE--Williams-K--Williams-NJ--Wattret...-2005"></a>Baptiste KE, Williams K, Williams NJ, Wattret A, Clegg PD, Dawson S, Corkill JE, O’Neill T, Hart CA (2005). Methicillin resistant <span class="CharOverride-6">Staphylococci </span>in companion animals. Emerg. Infect. Dis. 11(12): 1942–1944. <a href="http://dx.doi.org/10.3201/eid1112.050241"><span class="Hyperlink">http://dx.doi.org/10.3201/eid1112.050241</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Barber---1961-."></a>Barber, (1961). Methicillin-resistant <span class="CharOverride-6">Staphylococci</span>. J. Clin. Pathol. 14(4): 385–393.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Barr-BS--Waldridge-BM--Morresey-PR--Reed-SM--...-2013"></a>Barr BS,&#160;Waldridge BM,&#160;Morresey PR,&#160;Reed SM,&#160;Clark C,&#160;Belgrave R,&#160;Donecker JM,&#160;Weigel DJ (2013). Antimicrobial-associated diarrhoea in three equine referral practices. Equine. Vet. J. 45(2): 154–158. <a href="http://dx.doi.org/10.1111/j.2042-3306.2012.00595.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.2042-3306.2012.00595.x</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Beard-LA--2010-.-M"></a>Beard LA (2010). Multiple drug resistant bacteria in equine medicine: an emerging problem. Equine Vet. Educ. 22(6): 287–289. <a href="http://dx.doi.org/10.1111/j.2042-3292.2010.00067.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.2042-3292.2010.00067.x</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Belmonte-O---Pailhories-H--Kempf-M---Gaultier-MP--Lemarie..-2014"></a>Belmonte O,  Pailhories H, Kempf M,  Gaultier MP, Lemarie C, Ramont C,  Joly Guillou ML, Eveillard M (2014). High prevalence of closely-related <span class="CharOverride-6">Acinetobacter baumannii</span> in pets according to a multicentre study in veterinary clinics, Reunion Island. Vet. Microbiol. 170(3-4): 446–450. <a href="http://dx.doi.org/10.1016/j.vetmic.2014.01.042"><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2014.01.042</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Benedict-KM--Morley-PS--Van-Metre-DC--2008-."></a>Benedict KM, Morley PS, Van Metre DC (2008). Characteristics of biosecurity and infection control programs at veterinary teaching hospitals. J Am Vet Med Assoc. 233(5): 767–773. <a href="http://dx.doi.org/10.2460/javma.233.5.767"><span class="Hyperlink">http://dx.doi.org/10.2460/javma.233.5.767</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Bohme-H--Konigsmark-C--Klare-I--Zischka-M--Werner-G--2012-."></a>Bohme H, Konigsmark C, Klare I, Zischka M, Werner G (2012). Cross-transmission rates of enterococcal isolates among newborns in a neonatal intensive care unit. Pediatr. Reports. 4(1): e15. <a href="http://dx.doi.org/10.4081/pr.2012.e15"><span class="Hyperlink">http://dx.doi.org/10.4081/pr.2012.e15</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Bischoff-KM--White-DG--McDermott-PF--Zhao-S--Gaines-S--Maurer-JJ--Nisbet-DJ--2001"></a>Bischoff KM, White DG, McDermott PF, Zhao S, Gaines S, Maurer JJ, Nisbet DJ (2001). Characterization of chloramphenicol resistance in beta-hemolytic <span class="CharOverride-6">Escherichia coli </span>associated with diarrhea in neonatal swine. J. Clin. Microbiol. 40(2): 389–394. <a href="http://dx.doi.org/10.1128/JCM.40.2.389-394.2002"><span class="Hyperlink">http://dx.doi.org/10.1128/JCM.40.2.389-394.2002</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Biertuempfel--P.-H.--Ling--G.-V.--and-Ling--G.-A.--1981-."></a>Biertuempfel, P. H., Ling, G. V., and Ling, G. A. (1981). Urinary tract infection resulting from catheterization in healthy adult dogs. J Am Vet Med Assoc. 178(9): 989–991.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Boag-A--Loeffler-A--Lloyd-DH--2004-.-M"></a>Boag A, Loeffler A, Lloyd DH (2004). Methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus </span>in small animal practice. Vet. Rec. 154: 366–371.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Boerlin-P--Eugster-S--Gaschen-F--Straub-R--Schwalder-P--2001-."></a>Boerlin P, Eugster S, Gaschen F, Straub R, Schwalder P (2001). Transmission of opportunistic pathogens in a veterinary teaching hospital. Vet. Microbiol. 82(4): 347-359. <a href="http://dx.doi.org/10.1016/S0378-1135(01)00396-0"><span class="Hyperlink">http://dx.doi.org/10.1016/S0378-1135(01)00396-0</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Bootsma-MC--van-der-Horst-MA--Guryeva-T--ter-Kuile-BH--Diekmann-O--2012-."></a>Bootsma MC, van der Horst MA, Guryeva T, ter Kuile BH, Diekmann O (2012). Modeling non-inherited antibiotic resistance. Bull. Math. Biol. 74(8): 1691–1705. <a href="http://dx.doi.org/10.1007/s11538-012-9731-3 "><span class="Hyperlink">http://dx.doi.org/10.1007/s11538-012-9731-3</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Bortolaia-V--Larsen-J--Damborg-P--Guardabassi-L--2011-"></a>Bortolaia V, Larsen J, Damborg P, Guardabassi L (2011). Potential pathogenicity and host range of extended-spectrum b-lactamase producing <span class="CharOverride-6">Escherichia coli</span> isolates from healthy poultry. Appl. Environ. Microbiol. 77(16): 5830–5833. <a href="http://dx.doi.org/10.1128/AEM.02890-10"><span class="Hyperlink">http://dx.doi.org/10.1128/AEM.02890-10</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Brachman-PS--1993-."></a>Brachman PS (1993). Nosocomial infections surveillance. Infect. Control Hosp. Epidemiol. 14(4): 194–196. http://dx.doi.org/10.2307/30149727</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Brady-RR--Fraser-SF--Dunlop-MG--Brown-SP--Gibb-AP--2007-."></a>Brady RR, Fraser SF, Dunlop MG, Brown SP, Gibb AP (2007). Bacterial contamination of mobile communication devices in the operative environment. J. Hosp. Infect. 66(4): 397-398. <a href="http://dx.doi.org/10.1016/j.jhin.2007.04.015"><span class="Hyperlink">http://dx.doi.org/10.1016/j.jhin.2007.04.015</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Brossette-SE--Hacek-DM--Gavin-PJ--Kamdar-MA--Gadbois-KD--Fisher-AG--Peterson-LR--2006-"></a>Brossette SE, Hacek DM, Gavin PJ, Kamdar MA, Gadbois KD, Fisher AG, Peterson LR (2006). A laboratory-based, hospital-wide, electronic marker for nosocomial infection. American J. Clin. Pathol. 125(1): 34-39. <a href="http://dx.doi.org/10.1309/502AUPR8VE67MBDE"><span class="Hyperlink">http://dx.doi.org/10.1309/502AUPR8VE67MBDE</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Brown-RB--Bradley-S--Opitz-E--Cipriani-D--Pieczarka-R--Sands-M--1987-."></a>Brown RB, Bradley S, Opitz E, Cipriani D, Pieczarka R, Sands M (1987). Surgical wound infections documented after hospital discharge. Am. J. Infect. Control. 15(2): 54-58. <a href="http://dx.doi.org/10.1016/0196-6553(87)90002-2"><span class="Hyperlink">http://dx.doi.org/10.1016/0196-6553(87)90002-2</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Brusaferro-S--Regattin-L--Faruzzo-A--Grasso-A--Basile-M--Calligaris-L--Scudeller-L--Viale-P--2006-."></a>Brusaferro S, Regattin L, Faruzzo A, Grasso A, Basile M, Calligaris L, Scudeller L, Viale P (2006). Surveillance of hospital-acquired infections: a model for settings with resource constraints. Am. J. Infect. Control. 34(6): 362-366. <a href="http://dx.doi.org/10.1016/j.ajic.2006.03.002"><span class="Hyperlink">http://dx.doi.org/10.1016/j.ajic.2006.03.002</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Bubenik-L--Hosgood-G--2008-."></a>Bubenik L, Hosgood G (2008). Urinary tract infection in dogs with thoracolumbar intervertebral disc herniation and urinary bladder dysfunction managed by manual expression, indwelling catheterization or intermittent catheterization. Vet. Surg. 37(8): 791-800. <a href="http://dx.doi.org/10.1111/j.1532-950X.2008.00452.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1532-950X.2008.00452</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Bures-S--Fishbain-JT--Uyehara-CFT--Parker-JM--Berg-BW--2000-."></a>Bures S, Fishbain JT, Uyehara CFT, Parker JM, Berg BW (2000). Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit. Am. J. Infect. Control. 28(6): 465-470. <a href="http://dx.doi.org/10.1067/mic.2000.107267"><span class="Hyperlink">http://dx.doi.org/10.1067/mic.2000.107267</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Burgess-BA--Morley-PS--Hyatt-DR--2004-."></a>Burgess BA, Morley PS, Hyatt DR (2004). Environmental surveillance for <span class="CharOverride-6">Salmonella enteric </span>in a veterinary teaching hospital. J. Am. Vet. Med. Assoc. 225(9): 1344-1348. <a href="http://dx.doi.org/10.2460/javma.2004.225.1344"><span class="Hyperlink">http://dx.doi.org/10.2460/javma.2004.225.1344</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Burke-JP--2003-"></a>Burke JP (2003). Infection control – a problem for patient safety. N. Engl. J. Med. 348(7): 651-656. <a href="http://dx.doi.org/10.1056/NEJMhpr020557"><span class="Hyperlink">http://dx.doi.org/10.1056/NEJMhpr020557</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Burstiner-LC--Faires-M--Weese-JS--2010-."></a>Burstiner LC, Faires M, Weese JS (2010).<span class="CharOverride-17">&#160;</span>Methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus</span> colonization in personnel attending a veterinary surgery conference. Vet. Surg.<span class="CharOverride-19">&#160;</span>39(2): 150-157. <a href="http://dx.doi.org/10.1111/j.1532-950X.2009.00638.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1532-950X.2009.00638.x</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Castor-ML--Wooley-RE--Shotts-EB--Brown-J--Payeur-JB--1989-."></a>Castor ML, Wooley RE, Shotts EB, Brown J, Payeur JB (1989). Characteristics of <span class="CharOverride-6">Salmonella </span>isolated from an outbreak of equine salmonellosis in a veterinary teaching hospital. J. Equine Vet. Sci. 9(5): 236-241. <a href="http://dx.doi.org/10.1016/S0737-0806(89)80078-4"><span class="Hyperlink">http://dx.doi.org/10.1016/S0737-0806(89)80078-4</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="CCAR.-Infection-preven"></a>CCAR. Infection prevention and control best practices for small animal veterinary clinics. Canadian Committee on Antibiotic Resistance (CCAR) 2008. p 1-71.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Cefai-C--Ashurst-S--Owens-C--1994-.-H"></a>Cefai C, Ashurst S, Owens C (1994). Human carriage of methicillinresistant <span class="CharOverride-6">Staphylococcus aureus</span> linked with pet dog. Lancet. 344(8921): 539–540. <a href="http://dx.doi.org/10.1016/S0140-6736(94)91926-7"><span class="Hyperlink">http://dx.doi.org/10.1016/S0140-6736(94)91926-7</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Cherry-B--Burns-A--Johnson-GS--Pfeiffer-H--Dumas-N--Barrett-D--McDonough-PL--Eidson-M--2004-."></a>Cherry B, Burns A, Johnson GS, Pfeiffer H, Dumas N, Barrett D, McDonough PL, Eidson<span class="CharOverride-6"> </span>M (2004). <span class="CharOverride-6">Salmonella typhimurium </span>outbreak associated with veterinary clinic. Emerg. Infect. Dis. 10(12): 2249-2251. <a href="http://dx.doi.org/10.3201/eid1012.040714 "><span class="Hyperlink">http://dx.doi.org/10.3201/eid1012.040714 </span></a>PMid:15663875 PMCid:PMC3323366</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Chung-YS--Kwon-KH--Shin-S--Kim-JH--Park-YH--Yoon-JW--2014-"></a>Chung YS, Kwon KH, Shin S, Kim JH, Park YH, Yoon JW (2014). Characterization of Veterinary Hospital-Associated Isolates of <span class="CharOverride-6">Enterococcus </span>Species in Korea. J. Microbiol. Biotechnol. 24(3): 386–393. <a href="http://dx.doi.org/10.4014/jmb.1310.10088 "><span class="Hyperlink">http://dx.doi.org/10.4014/jmb.1310.10088 </span></a>PMid:24296459</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Clemetson-LL--Ward-AC--1990-."></a>Clemetson LL,&#160;Ward AC (1990). Bacterial flora of the vagina and uterus of healthy cats.  J. Am. Vet. Med. Assoc. 196(6): 902-906.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Clooten-J--Kruth-S--Arroyo-L--Weese-JS---2008-."></a>Clooten J, Kruth S, Arroyo L, Weese JS, (2008). Prevalence and risk factors for <span class="CharOverride-6">Clostridium difficile</span> colonization in dogs and cats hospitalized in an intensive care unit. Vet. Microbiol. 129(1-2): 209–214. <a href="http://dx.doi.org/10.1016/j.vetmic.2007.11.013"><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2007.11.013</span></a>  PMid:18164560</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Costa-MC--Stampfli-HR--Arroyo-LG--Pearl-DL--Weese-JS--2011-."></a>Costa MC,&#160;Stampfli HR,&#160;Arroyo LG,&#160;Pearl DL,&#160;Weese JS (2011). Epidemiology of <span class="CharOverride-6">Clostridium difficile</span> on a veal farm: prevalence, molecular characterization and tetracycline resistance. Vet. Microbiol.&#160;152(3-4): 379-384. <a href="http://dx.doi.org/10.1016/j.vetmic.2011.05.014"><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2011.05.014</span></a>  PMid:21641131</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Cowen-AE--2001-"></a>Cowen AE (2001). The clinical risks of infection associated with endoscopy. Can. J. Gastroenterol. 15(5): 321-331.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Cummings-KJ--Rodriguez-Rivera-LD--Katharyn-JM--Karin-H--Martin...-2014"></a>Cummings KJ, Rodriguez-Rivera LD, Katharyn JM, Karin H, Martin W, Patrick LM, Craig A, Lorin DW, Gillian AP (2014). <span class="CharOverride-6">Salmonella enterica</span><span class="CharOverride-17">&#160;</span>Serovar Oranienburg Outbreak in a Veterinary Medical Teaching Hospital with Evidence of Nosocomial and On-Farm Transmission. Vector-Borne Zoonotic Dis. 14(7): 496-502.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Cuny-C--Kuemmerle-J--Stanek-C--Willey-B--Strommenger-B--Witte-W--2006-"></a>Cuny C, Kuemmerle J, Stanek C, Willey B, Strommenger B, Witte W (2006). Emergence of MRSA infections in horses in a veterinary hospital: strain characterisation and comparison with MRSA from humans. Euro. Surveill. 11(1): 44–47. <a href="http://dx.doi.org/10.1016/j.jhin.2006.04.009 "><span class="Hyperlink">http://dx.doi.org/10.1016/j.jhin.2006.04.009 </span></a>PMid:16835000</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Cuny-C--Strommenger-B--Witte-W--Stanek-C--2008"></a>Cuny C,&#160;Strommenger B,&#160;Witte W,&#160;Stanek C (2008). Clusters of infections in horses with MRSA ST1, ST254, and ST398 in a veterinary hospital. Microb. Drug Resist. 14(4): 307-310. <a href="http://dx.doi.org/10.1089/mdr.2008.0845"><span class="Hyperlink">http://dx.doi.org/10.1089/mdr.2008.0845</span></a>  PMid:19025385</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="D-Agata-EM--Magal-P--Olivier-D--Ruan-S--Webb-GF--2007-."></a>D’Agata EM, Magal P, Olivier D, Ruan S, Webb GF (2007).  Modeling antibiotic resistance in hospitals: the impact of minimizing treatment duration. J. Theor. Biol. 249(3): 487–499. <a href="http://dx.doi.org/10.1016/j.jtbi.2007.08.011"><span class="Hyperlink">http://dx.doi.org/10.1016/j.jtbi.2007.08.011</span></a> PMid:17905310 PMCid:PMC2432019</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="D-Agata-EM--Dupont-Rouzeyrol-M--Magal-P--Olivier-D--Ruan-S--2008"></a>D’Agata EM, Dupont-Rouzeyrol M, Magal P, Olivier D, Ruan S (2008). The impact of different antibiotic regimens on the emergence of antimicrobial-resistant bacteria. PLoS One. 3: e4036. <a href="http://dx.doi.org/10.1371/journal.pone.0004036 "><span class="Hyperlink">http://dx.doi.org/10.1371/journal.pone.0004036 </span></a>PMid:19112501 PMCid:PMC2603320</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="D-Agata-EM--Horn-MA--Ruan-S--Webb-GF--Wares-JR--2012-."></a>D’Agata EM, Horn MA, Ruan S, Webb GF, Wares JR (2012). Efficacy of infection control interventions in reducing the spread of multidrug-resistant organisms in the hospital setting. PLoS One. 7: e30170. <a href="http://dx.doi.org/10.1371/journal.pone.0030170 "><span class="Hyperlink">http://dx.doi.org/10.1371/journal.pone.0030170 </span></a>PMid:22363420 PMCid:PMC3282714</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Dallap-Schaer-BL--Aceto-H--Rankin-SC--2010-."></a>Dallap Schaer BL, Aceto H, Rankin SC (2010). Outbreak of salmonellosis caused by <span class="CharOverride-6">Salmonella enterica </span>serovar Newport MDR-AmpC in a large animal veterinary teaching hospital. J. Vet. Intern. Med. 24(5): 1138-1146. <a href="http://dx.doi.org/10.1111/j.1939-1676.2010.0546.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1939-1676.2010.0546.x</span></a>  PMid:20584143</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Damborg-P--Top-J--Hendrickx-AP--Dawson-S--Willems-RJ--Guardabassi-L--2009-."></a>Damborg P, Top J, Hendrickx AP, Dawson S, Willems RJ, Guardabassi L (2009). Dogs are a reservoir of ampicillin-resistant <span class="CharOverride-6">Enterococcus faecium </span>lineages associated with human infections. Appl. Environ. Microbiol.<span class="CharOverride-6"> </span>75(8): 2360–2365.  <a href="http://dx.doi.org/10.1128/AEM.02035-08"><span class="Hyperlink">http://dx.doi.org/10.1128/AEM.02035-08</span></a> PMid:19233953 PMCid:PMC2675212</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Debast-SB--van-Leengoed-LA--Goorhuis-A--Harmanus-C--Kuijper-EJ--Bergwerff-AA--2009-."></a>Debast SB, van Leengoed LA, Goorhuis A, Harmanus C, Kuijper EJ, Bergwerff AA (2009). <span class="CharOverride-6">Clostridium difficile</span> PCR ribotype 078 toxinotype V found in diarrhoeal pigs identical to isolates from affected humans. Environ. Microbiol. 11(2): 505–511. <a href="http://dx.doi.org/10.1111/j.1462-2920.2008.01790.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1462-2920.2008.01790.x</span></a> PMid:19196280</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Delgado-Rodriguez-M--G-mez-Ortega-A--Sillero-Arenas-M--Llorca-J--2001-."></a>Delgado-Rodriguez M, Gómez-Ortega A, Sillero-Arenas M, Llorca J (2001). Epidemiology of surgical-site infections diagnosed after hospital discharge: a prospective cohort study. Infect. Control Hosp. Epidemiol. 22(1): 24–30. <a href="http://dx.doi.org/10.1086/501820"><span class="Hyperlink">http://dx.doi.org/10.1086/501820</span></a> PMid:11198018</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Dettenkofer-M--Ebner-W--Els-T--Babikir-R--L-cking-C--Pelz-K--Daschner-F--2001-.-S"></a>Dettenkofer M, Ebner W, Els T, Babikir R, Lücking C, Pelz K, Daschner F (2001). Surveillance of nosocomial infections in a neurology intensive care unit. J. Neurol. 248(11): 959–964. <a href="http://dx.doi.org/10.1007/s004150170048"><span class="Hyperlink">http://dx.doi.org/10.1007/s004150170048</span></a> PMid:11757959</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Devriese-LA--Vandamme-LR--Fameree-L--1972-."></a>Devriese LA, Vandamme LR, Fameree L (1972). Methicillin (cloxacillin)-resistant <span class="CharOverride-6">Staphylococcus aureus</span> strains isolated from bovine mastitis cases. Zentralblatt fur Veterinarmedizin B. 19(7): 598–605. <a href="http://dx.doi.org/10.1111/j.1439-0450.1972.tb00439.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1439-0450.1972.tb00439.x</span></a>  PMid:4486473</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Dierikx-CM--van-Duijkeren-E--Schoormans-AH--van-Essen-Zandbergen-...-2012"></a>Dierikx CM, van Duijkeren E, Schoormans AH, van Essen-Zandbergen, A, Veldman K, Kant A, Huijsdens XW, van der Zwaluw K, Wagenaar JA, Mevius DJ (2012). Occurrence and characteristics of extended-spectrum-beta-lactamase- and AmpC-producing clinical isolates derived from companion animals and horses. J. Antimicrob. Chemother. 67(6): 1368–1374. <a href="http://dx.doi.org/10.1093/jac/dks049"><span class="Hyperlink">http://dx.doi.org/10.1093/jac/dks049</span></a> PMid:22382469</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Donahue-JM--1986-."></a>Donahue JM (1986). Emergence of antibiotic-resistant <span class="CharOverride-6">Salmonella agona</span> in horses in Kentucky. J. Am. Vet. Med. Assoc. 188(6): 592–594.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Dunowska-M--Morley-PS--TraubDargatz-JL--Davis-MA--Patterson-G--Frye-JG--Hyatt-DR--Dargatz-DA--2007"></a>Dunowska M, Morley PS, TraubDargatz JL, Davis MA, Patterson G, Frye JG, Hyatt DR, Dargatz DA (2007). Comparsion of <span class="CharOverride-6">Salmonella</span> enteric Serotype Infantis isolates from a Veterinary Teaching Hospital. J. Appl. Microbiol. 102(6): 1527-1536. <a href="http://dx.doi.org/10.1111/j.1365-2672.2006.03198.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1365-2672.2006.03198.x</span></a> PMid:17578417</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Ehrenkranz-NJ--Alfonso-BC--1991-.-F"></a>Ehrenkranz NJ, Alfonso BC (1991). Failure of bland soap handwash to prevent hand transfer of patient bacteria to urethral catheters. Infect. Control Hosp. Epidemiol. 12(11): 654–662. <a href="http://dx.doi.org/10.1086/646261"><span class="Hyperlink">http://dx.doi.org/10.1086/646261</span></a> <a href="http://dx.doi.org/10.2307/30146898"><span class="Hyperlink">http://dx.doi.org/10.2307/30146898</span></a>  PMid:1753080</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Eickhoff-TC--1981-."></a>Eickhoff TC (1981). Nosocomial infections – A 1980 view: progress, priorities and prognosis. Am. J. Med. 70(2): 381–388. <a href="http://dx.doi.org/10.1016/0002-9343(81)90776-2"><span class="Hyperlink">http://dx.doi.org/10.1016/0002-9343(81)90776-2</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Ekiri-AB--Morton-AJ--Long-MT--MacKay-RJ--Hernandez-JA--2010-."></a>Ekiri AB, Morton AJ, Long MT, MacKay RJ, Hernandez JA (2010). Review of the epidemiology and infectio<a id="Anchor-1"></a>n control aspects of nosocomial <span class="CharOverride-6">Salmonella </span>infections in hospitalised horses. Equine Vet. Educ. 22(12): 631–641. <a href="http://dx.doi.org/10.1111/j.2042-3292.2010.00144.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.2042-3292.2010.00144.x</span></a> </li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Emori-TG--Gaynes-RP--1993"></a>Emori TG, Gaynes RP (1993). An overview of nosocomial infections, including the role of the microbiology laboratory. Clin. Microbiol. Rev. 6(4): 428–442. PMid:8269394 PMCid:PMC358296</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Enright-MC--Day-NP--Davies-CE--Peacock-SJ--Spratt-BG--2000-"></a>Enright MC, Day NP, Davies CE, Peacock SJ, Spratt BG (2000). Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of <span class="CharOverride-6">S. aureus</span>. J. Clin. Microbiol. 38(3): 1008–1015. PMid:10698988 PMCid:PMC86325</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Eugster-S--Schawalder-P--Gaschen-F--Boerlin-P--2004-."></a>Eugster S, Schawalder P, Gaschen F, Boerlin P (2004). A prospective study of postoperative surgical site infections in dogs and cats. Vet. Surg.  33(5): 542–550. <a href="http://dx.doi.org/10.1111/j.1532-950X.2004.04076.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1532-950X.2004.04076.x</span></a>  PMid:15362994</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Ewart-SL--Schott-HC--Robison-RL--Dwyer-RM--Eberhart-SW-Walker-RD--2001-."></a>Ewart SL, Schott HC, Robison RL, Dwyer RM, Eberhart SW Walker RD (2001). Identification of sources of <span class="CharOverride-6">Salmonella </span>organisms in a veterinary teaching hospital and evaluation of the effects of disinfectants on detection of <span class="CharOverride-6">Salmonella </span>organisms on surface materials. J. Am. Vet. Med. Assoc<span class="CharOverride-6">. </span>218(7): 1145–1151. <a href="http://dx.doi.org/10.2460/javma.2001.218.1145"><span class="Hyperlink">http://dx.doi.org/10.2460/javma.2001.218.1145</span></a>   PMid:11318367</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Ewers-C--Stamm-I--Pfeifer-Y--Wieler-LH---Kopp-PA---Sch-nning-K--2014-."></a>Ewers C, Stamm I, Pfeifer Y, Wieler LH, Kopp PA, Schønning K (2014). Clonal spread of highly successful ST15-CTX-M-15Klebsiella pneumoniae&#160;in companion animals and horses. J. Antimicrobial. Chemo.&#160;69(10): 2676–2680. <a href="http://dx.doi.org/10.1093/jac/dku217"><span class="Hyperlink">http://dx.doi.org/10.1093/jac/dku217</span></a>  PMid:24974381</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Faires-MC--Traverse-M--Tater-KC--Pearl-DL--Weese-JS--2010-"></a>Faires MC, Traverse M, Tater KC, Pearl DL, Weese JS (2010).<span class="CharOverride-17">&#160;</span>Methicillin-resistant and -susceptible <span class="CharOverride-6">Staphylococcus aureus</span> infections in dogs. Emerg. Infect. Dis.<span class="CharOverride-17">&#160;</span>16(5): 69–75. <a href="http://dx.doi.org/10.3201/eid1601.081758"><span class="Hyperlink">http://dx.doi.org/10.3201/eid1601.081758</span></a> PMid:20031045 PMCid:PMC2874348</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Fisher-K--Phillips-C--2009-"></a>Fisher K, Phillips C (2009). The ecology, epidemiology and virulence of <span class="CharOverride-6">Enterococcus</span>. Microbiology. 155(Pt 6): 1749–1757. <a href="http://dx.doi.org/10.1099/mic.0.026385-0"><span class="Hyperlink">http://dx.doi.org/10.1099/mic.0.026385-0</span></a> PMid:19383684</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Fox-JG--Beaucage-CM--Folta-CA--Thornton-GW--1981-"></a>Fox JG, Beaucage CM, Folta CA, Thornton GW (1981). Nosocomial transmission of <span class="CharOverride-6">Serratia marcescens </span>in a veterinary hospital due to contamination by benzalkonium chloride. J. Clin. Microbiol. 14(2): 157–160. PMid:7024303 PMCid:PMC271926</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Francey-T--Gaschen-F--Nicolet-J--Burnens-AP--2000-."></a>Francey T, Gaschen F, Nicolet J, Burnens AP (2000). The role of <span class="CharOverride-6">Acinetobacter baumannii</span> as a nosocomial pathogen for dogs and cats in an intensive care unit. J. Vet. Intern. Med. 14(2): 177–183. <a href="http://dx.doi.org/10.1111/j.1939-1676.2000.tb02233.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1939-1676.2000.tb02233.x</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Freeman-J--McGowan-JE--1981-."></a>Freeman J, McGowan JE (1981). Methodologic issues in hospital epidemiology. I. Rates, case-finding, and interpretation. Rev. Infect. Dis. 3(4): 658–667.  <a href="http://dx.doi.org/10.1093/clinids/3.4.658 "><span class="Hyperlink">http://dx.doi.org/10.1093/clinids/3.4.658 </span></a>PMid:7339779</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Fujita-H--Hansen-B--Hanel-R--2013-."></a>Fujita H, Hansen B, Hanel R (2013). Bacterial Contamination of Stethoscope Chest Pieces and the Effect of Daily Cleaning. J. Vet. Intern. Med. 27(2):&#160;354–358. <a href="http://dx.doi.org/10.1111/jvim.12032"><span class="Hyperlink">http://dx.doi.org/10.1111/jvim.12032</span></a> PMid:23425122</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Gaynes-RP--1997-."></a>Gaynes RP (1997). Surveillance of nosocomial infections: a fundamental ingredient for quality. Infect. Control Hosp. Epidemiol. 18(7): 475–478. http://dx.doi.org/10.2307/30141186 <a href="http://dx.doi.org/10.1086/647651"><span class="Hyperlink">http://dx.doi.org/10.1086/647651</span></a> PMid:9247829</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Ghosh-A--Dowd-SE--Zurek-L--2011-."></a>Ghosh A, Dowd SE, Zurek L (2011). Dogs leaving the ICU carry a very large multi-drug resistant enterococcal population with capacity for biofilm formation and horizontal gene transfer. PLoS ONE.<span class="CharOverride-6"> </span>6:e22451. <a href="http://dx.doi.org/10.1371/journal.pone.0022451"><span class="Hyperlink">http://dx.doi.org/10.1371/journal.pone.0022451</span></a> PMid:21811613 PMCid:PMC3139645</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Giannouli-M--Antunes-LCS--Marchetti-V--Triassi-M--Visca-P--Zarrilli-R--2013-"></a>Giannouli M, Antunes LCS, Marchetti V, Triassi M, Visca P, Zarrilli R (2013). Virulence-related traits of epidemic <span class="CharOverride-6">Acinetobacter baumannii</span> strains belonging to the international clonal lineage I–II and to the emerging genotypes ST25 and ST78. BMC Infect. Dis. 13: 282. <a href="http://dx.doi.org/10.1186/1471-2334-13-282"><span class="Hyperlink">http://dx.doi.org/10.1186/1471-2334-13-282</span></a> PMid:23786621 PMCid:PMC3691691</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Gibson-JS--Morton-JM--Cobbold-RN--Filippich-LJ--Trott-DJ--2011-"></a>Gibson JS, Morton JM, Cobbold RN, Filippich LJ, Trott DJ (2011). Risk factors for dogs becoming rectal carriers of multidrug-resistant <span class="CharOverride-6">Escherichia coli </span>during hospitalization. Epidemiol. Infect. 139(10): 1511–1521. <a href="http://dx.doi.org/10.1017/S0950268810002785"><span class="Hyperlink">http://dx.doi.org/10.1017/S0950268810002785</span></a> PMid:21156096</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Giraffa-G--2002-"></a>Giraffa G (2002). Enterococci from foods. FEMS Microbiol. Rev. 26(2): 163–171. http://dx.doi.org/10.1111/j.1574-6976.2002.tb00608.x PMid:12069881</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Goehring-LS--Landolt-GS--Morley-PS--2010-."></a>Goehring LS, Landolt GS, Morley PS (2010). Detection and management of an outbreak of equine herpesvirus type 1 infection and associated neurologic disease in a veterinary teaching hospital. J. Vet. Intern. Med. 24(5): 1176–1183. <a href="http://dx.doi.org/10.1111/j.1939-1676.2010.0558.x "><span class="Hyperlink">http://dx.doi.org/10.1111/j.1939-1676.2010.0558.x </span></a>PMid:20584137</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Goni-P--Vergara-Y--Ruiz-J--Albizu-I--Vila-J--Gomez-Lus-R--2004-."></a>Goni P, Vergara Y, Ruiz J, Albizu I, Vila J, Gomez-Lus R (2004). Antibiotic resistance and epidemiological typing of <span class="CharOverride-6">Staphylococcus aureus</span> strains from ovine and rabbit mastitis. Int. J. Antimicrob. Agents.  23(3): 268–272. <a href="http://dx.doi.org/10.1111/j.1939-1676.2010.0558.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1939-1676.2010.0558.x</span></a> PMid:20584137</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Grayson-ML--Eliopoulos-GM--Wennersten-CB--Ruoff-KL--De-Girolami-PC--Ferraro-MJ--1991-"></a>Grayson ML, Eliopoulos GM, Wennersten CB, Ruoff KL, De Girolami PC, Ferraro MJ (1991). Increasing resistance to beta-lactam antibiotics among clinical isolates of <span class="CharOverride-6">Enterococcus faecium</span>: a 22-year review at one institution. Antimicrob. Agents Chemother. 35(11): 2180–2184. <a href="http://dx.doi.org/10.1128/AAC.35.11.2180"><span class="Hyperlink">http://dx.doi.org/10.1128/AAC.35.11.2180</span></a> PMid:1803989 PMCid:PMC245356</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Gronthal-T--Moodley-A--Nykasenoja-S--Junilla-J--Guardabassi-L--Thomson-K--Rantala-M--2014"></a>Gronthal T, Moodley A, Nykasenoja S, Junilla J, Guardabassi L, Thomson K, Rantala M (2014). Large Outbreak Caused by Methicillin Resistant&#160;<span class="CharOverride-6">Staphylococcus pseudintermedius</span>&#160;ST71 in a Finnish Veterinary Teaching Hospital – From Outbreak Control to Outbreak Prevention. PLoS ONE 9(10): e110084. <a href="http://dx.doi.org/10.1371/journal.pone.0110084"><span class="Hyperlink">http://dx.doi.org/10.1371/journal.pone.0110084</span></a> PMid:25333798 PMCid:PMC4198203</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Guardabassi-L--Schwarz-S--Lloyd-DH--2004-."></a>Guardabassi L, Schwarz S, Lloyd DH (2004). Pet animals as reservoirs of antimicrobial-resistant bacteria. J. Antimicrobial. Chemo. 54(2): 321–332. <a href="http://dx.doi.org/10.1093/jac/dkh332 "><span class="Hyperlink">http://dx.doi.org/10.1093/jac/dkh332 </span></a>PMid:15254022</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Gustafsson-A--Ba--verud-V--Gunnarsson-A--Pringle-J--Franklin-A--2004-."></a>Gustafsson A, Ba˚ verud V, Gunnarsson A, Pringle J, Franklin A (2004). Study of faecal shedding of <span class="CharOverride-6">Clostridium difficile</span> in horses treated with penicillin. Equine. Vet. J. 36(2): 180–182. <a href="http://dx.doi.org/10.2746/0425164044868657"><span class="Hyperlink">http://dx.doi.org/10.2746/0425164044868657</span></a> PMid:15038443</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Haenni-M--Ponsin-C--Metayer-V--Medaille-C--Madec-JY--2012-"></a>Haenni M, Ponsin C, Metayer V, Medaille C, Madec JY (2012). Veterinary hospital-acquired infections in pets with a ciprofloxacin-resistant CTX-M-15-producing <span class="CharOverride-6">Klebsiella pneumoniae</span> ST15 clone. J. Antimicrob. Chemother. 67: 770–771. <a href="http://dx.doi.org/10.1093/jac/dkr527"><span class="Hyperlink">http://dx.doi.org/10.1093/jac/dkr527</span></a>  PMid:22178643</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Hall-IC--O-Toole-E--1935"></a>Hall IC, O’Toole E (1935). Intestinal flora in newborn infants with a description of a new pathogenic anaerobe, <span class="CharOverride-6">Bacillus difficilis</span>. <span class="CharOverride-21">Am. J. Dis. Child</span>. 49(2): 390– 402. <a href="http://dx.doi.org/10.1001/archpedi.1935.01970020105010"><span class="Hyperlink">http://dx.doi.org/10.1001/archpedi.1935.01970020105010</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Hall-Stoodley-L--Costerton-JW--Stoodley-P--2004-."></a>Hall-Stoodley L, Costerton JW, Stoodley P (2004). “Bacterial biofilms: from the natural environment to infectious diseases”. Nature Rev.  Microbiol.&#160;2<span class="CharOverride-17">&#160;</span>(2): 95–108. <a href="http://dx.doi.org/10.1038/nrmicro821"><span class="Hyperlink">http://dx.doi.org/10.1038/nrmicro821</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Hamilton-E--Kruger-JM--Schall-W--Beal-M--Manning-SD--2013-"></a>Hamilton E, Kruger JM, Schall W, Beal M, Manning SD (2013). Acquisition and persistence of antimicrobial-resistant bacteria isolated from dogs and cats admitted to a veterinary teaching hospital. J. Am. Vet. Med. 243(7): 990–1000.  <a href="http://dx.doi.org/10.2460/javma.243.7.990"><span class="Hyperlink">http://dx.doi.org/10.2460/javma.243.7.990</span></a> PMid:24050566</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Hanselman-B--Rousseau-J--Kruth-S--Weese-JS--2006-."></a>Hanselman B, Rousseau J, Kruth S, Weese JS (2006). Methicillinresistant <span class="CharOverride-6">Staphylococcus aureus</span> (MRSA) colonization in veterinary personnel. Emerg. Infect. Dis. 12(12): 1933–1938. <a href="http://dx.doi.org/10.3201/eid1212.060231"><span class="Hyperlink">http://dx.doi.org/10.3201/eid1212.060231</span></a> PMid:17326947 PMCid:PMC3291342</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"> <a id="Hardy-KJ--Oppenheim-BA--Gossain-S--Gao-F--Hawkey-PM--2006-."></a>Hardy KJ, Oppenheim BA, Gossain S, Gao F, Hawkey PM (2006). A study of the relationship between environmental contamination with methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus</span> (MRSA) and patients acquisition of MRSA. Infect. Control Hosp. Epidemiol.<span class="CharOverride-17">&#160;</span>27(2): 127-132. <a href="http://dx.doi.org/10.1086/500622"><span class="Hyperlink">http://dx.doi.org/10.1086/500622</span></a> PMid:16465628</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Harrison-WA--Grifith-CJ--Ayers-T--Michaels-B--2003-"></a>Harrison WA, Grifith CJ, Ayers T, Michaels B (2003). Bacterial transfer and cross-contamination potential associated with paper-towel dispensing. Am. J. Infect. Control. 31(7): 387–391. <a href="http://dx.doi.org/10.1067/mic.2003.81"><span class="Hyperlink">http://dx.doi.org/10.1067/mic.2003.81</span></a> PMid:14639433</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Hartmann-FA--1995-."></a>Hartmann FA (1995). West SEH. Antimicrobial susceptibility profiles of multidrug-resistant <span class="CharOverride-6">Salmonella anatum</span> isolated from horses. J. Vet. Diagn. Invest. 7: 159–61. <a href="http://dx.doi.org/10.1177/104063879500700128"><span class="Hyperlink">http://dx.doi.org/10.1177/104063879500700128</span></a> PMid:7779955</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Hartmann-FA--Callan-RJ--McGuirk-SM--West-SE--1996-."></a>Hartmann FA, Callan RJ, McGuirk SM, West SE (1996). Control of an outbreak of salmonellosis caused by drug-resistant <span class="CharOverride-6">Salmonella anatum </span>in horses at a veterinary hospital and measures to prevent future infections. J. Am. Vet. Med. Assoc. 209(3): 629-631.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Heller-J--Kelly-L--Reid-SW--Mellor-DJ--2010-."></a>Heller J, Kelly L, Reid SW, Mellor DJ (2010). Qualitative risk assessment of the acquisition of Meticillin-resistant <span class="CharOverride-6">staphylococcus aureus</span> in pet dogs. Risk Anal. 30(3): 458–472. <a href="http://dx.doi.org/10.1111/j.1539-6924.2009.01342.x "><span class="Hyperlink">http://dx.doi.org/10.1111/j.1539-6924.2009.01342.x </span></a>PMid:20136747</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Hird-DW--Casebolt-DB--Carter-JD--Pappaioanou-M--Hjerpe-CA--1986-."></a>Hird DW, Casebolt DB, Carter JD, Pappaioanou M, Hjerpe CA (1986). Risk factors for salmonellosis in hospitalized horses. J. Am. Vet. Med. Assoc. 188(2): 172–7.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Horan-TC--Andrus-M--Dudeck-MA--2008-."></a>Horan TC, Andrus M, Dudeck MA (2008). CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am. J. Infect. Control. 36(5): 309–332. <a href="http://dx.doi.org/10.1016/j.ajic.2008.03.002"><span class="Hyperlink">http://dx.doi.org/10.1016/j.ajic.2008.03.002</span></a> PMid:18538699</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Hordijk-J--Schoormans-A--Kwakernaak-M--Duim-B--Broens-E--Dierikx-C--Mevius-D--Wagenaar-JA--2013"></a>Hordijk J, Schoormans A, Kwakernaak M, Duim B, Broens E, Dierikx C, Mevius D, Wagenaar JA (2013). High prevalence of fecal carriage of extended-spectrum ß-lactamase/AmpC-producing Enterobacteriaceae in cats and dogs. Front. Microbiol. 4: 242. <a href="http://dx.doi.org/10.3389/fmicb.2013.00242"><span class="Hyperlink">http://dx.doi.org/10.3389/fmicb.2013.00242</span></a> PMid:23966992 PMCid:PMC3745002</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Howard-DH--Scott-RD--Packard-R--Jones-D--2003-."></a>Howard DH, Scott RD, Packard R, Jones D (2003). The Global Impact of Drug Resistance. Clin. Infect. Dis. 36(1): S4–S10. <a href="http://dx.doi.org/10.1086/344656 "><span class="Hyperlink">http://dx.doi.org/10.1086/344656 </span></a>PMid:12516025</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Huber-H--Zweifel-C--Wittenbrink-MM--Stephan-R--2013"></a>Huber H, Zweifel C, Wittenbrink MM, Stephan R (2013). ESBL-producing uropathogenic <span class="CharOverride-6">Escherichia coli</span> isolated from dogs and cats in Switzerland. Vet. Microbiol. 162(2-4): 992–996.  <a href="http://dx.doi.org/10.1016/j.vetmic.2012.10.029"><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2012.10.029</span></a> PMid:23177909</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Hugonnard-M--Chalvet-Monfray-K--Dernis-J--Pouzot-Nevoret-C--Barth-l-my-A--Vialard-J--Goy-Thollot-I--"></a>Hugonnard M,&#160;Chalvet-Monfray K,&#160;Dernis J,&#160;Pouzot-Nevoret C,&#160;Barthélémy A,&#160;Vialard J,&#160;Goy-Thollot I (2013). Occurrence of bacteriuria in 18 catheterised cats with obstructive lower urinary tract disease: a pilot study. J. Feline Med. Surg. 15(10): 843-8. <a href="http://dx.doi.org/10.1177/1098612X13477414 "><span class="Hyperlink">http://dx.doi.org/10.1177/1098612X13477414 </span></a>PMid:23400682</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Indra-A--Lassnig-H--Baliko-N--Much-P--Fiedler-A--Huhulescu-S--Allerberger-F--2009"></a>Indra A, Lassnig H, Baliko N, Much P, Fiedler A, Huhulescu S, Allerberger F (2009). <span class="CharOverride-6">Clostridium difficile</span>: a new zoonotic agent? Wien. Klin. Wochenschr. 121(3-4): 91–95. <a href="http://dx.doi.org/10.1007/s00508-008-1127-x"><span class="Hyperlink">http://dx.doi.org/10.1007/s00508-008-1127-x</span></a> PMid:19280132</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Ikeda-JS--Hirsh-DC--1985-"></a>Ikeda JS, Hirsh DC (1985). Common plasmid encoding resistance to ampicillin, chloramphenicol, gentamicin, and trimethoprim-sulfadiazine in two serotypes of <span class="CharOverride-6">Salmonella</span> isolated during an outbreak of equine salmonellosis. Am. J. Vet. Res. 46(4): 769–73.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Jevons-MP--1961"></a>Jevons MP (1961). ‘‘Celbenin’’-resistant <span class="CharOverride-6">staphylococci</span>. Br. Med. J. 1(5219): 124–125. <a href="http://dx.doi.org/10.1136/bmj.1.5219.124-a"><span class="Hyperlink">http://dx.doi.org/10.1136/bmj.1.5219.124-a</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Johnson-JA--2002"></a>Johnson JA (2002). Nosocomial infections. Vet. Clin .Small Anima. Pract. 32(5): 1101-1126. <a href="http://dx.doi.org/10.1016/S0195-5616(02)00038-4"><span class="Hyperlink">http://dx.doi.org/10.1016/S0195-5616(02)00038-4</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Jones-SL--2008-."></a>Jones SL (2008). Medical disorders of the large colon. In: Smith, B.P. (Ed.), Large Animal Internal Medicine, fourth ed. Mosby Elsevier, St. Louis, USA, pp. 743–744.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Jones-ID--Case-AM--Stevens-KB--Boag-A--Rycroft-AN--2009"></a>Jones ID, Case AM, Stevens KB, Boag A, Rycroft AN (2009). Factors contributing to the contamination of peripheral intravenous catheters in dogs and cats. The Vet. Rec. 164(20): 616–618. <a href="http://dx.doi.org/10.1136/vr.164.20.616"><span class="Hyperlink">http://dx.doi.org/10.1136/vr.164.20.616</span></a> PMid:19448253</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Jordan-D--Simon-J--Fury-S--Moss-S--Giffard-P--Maiwald...2011"></a> Jordan D, Simon J, Fury S, Moss S, Giffard P, Maiwald M, Southwell P, Barton MD, Axon JE, Morris SG, Trott DJ (2011). Carriage of methicillin-resistant<span class="CharOverride-6"> S. aureus </span>by veterinarians in Australia. Aust. Vet. J. 89(5): 152–159. <a href="http://dx.doi.org/10.1111/j.1751-0813.2011.00710.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1751-0813.2011.00710.x</span></a> PMid:21495985</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Julian-T--Singh-A--Rousseau-J--Weese-JS--2012-."></a>Julian T,<span class="CharOverride-17"> </span>Singh A,<span class="CharOverride-17">&#160;</span>Rousseau J,<span class="CharOverride-17">&#160;</span>Weese JS (2012). Methicillin-resistant staphylococcal contamination of cellular phones of personnel in a veterinary teaching hospital.<span class="CharOverride-6"> </span>BMC Res.  Notes.<span class="CharOverride-6"> </span>5: 193.&#160;<a href="http://dx.doi.org/10.1186/1756-0500-5-193"><span class="Hyperlink">http://dx.doi.org/10.1186/1756-0500-5-193</span></a> PMid:22533923 PMCid:PMC3393609</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Kampf-G--Rudolf-M--Labadie-JC--Barrett-SP--2002-."></a>Kampf G, Rudolf M, Labadie JC, Barrett SP (2002). Spectrum of antimicrobial activity and user acceptability of the hand disinfectant agent Sterillium gel. J. Hosp. Infect. 52(2): 141–147. <a href="http://dx.doi.org/10.1053/jhin.2002.1281"><span class="Hyperlink">http://dx.doi.org/10.1053/jhin.2002.1281</span></a> PMid:12392906</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Keessen-EC--Hensgens-MP--Spigaglia-P--Barbanti-F--Sanders-IM--Kuijper-EJ--Lipman-LJ--2013"></a>Keessen EC,&#160;Hensgens MP,&#160;Spigaglia P,&#160;Barbanti F,&#160;Sanders IM,&#160;Kuijper EJ,&#160;Lipman LJ (2013). Antimicrobial susceptibility profiles of human and piglet <span class="CharOverride-6">Clostridium difficile </span>PCR-ribotype 078. Antimicrob. Resist. Infect. Control. 2:14. <a href="http://dx.doi.org/10.1186/2047-2994-2-14 "><span class="Hyperlink">http://dx.doi.org/10.1186/2047-2994-2-14 </span></a>PMid:23566553 PMCid:PMC3651393</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Kempf-M.--Rolain-J.M--2012-"></a>Kempf M., Rolain J.M (2012). Emergence of resistance to carbapenems in <span class="CharOverride-6">Acinetobacter baumannii</span> in Europe: clinical impact and therapeutic options. Int. J. Antimicrob. Agents. 39(2): 105–114. <a href="http://dx.doi.org/10.1016/j.ijantimicag.2011.10.004 "><span class="Hyperlink">http://dx.doi.org/10.1016/j.ijantimicag.2011.10.004 </span></a>PMid:22113193</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Kevin-JC--Lorraine-DR--Katharyn-JM--Karin...-2014"></a>Kevin JC, Lorraine DR, Katharyn JM, Karin H, Martin W, Patrick ML, Craig A, Lorin DW,  Gillian AP (2014). <span class="CharOverride-6">Salmonella enterica</span><span class="CharOverride-17">&#160;</span>Serovar Oranienburg Outbreak in a Veterinary Medical Teaching Hospital with Evidence of Nosocomial and On-Farm Transmission. Vector-Borne  Zoonotic Dis. 14(7): 496-502. </li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Kim-LM--Morley-PS--Traub-Dargatz-JL--Salman-MD--Gentry-Weeks-C--2001-"></a>Kim LM, Morley PS, Traub-Dargatz JL, Salman MD, Gentry-Weeks C (2001). Factors associated with <span class="CharOverride-6">Salmonella </span>shedding among equine colic patients at a veterinary teaching hospital. J Am Vet Med Assoc. 218(5): 740-748. <a href="http://dx.doi.org/10.2460/javma.2001.218.740"><span class="Hyperlink">http://dx.doi.org/10.2460/javma.2001.218.740</span></a> PMid:11280409</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Konkle-DM--Nelson-KM--Lunn-DP--1997-"></a>Konkle DM, Nelson KM, Lunn DP (1997). Nosocomial transmission of <span class="CharOverride-6">Cryptosporidium </span>in a veterinary hospital. J. Vet. Intern. Med. 11(6), 340-343. <a href="http://dx.doi.org/10.1111/j.1939-1676.1997.tb00477.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1939-1676.1997.tb00477.x</span></a> PMid:9470158</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="KuKanich-KS--Ghosh-A--Skarbek-JV--Lothamer-KM--Zurek-L--2012-"></a>KuKanich KS, Ghosh A, Skarbek JV, Lothamer KM, Zurek L (2012). Surveillance of bacterial contamination in small animal veterinary hospitals with special focus on antimicrobial resistance and virulence traits of enterococci. J Am Vet Med Assoc. 240(4): 437–445. <a href="http://dx.doi.org/10.2460/javma.240.4.437"><span class="Hyperlink">http://dx.doi.org/10.2460/javma.240.4.437</span></a> PMid:22309016</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Kwon-NH--Park-KT--Moon-JS--Jung-WK--Kim-SH--Kim-JM--Hong-SK--Koo-HC--Joo-YS--Park-YH--2005"></a>Kwon NH, Park KT, Moon JS, Jung WK, Kim SH, Kim JM, Hong SK, Koo HC, Joo YS, Park YH (2005). Staphylococcal cassette chromosome mec (SCCmec) characterization and molecular analysis for methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus</span> and novel SCCmec subtype IVg isolated from bovine milk in Korea. J. Antimicrobial. Chemo. 56(4): 624–632. <a href="http://dx.doi.org/10.1093/jac/dki306 "><span class="Hyperlink">http://dx.doi.org/10.1093/jac/dki306 </span></a>PMid:16126781</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Kwon-KH--Moon-BY--Hwang-SY--Park-YH--2012"></a>Kwon KH, Moon BY, Hwang SY, Park YH (2012). Detection of CC17 <span class="CharOverride-6">Enterococcus faecium </span>in Dogsanda Comparison with Human Isolates. Zoonoses Public Health. 59(6): 375–378. <a href="http://dx.doi.org/10.1111/j.1863-2378.2012.01466.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1863-2378.2012.01466.x</span></a>  PMid:22372965</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Laarhoven-LM--de-Heus-P--van-Luijn-J--Duim-B--Wagenaar-JA--van-Duijkeren-E--2011"></a>Laarhoven LM, de Heus P, van Luijn J, Duim B, Wagenaar JA, van Duijkeren E (2011)<span class="CharOverride-17">. </span>Longitudinal study on methicillin-resistant <span class="CharOverride-6">staphylococcus pseudintermedius</span> in Households. PLoS One<span class="CharOverride-17">.&#160;</span>6:e27788. <a href="http://dx.doi.org/10.1371/journal.pone.0027788"><span class="Hyperlink">http://dx.doi.org/10.1371/journal.pone.0027788</span></a> PMid:22132141 PMCid:PMC3223215</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Landry-SL--Donowitz-LG--Wenzel-RP--1982-."></a>Landry SL, Donowitz LG, Wenzel RP (1982). Hospital-wide surveillance:perspective for the practitioner. Am. J. Infect. Control. 10(2): 66-67. <a href="http://dx.doi.org/10.1016/0196-6553(82)90005-0"><span class="Hyperlink">http://dx.doi.org/10.1016/0196-6553(82)90005-0</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Larson-EL--Leyden-JJ--McGinley-KJ--Grove-GL--Talbot-GH--1986"></a>Larson EL, Leyden JJ, McGinley KJ, Grove GL, Talbot GH (1986). Physiologic and microbiologic changes in skin related to frequent handwashing. Infect. Control Hosp. Epidemiol. 7(2): 59–63</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Lee-JH--2003-."></a>Lee JH (2003). Methicillin (oxacillin)-resistant <span class="CharOverride-6">Staphylococcus aureus</span> strains isolated from major food animals and their potential transmission to humans. Appl. Environ. Microbiol. 69(11): 6489–6494. <a href="http://dx.doi.org/10.1128/AEM.69.11.6489-6494.2003"><span class="Hyperlink">http://dx.doi.org/10.1128/AEM.69.11.6489-6494.2003</span></a> PMid:14602604 PMCid:PMC262320</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Leonard-FC--Abbott-Y--Rossney-A--Quinn-PJ--O-Mahony-R--Markey-BK--2006-."></a>Leonard FC, Abbott Y, Rossney A, Quinn PJ, O’Mahony R, Markey BK (2006). Methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus</span> isolated from a veterinary surgeon and five dogs in one practice. Vet. Rec. 158(5): 155–159. <a href="http://dx.doi.org/10.1136/vr.158.5.155"><span class="Hyperlink">http://dx.doi.org/10.1136/vr.158.5.155</span></a> PMid:16461622</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Leonard-FC--Markey-BK--2008-."></a>Leonard FC, Markey BK (2008). Meticillin-resistant <span class="CharOverride-6">Staphylococcus aureus</span> in animals: A review. Vet. J. 175(1):27–36. <a href="http://dx.doi.org/10.1016/j.tvjl.2006.11.008"><span class="Hyperlink">http://dx.doi.org/10.1016/j.tvjl.2006.11.008</span></a> PMid:17215151</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Levin-BR--Rozen-DE--2006-"></a>Levin BR, Rozen DE (2006). Non-inherited antibiotic resistance. Nature Rev.  Microbiol. 4(7): 556–562. <a href="http://dx.doi.org/10.1038/nrmicro1445 "><span class="Hyperlink">http://dx.doi.org/10.1038/nrmicro1445 </span></a>PMid:16778840</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Lloyd-DH--2007-"></a>Lloyd DH (2007). Reservoirs of Antimicrobial Resistance in Pet Animals. Clin Infect Dis. 45: Suppl.2: 148–152. <a href="http://dx.doi.org/10.1086/519254"><span class="Hyperlink">http://dx.doi.org/10.1086/519254</span></a> PMid:17683019</li>
                <p>&nbsp;</p>
          <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Lobetti-RG--Joubert-KE--Picard-J--Carstens-J--Pretorius-E--2002-."></a>Lobetti RG, Joubert KE, Picard J, Carstens J, Pretorius E (2002). Bacterial colonization of intravenous catheters in young dogs suspected to have parvoviral enteritis. J. Am. Vet. Med. Assoc. 220(9): 1321–1324. <a href="http://dx.doi.org/10.2460/javma.2002.220.1321 "><span class="Hyperlink">http://dx.doi.org/10.2460/javma.2002.220.1321 </span></a>PMid:11991409</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Loeffler-A--Boag-AK--Sung-J--Lindsay-JA--Guardabassi-L--Dalsgaard-A--Lloyd-DH--2005-"></a>Loeffler A, Boag AK, Sung J, Lindsay JA, Guardabassi L, Dalsgaard A, Lloyd DH (2005). Prevalence of methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus </span>among staff and pets in a small animal referral hospital in the UK. J. Antimicrobial. Chemo. 56(4): 692–697. <a href="http://dx.doi.org/10.1093/jac/dki312 "><span class="Hyperlink">http://dx.doi.org/10.1093/jac/dki312 </span></a>PMid:16141276</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Loeffler-A--Pfeiffer-DU--Lloyd-DH--Smith-H--Soares-Magalhaes-R--Lindsay-JA--2010"></a>Loeffler A, Pfeiffer DU, Lloyd DH, Smith H, Soares-Magalhaes R, Lindsay JA (2010). Methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus</span> carriage in UK veterinary staff and owners of infected pets: new risk groups. J. Hosp. Infect.<span class="CharOverride-17">&#160;</span>74(3): 282–288.<span class="CharOverride-17">&#160; </span><a href="http://dx.doi.org/10.1016/j.jhin.2009.09.020 "><span class="Hyperlink">http://dx.doi.org/10.1016/j.jhin.2009.09.020 </span></a>PMid:20080322</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Lombardo-J--Burkom-H--Elbert-E--Magruder-S--Lewis-SH--Loschen-W--Pavlin-J--2003"></a>Lombardo J, Burkom H, Elbert E, Magruder S, Lewis SH, Loschen W, Pavlin J (2003). A systems overview of the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE II). J. Urban Health. 80(2 Suppl 1): i32–142.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Low-JC--Tennant-B--Munro-D--1996-"></a>Low JC, Tennant B, Munro D (1996). Multiple-resistant <span class="CharOverride-6">Salmonella typhimurium</span> DT104 in cats. Lancet. 348: 1391.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Lynch-AS--Robertson-GT--2008-"></a>Lynch AS, Robertson GT (2008). Bacterial and Fungal Biofilm Infections. Annu. Rev. Med. 59: 415–428. <a href="http://dx.doi.org/10.1146/annurev.med.59.110106.132000"><span class="Hyperlink">http://dx.doi.org/10.1146/annurev.med.59.110106.132000</span></a> PMid:17937586</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Ma-J--Zeng-Z--Chen-Z--Xu-X--Wang-X--Deng-Y--Lu-D--Huang-L--Zhang-Y--Liu-J--Wang-M--2009"></a>Ma J, Zeng Z, Chen Z, Xu X, Wang X, Deng Y, Lu D, Huang L, Zhang Y, Liu J, Wang M (2009). High prevalence of plasmid-mediated quinolone resistance determinants qnr, aac(6’)-Ib-cr, and qepA among ceftiofur-resistant Enterobacteriaceae isolates from companion and food-producing animals. Antimicrob. Agents Chemother. 53(2): 519–524. <a href="http://dx.doi.org/10.1128/AAC.00886-08"><span class="Hyperlink">http://dx.doi.org/10.1128/AAC.00886-08</span></a> PMid:18936192 PMCid:PMC2630616</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Madewell-BR--Tang-YJ--Jang-S--Madigan-JE--Hirsh-DC--Gumerlockm-PH--Silva-J--1995-."></a>Madewell BR, Tang YJ, Jang S, Madigan JE, Hirsh DC, Gumerlockm PH, Silva J (1995). Apparent outbreaks of <span class="CharOverride-6">Clostridium difficile</span>-associated diarrhea in horses in a veterinary medical teaching hospital. J. Vet. Diagn. Invest. 7(3): 343–346. <a href="http://dx.doi.org/10.1177/104063879500700308"><span class="Hyperlink">http://dx.doi.org/10.1177/104063879500700308</span></a> PMid:7578449</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Major-RH--1954-"></a>Major RH (1954). A history of medicine<span class="CharOverride-6">. </span>Springfield, IL: Charles C. Thomas. Pp 950-951.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Malik-S--Peng-H--Barton-M--2006-"></a>Malik S, Peng H, Barton M (2006). Partial nucleotide sequencing of the mecA genes of <span class="CharOverride-6">Staphylococcus aureus</span> isolates from dogs and cats. J. Clin. Microbiol. 44(2): 413–416. <a href="http://dx.doi.org/10.1128/JCM.44.2.413-416.2006"><span class="Hyperlink">http://dx.doi.org/10.1128/JCM.44.2.413-416.2006</span></a> PMid:16455893 PMCid:PMC1392638</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Manian-FA--2003"></a>Manian FA (2003). Asymptomatic nasal carriage of mupirocin-resistant, methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus</span> (MRSA) in a pet dog associated with MRSA infection in household contacts. Clin. Infect. Dis. 36(2): e26–e28. <a href="http://dx.doi.org/10.1086/344772"><span class="Hyperlink">http://dx.doi.org/10.1086/344772</span></a> PMid:12522764</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Mann-P--1959-."></a>Mann P (1959). Antibiotic sensitivity testing and bacteriophage typing of <span class="CharOverride-6">staphylococci</span> found in the nostrils of dogs and cats. J. Am. Vet. Med. Assoc. 134(10): 469–470.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Marshal-BM--Ochieng-DJ--Levy-SB--2009-."></a>Marshal BM, Ochieng DJ, Levy SB (2009).<span class="CharOverride-17">&#160;</span>Commensals: unappreciated reservoir of antibiotic resistance. Microbe.<span class="CharOverride-17">&#160;</span>4(5): 231-238.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Marsh-Ng-ML--Burney-DP--Garcia-J--2007-."></a>Marsh-Ng ML, Burney DP, Garcia J (2007).  Surveillance of infections associated with intravenous catheters in dogs and cats in an intensive care unit. J. Am. Anim. Hosp. Assoc. 43(1): 13-20. <a href="http://dx.doi.org/10.5326/0430013"><span class="Hyperlink">http://dx.doi.org/10.5326/0430013</span></a> PMid:17209080</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Mathews-KA--Brooks-MJ--Valliant-AE--1996-."></a>Mathews KA, Brooks MJ, Valliant AE (1996). A prospective study of intravenous catheter contamination. J. Vet. Emerg. Crit. Care. 6(1): 33-43. <a href="http://dx.doi.org/10.1111/j.1476-4431.1996.tb00032.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1476-4431.1996.tb00032.x</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Metan-G--Zarakolu-P--Unal-S--2005-."></a>Metan G, Zarakolu P, Unal S (2005). Rapid detection of antibacterial resistance in emerging Gram-positive cocci. J. Hosp. Infect. 61(2): 93–99. <a href="http://dx.doi.org/10.1016/j.jhin.2005.02.020"><span class="Hyperlink">http://dx.doi.org/10.1016/j.jhin.2005.02.020</span></a> PMid:16009459</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Middleton-JR--Fales-WH--Luby-CD--Oaks-JL--Sanchez-S--Kinyon-JM--Hartmann-F--2005"></a>Middleton JR, Fales WH, Luby CD, Oaks JL, Sanchez S, Kinyon JM, Hartmann F (2005). Surveillance of <span class="CharOverride-6">Staphylococcus aureus </span>in veterinary teaching hospitals. J. Clin. Microbiol. 43(6): 2916-2919. <a href="http://dx.doi.org/10.1128/JCM.43.6.2916-2919.2005 "><span class="Hyperlink">http://dx.doi.org/10.1128/JCM.43.6.2916-2919.2005 </span></a>PMid:15956418 PMCid:PMC1151956</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Mielke-M--2010-"></a>Mielke M (2010). Prevention and control of nosocomial infections and resistance to antibiotics in Europe – Primum non-nocere: Elements of successful prevention and control of healthcare-associated infections. Int. J. Med.  Microbiol. 300(6): 346–350. <a href="http://dx.doi.org/10.1016/j.ijmm.2010.04.004"><span class="Hyperlink">http://dx.doi.org/10.1016/j.ijmm.2010.04.004</span></a> PMid:20451448</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Moodley-A--Stegger-M--Bagcigil-AF--Baptiste...-2006"></a>Moodley A, Stegger M, Bagcigil AF, Baptiste KE, Loeffler A, Lloyd DH, Williams NJ, Leonard N, Abbott Y, Skov R, Guardabassi L (2006). Spa typing of methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus</span> isolated from domestic animals and veterinary staff in theUK and Ireland. J. Antimicrobial. Chemo. 58(6): 1118–1123. <a href="http://dx.doi.org/10.1093/jac/dkl394"><span class="Hyperlink">http://dx.doi.org/10.1093/jac/dkl394</span></a> PMid:17030517</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Morley-PS--2002"></a>Morley PS (2002). Biosecurity of veterinary practices. Vet. Clin: Food Anim. Pract. 18(1): 133–155.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Morley-PS--2004-."></a>Morley PS (2004). Surveillance for nosocomial infections in veterinary hospitals. Vet. Clin: Equine Pract. 20(3): 561-576. <a href="http://dx.doi.org/10.1016/j.cveq.2004.08.002"><span class="Hyperlink">http://dx.doi.org/10.1016/j.cveq.2004.08.002</span></a> PMid:15519818</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Morley-PS--Apley-MD--Besser-TE--Burney-DP--Fedorka-Cray-PJ--2005"></a>Morley PS, Apley MD, Besser TE, Burney DP, Fedorka-Cray PJ (2005). Antimicrobial drug use in veterinary medicine. J. Vet. Intern. Med. 19(4): 617–629. <a href="http://dx.doi.org/10.1111/j.1939-1676.2005.tb02739.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1939-1676.2005.tb02739.x</span></a> PMid:16095186</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Morley-PS--Weese-JS--2008-."></a>Morley PS  Weese JS (2008). Biosecurity and infection control for large animal practice. In B. P. Smith (ed.) Large animal internal medicine. 4th ed. (510-527). New York: Elsevier</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Mostashari-F--Hartman-J--2003-."></a>Mostashari F, Hartman J (2003). Syndromic surveillance: a local perspective. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 80(2): i1-i7.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Murray-A--Dineen-A--Kelly-P--McGoey-K--Madigan-G--Nighallchoir-E--Gunn-Moore-DA--2014-."></a>Murray A,&#160;Dineen A,&#160;Kelly P,&#160;McGoey K,&#160;Madigan G,&#160;Nighallchoir E,&#160;Gunn-Moore DA (2014). Nosocomial spread of Mycobacterium bovis in domestic cats. J. Feline Med. Surg.&#160;Apr 7. [Epub ahead of print]. </li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Murphy-C--Reid-Smith-RJ--Prescott-JF--Bonnett-BN--Poppe-C--Boerlin-P--Weese-JS--Janecko-N--McEwen-SA"></a>Murphy C, Reid-Smith RJ, Prescott JF, Bonnett BN, Poppe C, Boerlin P, Weese JS, Janecko N, McEwen SA (2009). Occurrence of antimicrobial resistant bacteria in healthy dogs and cats presented to private veterinary hospitals in southern Ontario: a preliminary study. Can. Vet. J.&#160;50(10): 1047-53.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="National-Nosocomial-Infections-Surveillance--NNIS--System.--1991"></a>National Nosocomial Infections Surveillance (NNIS) System. (1991). Nosocomial infection rates for interhospital comparison: limitations and possible solutions. Infect. Control Hosp. Epidemiol. 12(10): 609-621. <a href="http://dx.doi.org/10.2307/30145247 "><span class="Hyperlink">http://dx.doi.org/10.2307/30145247 </span></a>PMid:1664844          </li>
		  <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Nicholson-M--Beal-M--Shofer-F--Brown-DC--2002-"></a>Nicholson M, Beal M, Shofer F, Brown DC (2002). Epidemiologic evaluation of postoperative wound infection in clean-contaminated wounds: a retrospective study of 239 dogs and cats. Vet. Surg.  31(6): 577-581. <a href="http://dx.doi.org/10.1053/jvet.2002.34661"><span class="Hyperlink">http://dx.doi.org/10.1053/jvet.2002.34661</span></a> PMid:12415527</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Nienhoff-U--Kadlec-K--Chaberny-IF--Verspohl-J--Gerlach-GF--Kreienbrock-L--Schwarz-S--2011"></a>Nienhoff U, Kadlec K, Chaberny IF, Verspohl J, Gerlach GF, Kreienbrock L, Schwarz S (2011). Methicillin-resistant <span class="CharOverride-6">Staphylococcus pseudintermedius</span> among dogs admitted to a small animal hospital. Vet. Microbiol.&#160;150(1-2):191-197. <a href="http://dx.doi.org/10.1016/j.vetmic.2010.12.018"><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2010.12.018</span></a> PMid:21247709</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="O-Keefe-A--Hutton-TA--Schifferli-DM--Rankin-SC--2010-"></a>O’Keefe A, Hutton TA, Schifferli DM, Rankin SC (2010). First detection of CTX-M and SHV extended-spectrum beta-lactamases in <span class="CharOverride-6">Escherichia coli</span> urinary tract isolates from dogs and cats in the United States. Antimicrob. Agents and Chemother. 54(8): 3489–3492. <a href="http://dx.doi.org/10.1128/AAC.01701-09"><span class="Hyperlink">http://dx.doi.org/10.1128/AAC.01701-09</span></a> PMid:20479196 PMCid:PMC2916344</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="O-Mahony-R--Abbott-Y--Leonard-FC--Markey-BK--Quinn-PJ--Pollock-PJ--Rossney-AS--2005-."></a>O’Mahony R, Abbott Y, Leonard FC, Markey BK, Quinn PJ, Pollock PJ, Rossney AS (2005). Methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus </span>(MRSA) isolated from animals and veterinary personnel in Ireland. Vet. Microbiol. 109(3-4): 285-296. <a href="http://dx.doi.org/10.1016/j.vetmic.2005.06.003 "><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2005.06.003 </span></a>PMid:16026939</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Oteo-J--Cercenado-E--Cuevas-O--Bautista-V--Delgado--...2010"></a>Oteo J, Cercenado E, Cuevas O, Bautista V, Delgado-Iribarren A, Orden B, Perez-Vazquez M, Garcı´a-Cobos S, Campos J (2010). AmpC beta-lactamases in <span class="CharOverride-6">Escherichia coli</span>: emergence of CMY-2-producing virulent phylogroup D isolates belonging mainly to STs 57, 115, 354, 393, and 420, and phylogroup B2 isolates belonging to the international clone O25b-ST131. Diagn. Microbiol. Infect. Dis. 67(3): 270–276. <a href="http://dx.doi.org/10.1016/j.vetmic.2005.06.003"><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2005.06.003</span></a> PMid:16026939</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Owens-CD--Stoessel-K--2008-"></a>Owens CD, Stoessel K (2008). Surgical site infections: epidemiology, microbiology and prevention. J. Hosp. Infect.<span class="CharOverride-17">&#160;</span>70(2): 3-10. <a href="http://dx.doi.org/10.1016/S0195-6701(08)60017-1"><span class="Hyperlink">http://dx.doi.org/10.1016/S0195-6701(08)60017-1</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Pak-SI--Han-HR--Shimizu-A--1999-.-C"></a>Pak SI, Han HR, Shimizu A (1999). Characterization of methicillinresistant <span class="CharOverride-6">Staphylococcus aureus</span> isolated from dogs in Korea. J. Vet. Med. Sci. 61(9): 1013–1018. <a href="http://dx.doi.org/10.1292/jvms.61.1013 "><span class="Hyperlink">http://dx.doi.org/10.1292/jvms.61.1013 </span></a>PMid:10535519</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Pandya-M--Wittum-T--Tadesse-DA--Gebreyes-W--Hoet-A--2009"></a>Pandya M, Wittum T, Tadesse DA, Gebreyes W, Hoet A (2009). Environmental <span class="CharOverride-6">Salmonella </span>surveillance in The Ohio State University Veterinary Teaching Hospital. Vector Borne and Zoonotic Dis<span class="CharOverride-6">. </span>9(6): 649-654. <a href="http://dx.doi.org/10.1089/vbz.2008.0120 "><span class="Hyperlink">http://dx.doi.org/10.1089/vbz.2008.0120 </span></a>PMid:19272003</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Panlilio-AL--Culver-DH--Gaynes-RP--Banerjee-S--Henderson-TS--Tolson-JS--Martone-WJ--1992-"></a>P<a id="anlilio-AL--Culver-DH--Gaynes-RP--Banerjee-S--Henderson-TS--Tolson-JS--Martone-WJ--1992-."></a>anlilio AL, Culver DH, Gaynes RP, Banerjee S, Henderson TS, Tolson JS, Martone WJ (1992). Methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus</span> in US hospitals, 1975–1991. Infect. Control Hosp. Epidemiol. 13(10): 582–586. <a href="http://dx.doi.org/10.2307/30148460"><span class="Hyperlink">http://dx.doi.org/10.2307/30148460</span></a> PMid:1469266</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Pitout-JDD--2010-"></a>Pitout JDD (2010).  Infections with extended-spectrum beta-lactamaseproducing enterobacteriaceae: changing epidemiology and drug treatment choices. Drugs. 70(3): 313–333. <a href="http://dx.doi.org/10.2165/11533040-000000000-00000"><span class="Hyperlink">http://dx.doi.org/10.2165/11533040-000000000-00000</span></a> PMid:20166768</li>
                <p>&nbsp;</p>
          <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Poeta-P--Costa-D--Rodrigues-J--Torres-C.--2006-."></a>Poeta P, Costa D, Rodrigues J, Torres C. (2006). Antimicrobial resistance and the mechanisms implicated in faecal enterococci from healthy humans, poultry and pets in Portugal. Int. J. Antimicrob. Agents. 27(2): 131–137. <a href="http://dx.doi.org/10.1016/j.ijantimicag.2005.09.018"><span class="Hyperlink">http://dx.doi.org/10.1016/j.ijantimicag.2005.09.018</span></a> PMid:16388931</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Pottinger--JM--Herwaldt-LA--Perl-TM--1997-."></a>Pottinger, JM, Herwaldt LA, Perl TM (1997). Basics of surveillance – an overview. Infect. Control Hosp. Epidemiol. 18(7): 513–527. <a href="http://dx.doi.org/10.1086/647659"><span class="Hyperlink">http://dx.doi.org/10.1086/647659</span></a> PMid:9247837</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Rich-M--Roberts-L--2004-."></a>Rich M, Roberts L (2004). Methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus</span> isolates from companion animals. Vet. Rec. 154(10): 310–17.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Rich-M--Roberts-L--Deighton-L--2005-"></a>Rich M, Roberts L, Deighton L (2005). Clindamycin resistance in methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus</span> isolated from animals. Vet. Microbiol. 111(3-4): 237-40. <a href="http://dx.doi.org/10.1016/j.vetmic.2005.09.011"><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2005.09.011</span></a> PMid:16289541</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Roberts-MC--O-Boyle-DA--1981-.-T"></a>Roberts MC, O’Boyle DA (1981). The prevalence and epizootiology of salmonellosis among groups of horses in south-east Queensland. Aust. Vet. J. 57(1): 27–35. <a href="http://dx.doi.org/10.1111/j.1751-0813.1981.tb07081.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1751-0813.1981.tb07081.x</span></a> PMid:7236142</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Rodriguez-Palacios-A--Reid-Smith-RJ--Staempfli...2009"></a>Rodriguez-Palacios A, Reid-Smith RJ, Staempfli HR, Daignault D, Janecko N, Avery BP, Martin H, Thomspon AD, McDonald LC, Limbago B, Weese JS (2009). Possible seasonality of Clostridium difficile in retail meat, Canada. Emerg. Infect. Dis. 15(5): 802–805. <a href="http://dx.doi.org/10.3201/eid1505.081084"><span class="Hyperlink">http://dx.doi.org/10.3201/eid1505.081084</span></a> PMid:19402975 PMCid:PMC2687045</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Rubin-JE--Pitout-JDD--2014-"></a>Rubin JE, Pitout JDD (2014). Extended-spectrum b-lactamase, carbapenemase and AmpC producing Enterobacteriaceae in companion animals. Vet. Microbiol. 170(1-2): 10–18. <a href="http://dx.doi.org/10.1016/j.vetmic.2014.01.017"><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2014.01.017</span></a> PMid:24576841</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Ruby-R--Magdesian-KG--Kass-PH--2009-"></a>Ruby R, Magdesian KG, Kass PH (2009). Comparison of clinical microbiologic, and clinicopathologic findings in horses positive and negative for <span class="CharOverride-6">Clostridium difficile</span> infection. J. Am. Vet. Med. Assoc. 234(6): 777–784. <a href="http://dx.doi.org/10.2460/javma.234.6.777"><span class="Hyperlink">http://dx.doi.org/10.2460/javma.234.6.777</span></a> PMid:19284345</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Ruple-Czerniak-A--Aceto-HW--Bender-JB--Paradis...2013"></a>Ruple-Czerniak A, Aceto HW, Bender JB, Paradis MR, Shaw SP, Van Metre DC, Weese JS, Wilson DA, Wilson JH, Morley PS (2013). Using Syndromic Surveillance to Estimate Baseline Rates for Healthcare-Associated Infections in Critical Care Units of Small Animal Referral Hospitals. J. Vet. Intern. Med. 27(6):&#160;1392–1399. <a href="http://dx.doi.org/10.1111/jvim.12190"><span class="Hyperlink">http://dx.doi.org/10.1111/jvim.12190</span></a> PMid:24134779</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Ruple-Czerniak-AA--Aceto-HW--Bender-JB--Paradis-...-2014"></a>Ruple-Czerniak AA, Aceto HW, Bender JB, Paradis MR, Shaw SP, Van Metre DC, Weese JS, Wilson DA, Wilson J, Morley PS (2014). Syndromic surveillance for evaluating the occurrence of healthcare-associated infections in equine hospitals. Equine. Vet. J. 46(4):&#160;435–440. <a href="http://dx.doi.org/10.1111/evj.12190"><span class="Hyperlink">http://dx.doi.org/10.1111/evj.12190</span></a> PMid:24028074</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><span class="CharOverride-17"><a id="Rupnik-M--Wilcox-MH--Gerding-DN--2009-."></a>Rupnik M, Wilcox MH, Gerding DN (2009)</span>. <span class="CharOverride-6">Clostridium difficile</span><span class="CharOverride-17">&#160;</span>infection: new developments in epidemiology and pathogenesis. Nature Rev. Microbiol.<span class="CharOverride-17">&#160;</span>7(7): 526-536. <a href="http://dx.doi.org/10.1038/nrmicro2164"><span class="Hyperlink">http://dx.doi.org/10.1038/nrmicro2164</span></a> PMid:19528959</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Sabino-CV--Weese-JS--2006-"></a>Sabino CV, Weese JS (2006). Contamination of multiple-dose vials in a veterinary hospital. Can. Vet. J. 47(8): 779-782.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Sanchez-S--Stevenson-MAM--Hudson-CR--Maier-M--Buffington-T--Dam-Q--Maurer-JJ--2002"></a>Sanchez S, Stevenson MAM, Hudson CR, Maier M, Buffington T, Dam Q, Maurer JJ (2002). Characterization of Multidrug-Resistant <span class="CharOverride-6">Escherichia coli </span>Isolates Associated with Nosocomial Infections in Dogs. J. Clin. Microbiol. 40(10): 3586–3595. <a href="http://dx.doi.org/10.1128/JCM.40.10.3586-3595.2002"><span class="Hyperlink">http://dx.doi.org/10.1128/JCM.40.10.3586-3595.2002</span></a> PMid:12354850 PMCid:PMC130861</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Sax-H--Pittet-D--and-the-Swiss-NOSO-network--2002-"></a>Sax H, Pittet D, and the Swiss-NOSO network (2002). Interhospital differences in nosocomial infection rates. Arch. Intern.  Med. 162(21): 2437–2442. <a href="http://dx.doi.org/10.1001/archinte.162.21.2437"><span class="Hyperlink">http://dx.doi.org/10.1001/archinte.162.21.2437</span></a> PMid:12437402</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Sax-H--Uckay-I--Richet-H--Allegranzi-B--Pittet-D--2007-."></a>Sax H, Uckay I, Richet H, Allegranzi B, Pittet D (2007). Determinants of good    adherence to hand hygiene among healthcare workers who have extensive exposure to hand   hygiene campaigns. Infect. Control Hosp. Epidemiol. 28(11): 1267–1274. <a href="http://dx.doi.org/10.1086/521663"><span class="Hyperlink">http://dx.doi.org/10.1086/521663</span></a> PMid:17926278</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Schelenz-S--French-G--2000-"></a>Schelenz S, French G (2000). An outbreak of multidrug-resistant <span class="CharOverride-6">Pseudomonas aeruginosa </span>infection associated with contamination of bronchoscopes and an endoscope washer-disinfector. J. Hosp. Infect. 46(1): 23–30. <a href="http://dx.doi.org/10.1053/jhin.2000.0800"><span class="Hyperlink">http://dx.doi.org/10.1053/jhin.2000.0800</span></a> PMid:11023719</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Schneeberg-A--Rupnik-M--Neubauer-H--Seyboldt-C--2012"></a>Schneeberg A,&#160;Rupnik M,&#160;Neubauer H,&#160;Seyboldt C (2012). Prevalence and distribution of <span class="CharOverride-6">Clostridium difficile</span> PCR ribotypes in cats and dogs from animal shelters in Thuringia, Germany. Anaerobe.&#160;18(5):484–488. <a href="http://dx.doi.org/10.1016/j.anaerobe.2012.08.002"><span class="Hyperlink">http://dx.doi.org/10.1016/j.anaerobe.2012.08.002</span></a> PMid:22951303</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Schott-HC--Ewart-SL--Walker-RD--Dwyer-RM--Dietrich-S--Eberhart-SW--Derksen-FJ--2001-."></a>Schott HC, Ewart SL, Walker RD, Dwyer RM, Dietrich S, Eberhart SW, Derksen FJ (2001). An outbreak of salmonellosis among horses at a veterinary teaching hospital. J. Am. Vet. Med. Assoc. 218(7): 1152–1159. <a href="http://dx.doi.org/10.2460/javma.2001.218.1152"><span class="Hyperlink">http://dx.doi.org/10.2460/javma.2001.218.1152</span></a> PMid:11318368</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Schwaber-MJ--Venezia-SN--Masarwa-S--Levy-...-2013"></a>Schwaber MJ, Venezia SN, Masarwa S, Levy ST, Adler A, Chmelnitsky I, Carmeli Y, Klement E, Steinman A (2013). Clonal transmission of a rare methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus</span> genotype between horses and staff at a veterinary teaching hospital. Vet. Microbiol. 162(2-4): 907–911. <a href="http://dx.doi.org/10.1016/j.vetmic.2012.11.020"><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2012.11.020</span></a> PMid:23265243</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Scott-GM--Thomson-R--Malone-Lee-J--Ridgway-GL--1988-"></a>Scott GM, Thomson R, Malone-Lee J, Ridgway GL (1988). Cross infection between animals and man: possible feline transmission of <span class="CharOverride-6">Staphylococcus aureus</span> infection in humans? J. Hosp. Infect. 12(1): 29–34. <a href="http://dx.doi.org/10.1016/0195-6701(88)90119-3"><span class="Hyperlink">http://dx.doi.org/10.1016/0195-6701(88)90119-3</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Seguin-JC--Walker-RD--Caron-JP--Kloos-WE--George-CG--Hollis-RJ--Pfaller-MA--1999"></a>Seguin JC, Walker RD, Caron JP, Kloos WE, George CG, Hollis RJ, Pfaller MA (1999). Methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus </span>outbreak in a veterinary teaching hospital: potential human-to-animal transmission. J. Clin. Microbiol. 37(5): 1459-1463.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Semmelweis-I--1848-"></a>Semmelweis I (1848). The etiology, concept, and prophylaxis of childbed fever. Translated by KC Carter. Madison: The University of Wisconsin Press.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Sieber-S--Gerber-V--Jandova-V--Rossano-A--Evison-JM--Perreten-V--2011-"></a>Sieber S, Gerber V, Jandova V, Rossano A, Evison JM, Perreten V (2011). Evolution of multidrug-resistant <span class="CharOverride-6">S. aureus</span> infections in horses and colonized personnel in an equine clinic between 2005 and 2010. Microb. Drug Resist. 17(3): 471–478. <a href="http://dx.doi.org/10.1089/mdr.2010.0188"><span class="Hyperlink">http://dx.doi.org/10.1089/mdr.2010.0188</span></a> PMid:21875361</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Simjee-S--White-DG--McDermott-PF--Wagner-DD--Zervos-MJ--Donabedian-SM--2002-."></a>Simjee S, White DG, McDermott PF, Wagner DD, Zervos MJ, Donabedian SM (2002). Characterization of Tn1546 in vancomycin-resistant Enterococcus<span class="CharOverride-6"> faecium </span>isolated from canine urinary tract infections: evidence of gene exchange between human and animal enterococci. J. Clin. Microbiol.<span class="CharOverride-6"> </span>40(12): 4659–4665. <a href="http://dx.doi.org/10.1128/JCM.40.12.4659-4665.2002"><span class="Hyperlink">http://dx.doi.org/10.1128/JCM.40.12.4659-4665.2002</span></a> PMid:12454168 PMCid:PMC154613</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Singh-A--Walker-M--Rousseau-J--Monteith-GJ--Weese-JS--2013-"></a>Singh A,&#160;Walker M,&#160;Rousseau J,&#160;Monteith GJ,&#160;Weese JS (2013). Methicillin-resistant staphylococcal contamination of clothing worn by personnel in a veterinary teaching hospital. Vet. Surg. 42(6): 643-648. <a href="http://dx.doi.org/10.1111/j.1532-950X.2013.12024.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1532-950X.2013.12024.x</span></a> PMid:23662728</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Shaheen-BW--Nayak-R--Foley-SL--Kweon-O--Deck-J--Park-M--Rafii-F--Boothe-DM--2011-."></a>Shaheen BW, Nayak R, Foley SL, Kweon O, Deck J, Park M, Rafii F, Boothe DM (2011). Molecular characterization of resistance to extended-spectrum cephalosporins in clinical <span class="CharOverride-6">Escherichia coli</span> isolates from companion animals in the United States. Antimicrob. Agents Chemother. 55(12): 5666–5675. http://dx.doi.org/10.1128/AAC.00656-11 PMid:21947397 PMCid:PMC3232758</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Smarick-SD--Haskins-SC.--Aldrich-J--Foley-JE--Kass-PH--Fudge-M--Ling-GV--2004-."></a>Smarick SD, Haskins SC., Aldrich J, Foley JE, Kass PH, Fudge M, Ling GV (2004). Incidence of catheter-associated urinary tract infection among dogs in a small animal intensive care unit. J. Am. Vet. Med. Assoc. 224(12): 1936–1940. <a href="http://dx.doi.org/10.2460/javma.2004.224.1936"><span class="Hyperlink">http://dx.doi.org/10.2460/javma.2004.224.1936</span></a> PMid:15230447</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Smith-MM--Vasseur-PB--Saunders-HM--1989-."></a>Smith MM, Vasseur PB, Saunders HM (1989). Bacterial growth associated with metallic implants in dogs. J. Am. Vet. Med. Assoc. 195(6): 765–767.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Smith-BP--2004-."></a>Smith BP (2004). Evolution of equine infection control programs. Vet. Clin: Equine Pract. 20(3): 521–530. <a href="http://dx.doi.org/10.1016/j.ajic.2004.04.002"><span class="Hyperlink">http://dx.doi.org/10.1016/j.ajic.2004.04.002</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Song-SJ--Lauber-C--Costello-EK--Lozupone-CA--Humphrey-G--2013-."></a>Song SJ, Lauber C, Costello EK, Lozupone CA, Humphrey G (2013). Cohabiting family members share microbiota with one another and with their dogs. Elife. 2: e00458.<span class="CharOverride-17">&#160; </span><a href="http://dx.doi.org/10.7554/eLife.00458"><span class="Hyperlink">http://dx.doi.org/10.7554/eLife.00458</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Steneroden-KK--Van-Metre-DC--Jackson-C--Morle-PS--2010-."></a>Steneroden KK, Van Metre DC, Jackson C, Morle PS (2010). Detection and control of a nosocomial outbreak caused by <span class="CharOverride-6">Salmonella </span>Newport at a large animal hospital. J. Vet. Intern. Med. 24(3): 606–616. <a href="http://dx.doi.org/10.1111/j.1939-1676.2010.0484.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1939-1676.2010.0484.x</span></a> PMid:20337913</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Stolle-I--Prenger-Berninghoff-E--Stamm-I--Scheufen...2013"></a>S<a id="tolle-I--Prenger-Berninghoff-E--Stamm-I--Scheufen-...-2013"></a>tolle I, Prenger-Berninghoff E, Stamm I, Scheufen S, Hassdenteufel E, Guenther S, Bethe A, Pfeifer Y, Ewers C (2013). Emergence of OXA-48 carbapenemase-producing <span class="CharOverride-6">Escherichia coli</span> and <span class="CharOverride-6">Klebsiella pneumoniae</span> in dogs. J. Antimicrobial. Chemo. 68(12): 2802–2808. <a href="http://dx.doi.org/10.1093/jac/dkt259"><span class="Hyperlink">http://dx.doi.org/10.1093/jac/dkt259</span></a> PMid:23833179</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Stone-AB--Hautala-JA--2008-"></a>Stone AB, Hautala JA (2008). Meeting report: panel on the potential utility and strategies for design and implementation of a national companion animal infectious disease surveillance system. Zoonoses and Public Health. 55(8-10): 378–384. <a href="http://dx.doi.org/10.1111/j.1863-2378.2008.01129.x "><span class="Hyperlink">http://dx.doi.org/10.1111/j.1863-2378.2008.01129.x </span></a>PMid:18811903</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Suthar-N--Roy-S--Call-DR--Besser-TE--Davis-MA--2014-."></a>Suthar N, Roy S, Call DR, Besser TE, Davis MA (2014). An Individual-Based Model of Transmission of Resistant Bacteria in a Veterinary Teaching Hospital. PLoS ONE. 9(6): e98589.  <a href="http://dx.doi.org/10.1371/journal.pone.0098589 "><span class="Hyperlink">http://dx.doi.org/10.1371/journal.pone.0098589 </span></a>PMid:24893006 PMCid:PMC4043964</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Tillotson-K--Savage-CJ--Salman-MD--Gentry-Weeks-C--Rice-D--Fedorka-Cray-PJ--Traub-Dargatz-JL--1997-"></a>Tillotson K, Savage CJ, Salman MD, Gentry-Weeks C, Rice D, Fedorka-Cray PJ, Traub-Dargatz JL (1997). Outbreak of <span class="CharOverride-6">Salmonella infantis </span>infection in a large animal veterinary teaching hospital. J Am Vet Med Assoc. 211(12): 1554–1557.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Traub-Dargatz-JL--Dargatz-DA--Morley-PS--Dunowska-M--2004"></a>Traub-Dargatz JL, Dargatz DA, Morley PS, Dunowska M (2004). An overview of infection control strategies for equine facilities, with an emphasis on veterinary hospitals. Vet. Clin: Equine Pract. 20(3): 507–520. <a href="http://dx.doi.org/10.1016/j.cveq.2004.07.004"><span class="Hyperlink">http://dx.doi.org/10.1016/j.cveq.2004.07.004</span></a> PMid:15519814</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Tremblay-CL--Charlebois-A--Masson-L--Archambault-M--2013"></a>Tremblay CL, Charlebois A, Masson L, Archambault M (2013). Characterization of hospital-associated lineages of ampicillin resistant <span class="CharOverride-6">Enterococcus faecium</span> from clinical cases in dogs and humans. Front Microbiol.&#160; 4(245): 1–11.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Van-Dijke-B--Koppen-H--Wannet-W--Huijsdens-X--de-Neeling-H--Voss-A--2006-."></a>Van Dijke B, Koppen H, Wannet W, Huijsdens X, de Neeling H, Voss A (2006). Methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus</span> and pig farming (abstract). In: Proceedings of the 16th European Congress of Clinical Microbiology and Infectious Diseases Conference,Nice,France,April14,2006,p.474. <a href="http://www.blackwellpublishing.com/eccmid16/PDFs/clm_1247.pdf."><span class="Hyperlink">http://www.blackwellpublishing.com/eccmid16/PDFs/clm_1247.pdf.</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Van-den-Berg-RWA--Claahsen-HL--Niessen-M--Muytjens-HL--Liem-K--Voss-A--2000"></a>Van den Berg RWA, Claahsen HL, Niessen M, Muytjens HL, Liem K, Voss A (2000). <span class="CharOverride-6">Enterobacter cloacae </span>outbreak in the NICU related to disinfected thermometers. J. Hosp. Infect. 45(1):  29–34. <a href="http://dx.doi.org/10.1053/jhin.1999.0657 "><span class="Hyperlink">http://dx.doi.org/10.1053/jhin.1999.0657 </span></a>PMid:10917779</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="van-Duijkeren-E--Moleman-M--Sloet-van-Oldruitenborgh-Oosterbaan-...-2010"></a>van Duijkeren E, Moleman M, Sloet van Oldruitenborgh-Oosterbaan MM, Multem J, Troelstra A, Fluit AC, van Wamel WJB, Houwers DJ, de Neeling AJ, Wagenaar JA (2010). Methicillin-resistant S. aureus in horses and horse personnel: an investigation of several outbreaks. Vet. Microbiol. 141(1-2): 96–102.  <a href="http://dx.doi.org/10.1016/j.vetmic.2009.08.009"><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2009.08.009</span></a> PMid:19740613</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Van-Metre-DC--Barkey-DQ--Salman-MD--Morley-PS--2009"></a>Van Metre DC, Barkey DQ, Salman MD, Morley PS (2009). Development of a syndromic surveillance system for detection of disease among livestock entering an auction market. J. Am. Vet. Med. Assoc. 234(5): 658–664. <a href="http://dx.doi.org/10.2460/javma.234.5.658"><span class="Hyperlink">http://dx.doi.org/10.2460/javma.234.5.658</span></a> PMid:19250046</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Vaneechoutte-M--Devriese-LA--Dijkshoorn-L--2000-"></a>Vaneechoutte&#160;M,&#160;Devriese&#160;LA,&#160;Dijkshoorn&#160;L (2000). <span class="CharOverride-6">Acinetobacter baumannii-</span>infected vascular catheters collected from horses in an equine clinic.&#160;J. Clin. Microbiol. 38(11): 4280–4281.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Voss-A--Loeffen-F--Bakker-J--Klaassen-C--Wulf-M--2005-."></a>Voss A, Loeffen F, Bakker J, Klaassen C, Wulf M (2005). Methicillin-resistant Staphylococcus aureus in pig farming. Emerg. Infect. Dis. 11(12): 1965–1966. <a href="http://dx.doi.org/10.3201/eid1112.050428 "><span class="Hyperlink">http://dx.doi.org/10.3201/eid1112.050428 </span></a>PMid:16485492 PMCid:PMC3367632</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Wagner-S--Gally-DL--Argyle-SA--2014-."></a>Wagner S, Gally DL, Argyle SA (2014). Multidrug-resistant Escherichia coli from canine urinary tract infections tend to have commensal phylotypes, lower prevalence of virulence determinants and ampC-replicons. Vet Microbiol 169(3-4) :171–178. <a href="http://dx.doi.org/10.1016/j.vetmic.2014.01.003 "><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2014.01.003 </span></a>PMid:24485933 PMCid:PMC3969583</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Wall-PG--Threllfall-EJ--Ward-LR--Rowe-B--1996-"></a>Wall PG, Threllfall EJ, Ward LR, Rowe B (1996). Multiresistant <span class="CharOverride-6">Salmonella </span>typhimurium DT104 in cats: a public health risk. Lancet. 348(9025): 471. <a href="http://dx.doi.org/10.1016/S0140-6736(96)24033-4"><span class="Hyperlink">http://dx.doi.org/10.1016/S0140-6736(96)24033-4</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Weber-DJ--Raasch-R--Rutala-WA--1999"></a>Weber DJ, Raasch R, Rutala WA (1999). Nosocomial infections in the ICU: the growing importance of antibiotic-resistant pathogens. Chest. 115(Suppl 3): 34–41. <a href="http://dx.doi.org/10.1378/chest.115.suppl_1.34S"><span class="Hyperlink">http://dx.doi.org/10.1378/chest.115.suppl_1.34S</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Weese-JS--Archambault-M--Willey-BM--Dick--2005a"></a>Weese JS, Archambault M, Willey BM, Dick H, Hearn P, Kreiswirth BN, Said-Salim B, McGeer A, Likhoshvay Y, Prescott JF, Low DE (2005a). Methicillin-resistant Staphylococcus aureus in horses and horse personnel, 2000–2002. Emerg. Infect. Dis. 11(3): 430–435. <a href="http://dx.doi.org/10.3201/eid1103.040481"><span class="Hyperlink">http://dx.doi.org/10.3201/eid1103.040481</span></a> PMid:15757559 PMCid:PMC3298236</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Weese-JS--Rousseau-J--2005b-."></a>Weese JS, Rousseau J (2005b). Attempted eradication of methicillinresistant S. aureus colonization in horses on two farms. Equine. Vet. J. 37(6): 510–514. <a href="http://dx.doi.org/10.2746/042516405775314835 "><span class="Hyperlink">http://dx.doi.org/10.2746/042516405775314835 </span></a>PMid:16295927 </li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Weese-JS-Armstrong-J--2003-"></a>Weese JS Armstrong J (2003). Outbreak of <span class="CharOverride-6">Clostridium difficile</span>-associated disease in a small animal veterinary teaching hospital. J. Vet. Intern. Med. 17(6): 813–816. <a href="http://dx.doi.org/10.1111/j.1939-1676.2003.tb02519.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1939-1676.2003.tb02519.x</span></a> PMid:14658717</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Weese-JS--Caldwell-F--Willey-BM--Kreiswirth-BN--McGeer-A--Rousseau-J--Low-DE--2006a-"></a>Weese JS, Caldwell F, Willey BM, Kreiswirth BN, McGeer A, Rousseau J, Low DE (2006a). An outbreak of methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus </span>skin infections resulting from horse to human transmission in a veterinary hospital. Vet. Microbiol. 114(1-2): 160–164. <a href="http://dx.doi.org/10.1016/j.vetmic.2005.11.054"><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2005.11.054</span></a> PMid:16384660</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Weese-JS--DaCosta-T--Button-L--Goth-K--Ethier-M--Boehnke-K--2004-."></a>Weese JS, DaCosta T, Button L, Goth K, Ethier M, Boehnke K (2004). Isolation of methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus </span>from the environment in a veterinary teaching hospital. J. Vet. Intern. Med. 18(4): 468–470. <a href="http://dx.doi.org/10.1111/j.1939-1676.2004.tb02568.x "><span class="Hyperlink">http://dx.doi.org/10.1111/j.1939-1676.2004.tb02568.x </span></a>PMid:15320581</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Weese-JS--Rousseau-J--Willey-BM--Archambault-M--McGeer-A--Low-DE--2006b"></a>Weese JS, Rousseau J, Willey BM, Archambault M, McGeer A, Low DE (2006b). Methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus </span>in horses at a veterinary teaching hospital: frequency, characterization, and association with clinical disease. J. Vet. Intern. Med. 20(1): 182–186. <a href="http://dx.doi.org/10.1111/j.1939-1676.2006.tb02839.x"><span class="Hyperlink">http://dx.doi.org/10.1111/j.1939-1676.2006.tb02839.x</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Weese-JS--Staempfli-HR--Prescott-JF--2000"></a>Weese JS, Staempfli HR, Prescott JF (2000). Isolation of environmental <span class="CharOverride-6">Clostridium difficile </span>from a veterinary teaching hospital. J. Vet. Diagn. Invest. 12(5): 449–452. <a href="http://dx.doi.org/10.1177/104063870001200510 "><span class="Hyperlink">http://dx.doi.org/10.1177/104063870001200510 </span></a>PMid:11021433</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Weese-JS--2008"></a>Weese JS (2008). Investigation of <span class="CharOverride-6">Enterobacter cloacae</span> infections at a small animal veterinary teaching hospital. Vet. Microbiol. 130(3-4): 426–428. <a href="http://dx.doi.org/10.1016/j.vetmic.2008.02.009 "><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2008.02.009 </span></a>PMid:18374521</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Weese-JS--Duijkeren-EV--2010"></a>Weese JS, Duijkeren EV (2010). Methicillin-resistant <span class="CharOverride-6">Staphylococcus aureus</span> and <span class="CharOverride-6">Staphylococcus pseudintermedius</span> in veterinary medicine. Vet. Microbiol.<span class="CharOverride-17">&#160;</span>140(3-4): 418–429. <a href="http://dx.doi.org/10.1016/j.vetmic.2009.01.039"><span class="Hyperlink">http://dx.doi.org/10.1016/j.vetmic.2009.01.039</span></a> PMid:19246166</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Weese-JS--Finley-R--Reid-Smith-RR--Janecko-N--Rousseau-J--2010-."></a>Weese JS, Finley R, Reid-Smith RR, Janecko N, Rousseau J (2010). Evaluation of <span class="CharOverride-6">Clostridium difficile</span> in dogs and the household environment. Epidemiol. Infect. 138(8): 1100–1104. <a href="http://dx.doi.org/10.1017/S0950268809991312"><span class="Hyperlink">http://dx.doi.org/10.1017/S0950268809991312</span></a> PMid:19951453</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Weese-JS--2008a"></a>Weese JS (2008a). Review of multidrug resistant surgical site infections. Vet. Comp. Orthop. Traumatol<span class="CharOverride-19">. </span>21(1): 1–7.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Weese-JS--2008b"></a>Weese JS (2008b). A review of post-operative infections in veterinary orthopedic surgery. Vet Comp Orthop Traumatol. 21(2): 99–105.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Weese-JS--Stull-J--2013-"></a>Weese JS, Stull J (2013). Respiratory disease outbreak in a veterinary hospital associated with canine parainfluenza virus infection. Can. Vet. J. 54(1): 79–82.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Wenzel-RP--Osterman-CA--Donowitz-LG--Hoyt-JW--Sande-MA--Martone-WJ--Miller-GB--1981-"></a>Wenzel RP, Osterman CA, Donowitz LG, Hoyt JW, Sande MA, Martone WJ, Miller GB (1981). Identification of procedure-related nosocomial infections in high-risk patients. Rev. Infect. Dis. 3(4): 701–707. <a href="http://dx.doi.org/10.1093/clinids/3.4.701 "><span class="Hyperlink">http://dx.doi.org/10.1093/clinids/3.4.701 </span></a>PMid:6951236</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Wenzel-RP--Osterman-CA--Hunting-KJ--Gwaltney-JM--1976-."></a>Wenzel RP, Osterman CA, Hunting KJ, Gwaltney JM (1976). Hospital-acquired infections: I. Surveillance in a university hospital. Am. J. Epidemiol. 103(3): 251–260.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Wilberger-MS--Anthony-KE--Rose-S--McClain-M--Bermudez-LE--2012-"></a>Wilberger MS, Anthony KE, Rose S, McClain M, Bermudez LE (2012) Beta-Lactam Antibiotic Resistance among <span class="CharOverride-6">Enterobacter</span> spp. Isolated from Infection in Animals. Adv. Microbiol. 2(2): 129–137. <a href="http://dx.doi.org/10.4236/aim.2012.22018"><span class="Hyperlink">http://dx.doi.org/10.4236/aim.2012.22018</span></a></li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Willems-RJ--Top-J--VanSchaik-W--Leavis-H--Bonten-M--Siren-J--2012-"></a>Willems RJ, Top J, VanSchaik W, Leavis H, Bonten M, Siren J (2012).Restricted gene flow among hospital subpopulations of  <span class="CharOverride-6">Enterococcus faecium</span>. MBio.<span class="CharOverride-6"> </span>3(4): e00151–00112. <a href="http://dx.doi.org/10.1128/mBio.00151-12"><span class="Hyperlink">http://dx.doi.org/10.1128/mBio.00151-12</span></a> PMid:22807567 PMCid:PMC3413404</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Willems-RJ--VanSchaik-W--2009-."></a>Willems RJ, VanSchaik W (2009). Transition of <span class="CharOverride-6">Enterococcus faecium </span>from commensal organism to nosocomial pathogen. Future Microbiol<span class="CharOverride-6">. </span>4(9): 1125–1135.   <a href="http://dx.doi.org/10.2217/fmb.09.82 "><span class="Hyperlink">http://dx.doi.org/10.2217/fmb.09.82 </span></a>PMid:19895216</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Winnefeld-M--Richard-MA--Drancourt-M--Grubb-JJ--2000-."></a>Winnefeld M, Richard MA, Drancourt M, Grubb JJ (2000). Skin intolerance and effectiveness of two hand decontamination procedures in everyday hospital use. Br. J. Dermatol. 143(3): 546–550. <a href="http://dx.doi.org/10.1111/j.1365-2133.2000.03708.x "><span class="Hyperlink">http://dx.doi.org/10.1111/j.1365-2133.2000.03708.x </span></a>PMid:10971327</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Wise-LA--Jones-RL--Reif-JS--1990-."></a>Wise LA, Jones RL, Reif JS (1990). Nosocomial canine urinary tract infections in a veterinary teaching hospital (1983 to 1988). J. Am. Anim. Hosp. Assoc. 26(2): 148–152.</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Wright-JG--Tengelsen-LA--Smith-KE--Bender-JB--Frank-RK--Grendon-JH--Angulo-FJ--2005-."></a>Wright JG, Tengelsen LA, Smith KE, Bender JB, Frank RK, Grendon JH, Angulo FJ (2005). Multidrug-resistant <span class="CharOverride-6">Salmonella typhimurium</span> in four animal facilities. Emerg. Infect. Dis. 11(8): 1235–1241. <a href="http://dx.doi.org/10.3201/eid1108.050111 "><span class="Hyperlink">http://dx.doi.org/10.3201/eid1108.050111 </span></a>PMid:16102313 PMCid:PMC3320505</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Zarrilli-R--Pournaras-S--Giannouli-M--Tsakris-A--2013-"></a>Zarrilli R, Pournaras S, Giannouli M, Tsakris A (2013). Global evolution of multidrug-resistant <span class="CharOverride-6">Acinetobacter baumannii</span> clonal lineages. Int. J. Antimicrob. Agents. 41(1): 11–19. <a href="http://dx.doi.org/10.1016/j.ijantimicag.2012.09.008"><span class="Hyperlink">http://dx.doi.org/10.1016/j.ijantimicag.2012.09.008</span></a> PMid:23127486</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Zhao-S--White-DG--McDermott-PF--Friedman-2001"></a>Zhao S, White DG, McDermott PF, Friedman S, English L, Ayers S,  Meng J, Maurer JJ, Holland R, Walker RD (2001). Identification and expression of cephamycinase <span class="CharOverride-6">bla</span>CMY genes in <span class="CharOverride-6">Escherichia coli </span>and <span class="CharOverride-6">Salmonella</span> isolated from animals and food.  Antimicrob. Agents Chemother. 45(12): 3647–3650. <a href="http://dx.doi.org/10.1128/AAC.45.12.3647-3650.2001"><span class="Hyperlink">http://dx.doi.org/10.1128/AAC.45.12.3647-3650.2001</span></a> PMid:11709361 PMCid:PMC90890</li>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Zhang-C--Qiu-S--Wang-Y--Qi-L--Hao-R--Liu-X--Shi-Y--Hu-X--An-D--Li-Z---2013"></a>Zhang C, Qiu S, Wang Y, Qi L, Hao R, Liu X, Shi Y, Hu X, An D, Li Z, Li P, Wang L, Cui J, Wang P, Huang L, Klena JD, Song H (2013). Higher isolation of NDM-1 producing <span class="CharOverride-6">Acinetobacter baumannii</span> from the sewage of the hospitals in Beijing. PLoS One. 8: e64857. <a href="http://dx.doi.org/10.1371/journal.pone.0064857"><span class="Hyperlink">http://dx.doi.org/10.1371/journal.pone.0064857</span></a> PMid:23755152 PMCid:PMC3670931</li>
                <p>&nbsp;</p>
                <p>&nbsp;</p>
				<li class="References ParaOverride-5"><a id="Zordan-S--Prenger-Berninghoff-E--Weiss-R--van-der-Reijden-T--van-den-Broek-P--Baljer-G--Dijkshoorn-L"></a>Zordan S, Prenger-Berninghoff E, Weiss R, van der Reijden T, van den Broek P, Baljer G, Dijkshoorn L (2011). Multidrug-resistant <span class="CharOverride-6">Acinetobacter baumannii</span> in veterinary clinics, Germany. Emerg. Infect. Dis. 17(9): 1751–1754. <a href="http://dx.doi.org/10.3201/eid1709.101931"><span class="Hyperlink">http://dx.doi.org/10.3201/eid1709.101931</span></a> PMid:21888812 PMCid:PMC3322069</li>
                <p>&nbsp;</p>
                <p>&nbsp;</p>
                <p>&nbsp;</p>
                <p>&nbsp;</p>
                <p>&nbsp;</p>
                <p>&nbsp;</p>
          <p>&nbsp;</p>
		
		</div>
	</body>
</html>
