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Quality Milk Production Services, Cornell University, Ithaca, NY 14850-1263
1 Corresponding author: rz26{at}cornell.edu
| ABSTRACT |
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Key Words: Klebsiella mastitis bedding sand
| INTRODUCTION |
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Considering the damage caused by infections, and the poor response of Klebsiella mastitis to treatment, prevention is of paramount importance in control of Klebsiella mastitis. The primary source of Klebsiella spp. in the cows environment is organic bedding. Outbreaks of Klebsiella are commonly associated with sawdust bedding (National Mastitis Council, 1999). Klebsiella can be present in living wood (Bagley et al., 1978) and fresh sawdust bedding can be a source of Klebsiella mastitis (Newman and Kowalski, 1973; Hogan et al., 1989). Other organic bedding materials, such as recycled newspaper and straw also support growth of Klebsiella (Hogan et al., 1990). Inorganic materials such as crushed limestone and sand are least likely to harbor Klebsiella (Hogan et al., 1989). Rates of teat-end contamination and clinical mastitis have been correlated to bacterial loads in bedding (Hogan et al., 1989; Zdanowicz et al., 2004), and use of inorganic bedding is recommended as an effective means of environmental sanitation and mastitis prevention (National Mastitis Council, 1999). Klebsiella levels in clean or recycled sand are generally low, especially when the sand is first brought into the stalls (Kristula et al., 2005). During use, Klebsiella counts in bedding increase. Mean Klebsiella counts in sand bedding typically increased approximately 100-fold in winter. In summer, up to 1,000-fold increases in Klebsiella counts could be observed (Kristula et al., 2005).
Clinical Klebsiella mastitis is more common in herds with low bulk milk SCC; that is, bulk milk SCC <150,000 cells/mL, than in herds with medium bulk milk SCC (between 150,000 and 250,000 cells/mL), indicating that it is of specific concern in well-managed dairy herds (Barkema et al., 1998). In New York State, many of the well-managed dairy herds that are serviced by Cornell Universitys Quality Milk Production Services use inorganic bedding material. Even so, complaints about the high incidence of clinical Klebsiella mastitis continue to exist in some herds. In humans, fecal shedding of Klebsiella plays an important role in pathogen dissemination (Podschun and Ullmann, 1998). We hypothesized that fecal shedding of Klebsiella spp. by dairy cows may contribute to the Klebsiella load in their environment. Intestinal carriage of K. pneumoniae in animals has been claimed to occur (Bagley and Seidler, 1977), but we were not able to locate any peer-reviewed studies documenting fecal shedding of Klebsiella in dairy cattle. The goal of our study, therefore, was to determine the prevalence of fecal shedding of Klebsiella by healthy, adult dairy cattle. A cross-sectional study was performed in the northeastern United States to determine the prevalence of fecal shedding in different herds, and a longitudinal study was performed to determine variability in the prevalence of fecal shedding in one herd over time. In the longitudinal study, Klebsiella counts of bedding from the stalls of the tested animals and from the unused sand pile were also determined. The testing methodology is cheap and simple and could easily be implemented in diagnostic laboratories.
| MATERIALS AND METHODS |
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Cross-Sectional Study
Fecal samples were collected from animals in 9 dairy herds throughout New York State and from one dairy herd in Massachusetts (Figure 1
). Herd size ranged from 109 to 1,500 milking cows. In some herds, multiple animals had shown clinical Klebsiella mastitis in the past year. Klebsiella mastitis was not specifically reported as a problem in other herds. Within each herd, a convenience sample of 10 cows was chosen for fecal sample collection during routine health and fertility checks by herd veterinarians, or during herd surveys for mastitis conducted by Quality Milk Production Services personnel. Mastitis history of sampled cows was not taken into consideration. Sample collection and transportation were as described for the longitudinal study.
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Fecal Sample Processing
Upon arrival in the laboratory, within 4 h of sample collection for the longitudinal study and within 24 h of sample collection for the cross-sectional study, the outside of each sleeve was wiped clean, and disinfected with 70% isopropyl alcohol. The tip of a finger was cut off the sleeve, and 7 to 10 g of fecal matter was transferred into an 11-mL snap-seal vial (Capitol Vial, Inc., Fultonville, NY). Samples were stored at 4°C and processed further within 24 h of arrival for the longitudinal study or within 2 d of arrival for the cross-sectional study. A 1:10 dilution of fecal matter in saline was prepared by adding 1 g of fecal matter to 9 mL of saline in polystyrene culture tubes with dual-position polyethylene caps (VWR International, Batavia, IL). Samples were preincubated at 37°C for 4 h and streaked onto MacConkey containing ampicillin (MacA) using sterile cotton wool swabs, based on a modification of published methods (Degener et al., 1983): the original ampicillin concentration of 40 mg/L was reduced to 10 mg/L, and only one dilution of the inoculum was plated. The lower ampicillin concentration allowed for growth of all Klebsiella isolates while inhibiting all E. coli isolates tested in a pilot experiment (data not shown). MacConkey agar was prepared following manufacturers recommendations (MacConkey Agar No. 3, CM0115, Oxoid Ltd.). After autoclaving, media were tempered to 50°C and ampicillin (ampicillin sodium salt, Sigma-Aldrich Chemie GmbH, Steinheim, Germany) was added to a final concentration of 10 mg/L. After the 4-h preincubation, fecal dilution vials were stored at 4°C in case they would be needed for further processing. The MacA plates were incubated overnight (
20 h) at 37°C. For each set of samples, positive and negative controls were included. As positive control, a duplicate of one of the fecal samples was used and spiked with 1 µL of fresh culture of Klebsiella pneumoniae ATCC 13883 in Todd Hewitt broth before preincubation. Saline was used as negative control.
Preliminary Identification of Klebsiella spp.
After overnight incubation, MacA plates were assessed visually for presence of Klebsiella-like colonies and other colonies. The following criteria were use to identify Klebsiella-like colonies on MacA: small to large (1 to 7 mm range), dome-shaped, wet, mucoid, glistening colonies with smooth edges, without precipitate in the surrounding agar. Colonies had a pink center and pink edges, or a yellow center with pink or yellow edges. For most samples, the density of growth on MacA allowed for good visual assessment of colony morphology when the sample had been preincubated for 4 h before streaking (standard preincubation). For samples yielding no growth or very heavy growth on MacA, prolonged preincubation or no incubation of the fecal sample was used, as described below.
For MacA plates that showed no growth of Klebsiella-like colonies and fewer than 200 colonies of other morphological appearance, the vial with 1:10 fecal:saline dilution was taken from the refrigerator and incubated at 37°C for an additional 20 h (prolonged preincubation). Colony counts were approximated by counting of colonies on 1 quadrant of the MacA plate using a handheld colony counter. Plates that contained between 200 and 800 colonies but no Klebsiella-like colonies were considered to be Klebsiella negative. When more than approximately 800 colonies were present on a plate, it was difficult to assess presence or absence of Klebsiella-like colonies, and plates were considered to be too crowded to evaluate. For fecal samples yielding overcrowded plates, a new 1:10 dilution of the original fecal sample in saline was prepared and swabbed onto MacA without preincubation. The MacA plates that were streaked after prolonged or no preincubation of the fecal samples were incubated and interpreted as described for the standard preincubation.
Isolated Klebsiella-like colonies identified on MacA were subcultured onto TSA-BE for further testing. Klebsiella-like colonies that were in contact with adjacent colonies on the primary MacA plate were subcultured onto a secondary MacA plate to obtain isolated colonies. Isolated colonies from the secondary MacA plate were then subcultured onto TSA-BE. Per fecal sample, up to 4 Klebsiella-like colonies were subcultured on TSA-BE and used for biochemical confirmation of species identity. The cost of supplies for fecal sample testing (commercial pricing) was approximately $1.60 per sample.
Confirmation of Species Identity
To confirm the identity of putative Klebsiella isolates, citrate and motility tests were performed as recommended by the National Mastitis Council (National Mastitis Council, 1999). Cultures on TSA-BE were visually checked for purity, and subsequently inoculated on Simmons citrate agar slants (Simmons citrate agar, Oxoid Ltd.) using sterile 1-µL loops, and stabbed into vials with motility-indole-ornithine medium (Difco, Becton, Dickinson and Company, Sparks, MD) using sterile culture needles. Citrate slants and motility-indole-ornithine vials were incubated for approximately 16 h at 37°C. When results of the citrate test were inconclusive, incubation was continued for an additional 24 h. The citrate test was considered positive when the green medium turned blue. Klebsiella pneumoniae ATCC 13883 was used as positive control and E. coli ATCC 25922 as negative control. For motility testing, cloudiness throughout the medium was considered a positive reaction. Escherichia coli ATCC 25922 was used as positive control and K. pneumoniae ATCC 13883 as negative control. The indole reaction was not read from the motility-indole-ornithine vial but was tested independently using the indole spot test (BBL DMACA indole reagent droppers, Becton, Dickinson and Co.). For the indole test, E. coli ATCC 25922 was used as positive control and K. pneumoniae ATCC 13883 as negative control. Isolates were considered to belong to the genus Klebsiella if they were citrate positive and motility negative. Indole-positive Klebsiella isolates were considered to belong to the species Klebsiella oxytoca and indole-negative isolates were considered to belong to the species Klebsiella pneumoniae. Cows were considered to be shedding K. pneumoniae or K. oxytoca if at least one Klebsiella-like colony from the fecal sample was confirmed to belong to the respective species. The cost of supplies for confirmation of species identity (commercial pricing) was approximately $1.96 per isolate.
| RESULTS |
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Cross-Sectional Study
Of 100 cows from 10 herds (10 per herd), 84% tested positive for Klebsiella spp. in feces. The number of Klebsiella-positive animals ranged from 3 to 10 of 10 tested (Figure 1
). In 8 of 10 herds, 8 or more animals tested positive for fecal Klebsiella. Of 197 Klebsiella-like isolates that were identified based on colony morphology on MacA, 183 (93%) were confirmed as Klebsiella spp. by means of biochemical testing. In one fecal sample, 2 colonies of K. oxytoca were identified. All other Klebsiella isolates were indole negative and were considered to be K. pneumoniae. Most positive samples (73 of 84, or 87% of positive samples) were identified after 4-h incubation. Seven plates were initially Klebsiella-negative, and testing was repeated after prolonged incubation. After prolonged incubation, presence of K. pneumoniae was confirmed for 2 of 7 samples (29%). Sixteen samples yielded plates that were too crowded to identify putative Klebsiella colonies and new plates were streaked from these samples without preincubation. Klebsiella was identified on 9 of 16 plates that were restreaked without preincubation. The 9 samples that were identified as K. pneumoniae-positive after restreaking without preincubation originated from a single herd, and had been transported to the laboratory without adequate cooling.
| DISCUSSION |
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Klebsiella mastitis is usually attributed to the presence of the bacteria in organic bedding material, particularly wood by-products (Hogan et al., 1989; Zdanowicz et al., 2004). However, Klebsiella can also be present in sand, with average numbers ranging from 100 to 2,200 cfu/g for clean or recycled sand taken from the pile, to more than 100,000 cfu/g in sand taken from stalls during summer (Kristula et al., 2005). Klebsiella levels in sand reported by Kristula and coworkers (2005) are similar to the results from our study, which was conducted in summer: <200 cfu/g for the pile and 104.5 cfu/g (median value) for used sand. The large increase in Klebsiella numbers after introduction of sand into stalls implies that Klebsiella multiplies in sand, or that additional Klebsiella is contributed from other sources. Considering the high prevalence of fecal shedding of K. pneumoniae and the fact that there is direct contact or mixing of feces and bedding, feces are a very likely source of bedding contamination. The fact that cows harbor K. pneumoniae in their gastrointestinal tract implies that construction of new facilities, as considered by one of our clients to solve a Klebsiella mastitis problem, is no guarantee that Klebsiella will be eliminated from the herd environment. Fecal carriage of Klebsiella is also common in humans, with prevalence ranging from 5% in the general population to 77% in hospital settings (Degener et al., 1983; Podschun and Ullmann, 1998). Early reviews of K. pneumoniae or Klebsiella spp. ecology mention gastrointestinal carriage by animals, including cattle, but do not provide data to support this claim, or quantification of the prevalence of fecal shedding (Bagley and Seidler, 1977; Bagley, 1985).
The focus of the current study was to determine the prevalence of fecal shedding of Klebsiella by dairy cattle rather than to correlate the prevalence of fecal shedding with bedding counts of Klebsiella, or to compare strains of Klebsiella between feces, bedding, and cases of clinical mastitis. Strain-level comparisons of fecal and environmental isolates with clinical mastitis isolates have been performed for other pathogens; that is, E. coli (Nemeth et al., 1994) and Streptococcus uberis (Zadoks et al., 2005). In both studies, isolates from feces, the environment, and milk constituted overlapping bacterial populations. It seems reasonable to postulate that this will also be the case for Klebsiella. This hypothesis is supported by the observation that environmental and human clinical isolates of K. pneumoniae constitute overlapping populations (Struve and Krogfelt, 2004) and by the ubiquitous and opportunistic nature of Klebsiella (Podschun and Ullmann, 1998; Hogan and Smith, 2003).
The method used for identification of Klebsiella in fecal samples is simple and cheap. It relies on the use of MacConkey agar with ampicillin for sample screening, followed by biochemical testing for confirmation of isolate identity. Genus identity was confirmed for 93% of Klebsiella-like colonies when isolate selection was aimed at high sensitivity, potentially compromising specificity. As the project progressed, project personnel gained experience in phenotypic recognition of Klebsiella, and specificity of preliminary identification increased (data not shown). The majority of positive samples were identified after a 4-h preincubation, with the exception of samples that were not cooled properly during transport. Across both parts of the study, 13% of fecal samples were subjected to prolonged incubation, and 30% of samples subjected to prolonged incubation showed growth of Klebsiella. Thus, the false-negative rate if no prolonged incubation were used would be 4% of the total number of samples tested.
It could be argued that K. pneumoniae is present in feces at low levels if enrichment is needed for detection, and that such low levels may be of limited clinical relevance. However, freshly voided feces would constitute an "inoculant," adding bacteria, organic matter, and nutrients for their growth to sand bedding. Klebsiella levels in used sand in our study and those reported by others (Zdanowicz et al., 2004; Kristula et al., 2005) are below the "generally accepted threshold number of 1,000,000 cfu/g thought to cause mastitis" (Kristula et al., 2005). However, use of a threshold value of 106 cfu/g as indicator for the risk of mastitis is a matter of habit rather than science (Smith and Hogan, 2006). Factors other than pathogen load also affect teat-end contamination and incidence of mastitis (Zdanowicz et al., 2004; Smith and Hogan, 2006). In our opinion, it is logical and plausible to assume that the occurrence of clinical mastitis in sand-bedded herds can be the result of fecal shedding of K. pneumoniae and contamination of bedding with Klebsiella at levels below 106 cfu/g.
| CONCLUSIONS |
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| ACKNOWLEDGEMENTS |
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Received for publication February 28, 2006. Accepted for publication March 31, 2006.
| REFERENCES |
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