# data[].attributes.body
Q1.

yes Salmonella typhimurium with resistance pattern 2 was already circulating in the heard during week one of testing so must have been there prior

Q2.

yes as in week 4 the dam tested positive for pattern 2 which includes an increased range of antibiotics that the bacteria is resistant to including the one used in treatment

# data[].attributes.body
1. Was Salmonella typhimurium with resistance pattern 2 circulating in this herd prior to the original clinical case of Salmonella septicaemia in the foal?

Yes, because the Dam tested positive in week 1, along with the other mares and foals for resistance pattern 2. The likelihood that the dam passes the bacterial infection to the foal is more likely than the foal passing it to the rest of the herd.

2.      Did therapeutic antimicrobial use provide enough selective pressure for transfer of a CTX-M bearing plasmid from resident E. coli to the Salmonella?

In week 1, a large % of the herd were positive for Salmonella, suggesting the bacteria were already resistant at this point (and the resistant population had spread between the individuals in the herd). I think the foal died because it was infected with resistant bacteria, that had become resistant from the use of cefquinome the bacteria in the foal were then resistant to the treatment of salmonella. Therefore, as I suspect the AMR was present before the salmonella infection, the therapeutic antimicrobial use for transfer of a CTX-M bearing plasmid wasn’t a strong enough selection pressure.

# data[].attributes.body
Q1: pattern 2 seems to be present before the original clinical case in the foal. since even though a strong antibiotic was used the foal still died. meaning that the bacteria had enough resistance to survive long enough to finish off dealing damage to the foal's body. and in week 1 many of the other horses show pattern 2 resistance to antibiotics.

Q2: The antimicrobial therapy caused enough selective pressure to transfer a CTX-M bearing plasmid from E.coli to Salmonella. since after the treatment, the number of antibiotics the Salmonella was resistant to increased significantly and matches the resistance that E.coli already has. it's at week 4 where the horses show the pattern 1 antibiotic resistance, showing that it took time for the selective pressure to cause the transfer of the plasmid after consistent exposure to the antibiotics.

# data[].attributes.body
1- i think that no the foal was the first point of contact for the case as it occured within weeks 2 and 3 meaning that it was present after foal infection not before in the herd however there was a positive test so i am not completely sure

2- i think that most likley the tehiputic responce provided enough pressure facilitating the transfer of a CTX-M bearing plasmid from resident E. coli to Salmonella

# data[].attributes.headline
1. For me, the treated foal died although a potent antibiotic cefquinome was used, it suggest the foal was infected with Salmonella typhimurium with resistance pattern 2 circulating in this herd prior to the original clinical case of Salmonella septicaemia. 

# data[].attributes.subject
1. For me, the treated foal died although a potent antibiotic cefquinome was used, it suggest the foal was infected with Salmonella typhimurium with resistance pattern 2 circulating in this herd prior to the original clinical case of Salmonella septicaemia. 

# data[].attributes.body
Yes, therapeutic antimicrobial use might have provided enough selective pressure for transfer of a CTX-M bearing plasmid from resident E. coli to the Salmonella..

# data[].attributes.body
Question 1
The microbiological findings indicate that the Salmonella Typhimurium isolated from the foal exhibited resistance pattern 1, characterized by extended-spectrum β-lactamase (CTX-M-15) positivity and resistance to several β-lactams and aminoglycosides. In contrast, resistance pattern 2, which included additional resistance to fluoroquinolones, tetracycline, and trimethoprim-sulphamethoxazole, was identified in E. coli isolates from the foal’s umbilicus, its faeces, and the dam’s faeces. Importantly, no Salmonella isolates with resistance pattern 2 were detected prior to or during the foal’s illness. This strongly suggests that Salmonella Typhimurium with pattern 2 was not circulating in the herd before the clinical case of septicaemia, and that the herd’s resident ESBL-producing E. coli were the primary carriers of the broader resistance profile.

Question 2
The intensive antimicrobial regimen, particularly the use of cefquinome, created a selective environment conducive to plasmid-mediated resistance transfer. CTX-M-15 plasmids are well-documented for their mobility among Enterobacteriaceae, and therapeutic pressure from extended-spectrum cephalosporins is known to favor the persistence and dissemination of ESBL determinants. In this case, the overlap between the resistance determinants in resident E. coli (pattern 2) and the Salmonella Typhimurium (pattern 1) points to a plausible scenario in which antimicrobial therapy facilitated the acquisition of CTX-M-bearing plasmids by Salmonella. Thus, while the foal’s initial infection involved Salmonella with a narrower resistance profile, the selective pressure exerted by treatment likely contributed to the emergence of ESBL-positive Salmonella within the herd environment.

# data[].attributes.body
1. yes it was already widespread

2. yes probably, the cefquinome created a strong selection pressure which led to transfer of the plasmid from E.coli to Salmonella.

# data[].attributes.body
1. Probably as other Horses were positive

2. I dont know

# data[].attributes.body
1 - I believe so

2 - yes most likely - resistance could have occurred via genes being passed through conjugation.

# data[].attributes.body
1- Yes it is likely.

2- Possibly as the antibiotics used may have provided enough pressure to transfer resistant genes

# data[].attributes.body
1) Yes, it definitely was.

2) yes it seemed to be the most probable conclusion considering the quantitative data and evidence gathered.

# data[].attributes.body
1. Yes I think it was.

2. Possibly but most likely yes

# data[].attributes.body
1. Yes, it is likely that salmonella was already present and was only observed when the vulnerable young foal showed visible symptoms.

2. I believe that yes, the antibiotic provided a selection pressure that led to a resistant microbe.

# data[].attributes.body
1. Yes

2. Yes posibly considering the new resistance genes in the S.typhimurium pattern 1

# data[].attributes.body
1. Yes, as it was present in the mother's faeces in Week 1

2. The gene may have been spread via conjugation

# data[].attributes.body
1. yes

2. Resistent gene cauld have been spread by conjugation mechanism

# data[].attributes.body
1) Yes, Salmonella typhimurium with resistance pattern 2 was already present in the herd before the clinical case. In week 1, the mare (mother) of the deceased foal was tested - positive result. In the following weeks (2 and 3), Salmonella was also isolated from other mares and foals (7 of 8 mares and 6 of 8 foals positive at least once). This indicates that the bacterium was already widespread in the herd (most likely subclinically) before the fatal clinical case occurred.

2) This is possible and probable. The text indicates that E. coli was isolated between 2 and 3 weeks of age from the infected umbilicus and feces of the foal and its mother - the strains had the CTX-M-15 gene. The same resistance gene was detected in Salmonella typhimurium (ESBL positive - CTX-M-15). Intensive treatment with cefquinome (a fourth-generation cephalosporin) could have created strong selection pressure. Such pressure could have promoted horizontal transfer of plasmid from E. coli to Salmonella. Thus, antibiotic therapy could have promoted selection and transfer of resistance.

# data[].attributes.body
1)yes as resistance pattern was present in the mothers faeces so could have been spread that way

2) Resistant genes could have been spread via conjugation, if the selective pressures were strong enough

# data[].attributes.body
Yes, the foal could have gotten it from its mother.

It could have been transferred from the resident E.coli

# data[].attributes.body
1) Yes, it is likely. The same resistance gene (CTX-M-15) was found in e.coli from the foal and its dam, suggesting that resistant bacteria were already present in the herd before the development of septicaemia in the foal.

2) The strong antibiotics used could have created enough pressure to transfer resistant genes from e.coli to Salmonella through conjugation, therefore helping salmonella become more resistant

# data[].attributes.body
1) yes because the mare had this species in her faeces.

2) The e.coli may of transmited its resistance to some antimicrobials to the samonella via conjugation and so the samonella develpoed its own resistance

# data[].attributes.body
1) Yes the resistance pattern was present in the screening from the mare faeces

2) It may have been transferred from the E.coli to the salmonella if the selective pressures were strong enough

# data[].attributes.body
1. yes

2. there could of been resistance to the therapeutic treatment due to transfer of bacteria through direct contact with the infected

# data[].attributes.body
1) yes, due to the disease being present within the faces of the mare.

2) The conjugation transfer of the bacteria through plasmids may have built further resistance to the therapeutic treatment, thus potentially limiting the effectiveness as the transfer of bacteria contained resident genes.

# data[].attributes.body
1) Yes, resistance pattern 2 was already detetected in the first week of salmonella screening.

2) Possibly, as the resistance to cefquinome was not present during the first week, so the plasmid containing the resistance gene may have been transferred from the E.coli to the salmonella.

# data[].attributes.headline
1. Yes, the foal had to catch it from somewhere, likely the mother

# data[].attributes.subject
1. Yes, the foal had to catch it from somewhere, likely the mother

# data[].attributes.body
2. may have been transferred from the resident E.coli

# data[].attributes.body
1. I think yes.

2. May sometimes, depends to the strong.

# data[].attributes.body
2. possible it may have transferred from E. coli

# data[].attributes.body
1. I believe the foal contracted the salmonella from the mother considering the disease was present in the mother’s faeces.

2. Plasmids containing genes for resistance can be transferred between the bacteria of different species perhaps by transformation, conjugation or transduction. As a result of this, using anti microbials could have caused transfer of resistance from E.coli to Salmonella.

# data[].attributes.headline
It must have been circulating in the herd for the foal to have caught the pathogen. The selective pressure caused ecoli to mutate to salmonela becoming AMR, which caused the foal to die.

# data[].attributes.subject
It must have been circulating in the herd for the foal to have caught the pathogen. The selective pressure caused ecoli to mutate to salmonela becoming AMR, which caused the foal to die.

# data[].attributes.headline
Yes, it's possible that there was a great enough selection pressure but I don't think you can say for sure.

# data[].attributes.subject
Yes, it's possible that there was a great enough selection pressure but I don't think you can say for sure.

# data[].attributes.body
1) Yes
2) As plasmids with genes for resistance can be transferred, I think that use of antimicrobials could have caused the transfer of plasmids from E.coli to salmonella.

# data[].attributes.body
1. I think it probably developed post treatment, although without herd/environmental testing it's hard to know.
2. I could have, but without knowing whether it was present beforehand it's difficult to say with certainty.

# data[].attributes.body
Yes it is evidence that S. Typhimurim was circulated prior to infection. It is isolated pre and post death.

# data[].attributes.body
1. I think it must have been circulating prior to that time in the hard.
2. It probably may transferred form E.coli.

# data[].attributes.body
1. Resistance pattern 2 was present in the herd at the outset of week 1, so yes, it must have been circulating prior to that time.

2. There is not sufficient information to determine if it was antimicrobial use that provided selection pressure to allow the plasmid transfer.

# data[].attributes.body
1. Yes, it may be possible that Salmonella was already circulating in the herd.
2. Yes, E. Coli could be the reason behind the Plasmid transmitted ESBL (Extended Spectrum Beta- Lactamase) genes transfer to Salmonella.

# data[].attributes.body
1. It is likely to have been circulating already.
2. As the plasmids that contain resistant genes are able to transfer by conjugation and transduction, the Antimicrobials may have transferred the E.coli to salmonella.

# data[].attributes.body
1. It was probably already circulating and was passed on from mother foal.

2.Because plasmids that contain resistant genes are able to be transferred by transformation, conjugation and transduction, I believe that using that antimicrobials may have transferred the plasmids from E.coli to salmonella. I am unsure that this would of been the reason for the foals death.

# data[].attributes.body
1. It's likely salmonella was circulating in the herd as it was found in the mother's faeces and was likely passed on from the mother to the offspring
2. Plasmids containing genes for resistance can be transferred between bacteria of different species by transformation, conjugation or transduction, so using antimicrobials could have caused transfer of resistance from E.coli to Salmonella.

# data[].attributes.body
It is likely to be present due to the infection transmission from mother to foal and due to the nature of the stud yard with horses entering and leaving.
2. I think the transfer of plasmids could have occurred due to this pressure.

# data[].attributes.body
1. It is likely that salmonella was present in the population before the foal contracted it, as it was likely passed on from the mother to the offspring, since it was also found in her faeces.
2. Plasmids containing resistance genes can be transferred between bacteria of different species by transformation, conjugation or transduction, so using therapeutic antimicrobials could have caused a transfer of resistant plasmids from E.coli to Salmonella.

# data[].attributes.body
1) I think salmonella was present in the population before infection in the goal.
2) I don't think so that conjugation can occur between them.

# data[].attributes.headline
1. I think that AMR Salmonella was already in circulation in the herd.

# data[].attributes.subject
1. I think that AMR Salmonella was already in circulation in the herd.

# data[].attributes.body
2. Not sure of transmission of AMR genes from E. coli to Salmonella

# data[].attributes.body
Q 1 - I think that Pattern 2 was already circulating in the herd .
Q 2 - I dont Know if its possible E.Coli transmit resistant to salmonella

# data[].attributes.body
1. Yes, I believe that pattern 2 was present in the herd before the the foals infection. This is shown through the shared resistance among the mares and foals. We also see this through 3/3 mares and 3/3 foals testing positive for AMR. Also considering the age of the foal it is highly unlikely to have been travelling and must have picked it up from another horse.
2. I think it is possible that the resident from the present E.coli, however it most likely wouldn't have resulted in the foals death.

# data[].attributes.body
Question 1: Pattern 2 could have already been circulating in the herd prior to the infection of the foal, as samples taken in week 1 show that other mares and foals had the resistance pattern 2. The mares may have acquired this Salmonella Typhimurium resistance pattern travelling, or while in contact with other horses, and could have ended up passing it on to their foals.
Question 2: The therapeutic use of antimicrobial could have provided enough selective pressure for the transfer of resistance pattern 1 from E.coli to Salmonella.

# data[].attributes.body
Yes, I do believe the case was circulating prior due to the large percentage of affected animals in the herd and the foals lack of travel due to its young age, therefore would not be exposed outside the herd. It is possible the resistant E.coli could have influenced the resistance present in the salmonella, but it would have been unlikely as this would have not lead to the same fatal outcome of the foal.

# data[].attributes.body
1.
Yes the foal would have probably not been able to travel and therefore must have caught it from the other goals or mares due to significant high positive cases.
2.
No because result would not have been the death of the foal

# data[].attributes.body
I believe that the salmonella bacteria with resistance pattern 2 were circulating prior to the case, as multiple other mares and foals were affected alongside. However, due to the consecutive negative salmonella tests on the dam, followed by the fourth positive test, I believe that the antibiotic treatment was sufficient to initiate conjugation between the E.Coli and Salmonella.

# data[].attributes.body
Yes, because there were other mares also affected with the virus at the time and as the foal must have been relatively young (considering it’s a foal) it’s unlikely it could’ve travelled anywhere to catch it and so must have caught it from another horse?

# data[].attributes.headline
Yes I believe Salmonella typhimurium with resistance pattern 2 was circulating in the herd prior to the original clinical case as 3/3 mares and foals were positive. 

# data[].attributes.subject
Yes I believe Salmonella typhimurium with resistance pattern 2 was circulating in the herd prior to the original clinical case as 3/3 mares and foals were positive. 

# data[].attributes.body
It is possible that use of cefquinome could have aided transfer of a CTX-m

# data[].attributes.body
1. Yes, the number of positive cases suggests that Salmonella typhimurium with resistance pattern 2 did circulate the herd. 2. Yes, it is likely that the resistant E. Coli strain transferred the resistance pattern to the Salmonella bacterium.

# data[].attributes.headline
I think sensitivity test was to be done before administering the antimicrobial

# data[].attributes.subject
I think sensitivity test was to be done before administering the antimicrobial

# data[].attributes.body
Yes, I think S.typhimurium with resistance pattern 2 have been circulating in the herd even before the case of the foal .
Under the stress of antibiotic therapy , the S.typhimurium might have acquired the plasmid containing resistance pattern 1 from the E-coli.

# data[].attributes.headline
Yes, the results from the study supports the idea that Salmonella Typhimurium was circulating in the herd. The occurence of resistant E. coli can be a possibility, resulting from the transfer of resistant gene containing plasmids . 

# data[].attributes.subject
Yes, the results from the study supports the idea that Salmonella Typhimurium was circulating in the herd. The occurence of resistant E. coli can be a possibility, resulting from the transfer of resistant gene containing plasmids . 

# data[].attributes.body
yes as the number of positive cases would suggest so

# data[].attributes.body
2. there may have been potentially enough selective pressure for conjugation/ transfer, leading to resistance pattern 2 from the salmonella

# data[].attributes.body
1. yes majority were infected. suggesting resistance present prior

# data[].attributes.body
1) I belive that it was circulating in the group before this incident, however it may not have become prevalent if it wasn't for the ill health of the foul. 2) This is a possibility. Treatment using antimicrobial does pro ice an opportunity for selection of resistant strains to take place. But it is difficult to know for certain what allowed for selection to take place. It could have been due to poor hygiene letting harmful microbes grow.

# data[].attributes.body
2.I would say not

# data[].attributes.body
1.I think so, because the mother was a carrier of the gene, therefore, she had to obtain it from somewhere, assuming she was born there.

# data[].attributes.body
2) yes likely the resistant E. coli transferred the resistance pattern 2 developed and transferred the resistance.

# data[].attributes.body
1) No, only resistance pattern 1 was initially present

# data[].attributes.body
2. No

# data[].attributes.body
1.Yes, could easily be spread by close contact in the herd/between mares and foals/sharing feed and water/etc

# data[].attributes.body
1. yes 2. yes

# data[].attributes.body
1. yes it was already circulating in the herd prior to the original case

# data[].attributes.body
1. yes as the number of positive cases between both mares and foals. As it is most likely transmitted from one animal to another by direct contact with an infected animal or surfaces they have been in contact with.

# data[].attributes.body
1- Yes, I think so, due to the number of positive cases between mares and foals. It's very propably that the resistant pattern 2 was transmitted from one animal to another , by direct contact with infected animals or with any infected surfaces.
2- It didn't, otherwise the result would not have been the death of the foal. So, instead of eliminating the susceptible cells of Salmonella, the result was a multi-drug-resistant (MDR) development.

# data[].attributes.body
2. The cephalosporin selected should result in the destruction of the susceptible strains of Salmonella. Those strains of Salmonella that had acquired to CTX-M plasmid from the E. coli, would have survived the antimicrobial therapy and allowed to proliferate resulting in the multi-drug resistant strains being isolated 4 weeks later.

# data[].attributes.body
1. No, there was 1st generation resistance to cephalosporins, but not the pattern associated with the isolate 4 weeks after the initial Salmonella was cultured.

# data[].attributes.body
1) Yes, It was.2) No it didin't

# data[].attributes.body
Infected and 2 no

# data[].attributes.body
Already there.....

# data[].attributes.body
1. yes, it was circulating.  2. No

# data[].attributes.body
yes, it was circulating.

# data[].attributes.body
2)no

# data[].attributes.body
1) yes all of the herd were infected

# data[].attributes.body
1. Yes all heard were infectedead with salmonella, and was unlikely to be spread quickly from a dead foul.
2. No

# data[].attributes.body
Yes salmonella effectes all dam and fials

No

# data[].attributes.body
1) yes, all of the herd were infected
2) no

# data[].attributes.body
1) all of the herd were infected. 2) no

# data[].attributes.body
2)no,

# data[].attributes.body
1)yes, as all in the herd were infected, which would be extremely unlikely to see such a fast infection if it was caused by the dead foal

# data[].attributes.body
Yes, and there was probably enough selective pressure for conjugation to take place, producing antimicrobial resistance.

# data[].attributes.body
2. No

# data[].attributes.body
2) The selective pressures exerted by the use of cephquinome may have been permissive to allow the transfer of E.coli resistance genes to S. typhimurium isolate via conjugation resulting in resistance patter one.

# data[].attributes.body
1) It is likely given that all subjects tested positive for S. typhimurium conferring resistance pattern two, that this was circulating in the herd prior to the original case of Salmonella septicaemia in the foal.

# data[].attributes.body
1. yes        2.  no as there may have been cross contamination , or other factors that could have caused the death of the foal .

# data[].attributes.body
1.Yes
2. No it didn't

# data[].attributes.body
As the majority of the herd tested positive at some point it would strongly suggest that resistance pattern 2 was circulating within the herd before this case. Additionally, it is entirely possible that through the inappropriate dispersal of antibiotics allowed the resistance to be transmitted however, there may be other factors such as cross contamination that were at play.

# data[].attributes.body
I believe yes is the most likely answer to the two questions E.coli is a good source of Plaamid transmitted ESBL genes among bacteria.

# data[].attributes.body
1. Yes
2. No, possibly environmental influences? Husbandry or cross contamination could be an issue.

# data[].attributes.body
I belive most of the herd tested positive either at any point for the testing.
The irresponsible usage of antibiotics might have resulted to resistance.

# data[].attributes.body
2. There was probably enough selective pressure for conjugation to take place caused by irresponsible use of antimicrobials producing resistant genes

# data[].attributes.body
1. As multiple of the mares tested positive for consecutive weeks for Salmonella typhimurium it is most likely that resistance pattern 2 was contaminating the mares before this case.

# data[].attributes.body
1. Yes  2. No it didnt

# data[].attributes.body
i think that if most of the herd tested positive either at one point for the testing as the timeline says then it must have been circulating in the herd...

# data[].attributes.body
2) I believe that because of the selective pressures this allowed the CTX-M bearing plasmid to become united with the foreign bacterial infection. Therefore the death was untreatable and resulted in the mortality of the foal.