Puppy poop gave 118 people diarrhea in a recent outbreak caused by antibiotic-resistant bacteria, the Centers for Disease Control and Prevention reports. Nobody died, but 26 people were hospitalized. And if the pet industry doesn’t change its puppy-peddling ways, these outbreaks could continue.

The CDC was first clued into the outbreak in August 2017, when the Florida Department of Health reported that six people had been infected with a type of bacteria that causes fevers, vomiting, and bloody diarrhea. By February 2018, the CDC discovered that more than 118 people in 18 states had been infected with the same thing: a bacteria called Campylobacter that’s usually linked to eating raw chicken or food contaminated by chicken juices.

This time, the source was decidedly hairier: puppies and their poop. Almost all of the people infected in the outbreak had some sort of contact with a puppy, and 29 of them were pet store employees. Most of the cases were linked to a pet store chain called Petland, according to earlier reports. But by the end of the investigation, five other unnamed companies were also apparently tied to the outbreak, according to the CDC’s latest findings, which were published today in the Morbidity and Mortality Weekly Report.

The bacteria were resistant to commonly used antibiotics

The most alarming detail in the CDC’s report was that the particular Campylobacter bacteria spread by the infected puppies were resistant to commonly used antibiotics. That’s dangerous because while Campylobacter infections typically clear up without antibiotics, people with weak immune systems need those drugs to work.

To find out where these puppies caught the bug in the first place, the CDC checked the dogs’ food. But the Campylobacter wasn’t coming from there. Investigators also used the puppies’ microchips to track down their origins with 25 different breeders and eight distributors. That means these infections are more widespread than just one single contaminated breeder.

By digging through roughly 150 puppies’ medical records, investigators discovered that these pups had been treated with antibiotics at least once, and over half of them had been treated preventatively when they weren’t even sick. That’s worrying because overzealous antibiotic use can push bacteria toward becoming resistant to those antibiotics — our only effective weapons against them.

That might be what happened here. Broadly speaking, this outbreak indicates that antibiotic use in the pet industry needs to be monitored more closely. But in the short term, people can protect themselves by washing their hands after touching dogs, their poop, or anything else that comes out of their adorable little bodies.