CREATE a PATH: Prevalence at Teaching Hospitals of CRE in Veterinary Patients through Passive Surveillance

由碳青霉烯类耐药肠球菌（CRE）引起的人类感染的增加被认为是其中之一 疾病控制和预防中心对现代医疗保健最紧迫的威胁。直到最近 CRE与卫生保健相关感染（HCAIs）相关，但在研究中获得的感染报告 社区现在很关心。与此同时，兽医界越来越关注关于 从伴侣动物中分离CRE。伴侣动物可能在CRE传播中发挥作用 然而，目前还不清楚在社区中动物中CRE携带的流行率是多少。 USA.本研究的目的是（1）估计碳青霉烯类耐药肠球菌（CRE）的患病率 在美国兽医教学医院就诊的狗和猫中，以及（2）表征 通过全基因组测序（WGS）从伴侣动物中获得CRE。为了实现本项目的第一个目标， Vet-LIRN基础设施将被用来完成一个短期的、概念验证的被动监视项目 用于伴侣动物的CRE。与兽医教学医院有关的总共五个实验室将 参与这项初步研究。所有实验室将使用显色琼脂筛选30-50份粪便 在10个月内每月收集样本进行综合招聘考试。假定的阳性分离株将被送往 宾夕法尼亚州的鉴定、抗菌药物敏感性试验（AST）和表型 碳青霉烯酶生产的表征。估计患病率将计算为 阳性标本占检测标本总数的比例。在第二个目标下， 经确认的CRE将被送往路易斯安那州动物疾病诊断实验室（LANDO）， 州立大学进行全基因组测序。原始测序数据将通过 NCBI病原体检测管道检测抗菌素耐药基因，并通过 多位点序列分型沿着补充分析。根据以前的研究，我们估计 患病率约为1%的狗和猫，将有不同的遗传背景和港口的各种 碳青霉烯耐药的不同机制。这项研究将作为更广泛监测的基础 在伴侣动物中实施CRE战略，并将在Vet-LIRN计划中建立能力， 表征CRE。

The rise of human infections caused by carbapenem-resistant Enterobacterales (CRE) is considered one of the most urgent threats to modern healthcare by the Centers for Disease Control and Prevention. Until recently CRE were associated with healthcare-associated infections (HCAIs) but reports of infections acquired in the community are now a concern. In parallel, there is growing concern in veterinary medicine over reports of the isolation of CRE from companion animals. Companion animals could potentially play a role in CRE transmission in communities; however, it is currently unknown what the prevalence of CRE carriage among animals is in the USA. The aims of this study are to (1) estimate the prevalence of carbapenem-resistant Enterobacterales (CRE) among dogs and cats presenting to veterinary teaching hospitals in the USA and (2) characterize isolates of CRE from companion animals by whole genome sequencing (WGS). For the first aim of this project, the existing Vet-LIRN infrastructure will be leveraged to complete a short-term, proof-of-concept, passive surveillance project for CRE in companion animals. A total of five laboratories associated with veterinary teaching hospitals will participate in this initial study. All laboratories will use chromogenic agar to screen between 30-50 fecal specimens monthly for CRE over 10 months. Presumptive positive isolates will be sent to the University of Pennsylvania’s laboratory for identification, antimicrobial susceptibility testing (AST) and phenotypic characterization of carbapenemase enzyme production. The estimated prevalence will be calculated as the proportion of the positive specimens out of the total number of specimens tested. Under the second aim, confirmed CRE will be sent to the Louisiana Animal Disease Diagnostic Laboratory (LADDL) at the Louisiana State University for whole genome sequencing. Raw sequencing data will be uploaded and processed through the NCBI Pathogen Detection pipeline to detect antimicrobial resistance genes and to characterize isolates by multilocus sequence typing along with supplementary analyses. Based on previous studies, we estimate a prevalence of about 1% among dogs and cats that will have genetically distinct background and harbor a variety of different mechanisms for carbapenem resistance. This study will serve as a basis for wider surveillance strategies for CRE in companion animals and will build capacity within the Vet-LIRN program to identify and characterize CRE.