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Volume 32, Number 3—March 2026

Research

Genetically Similar High-Risk Strains of Carbapenemase-Producing Enterobacterales in Humans and Companion Animals, United States

Lingzi Xiaoli, Allison E. JamesComments to Author , Anna L. Stahl, Maho Okumura, Stephen D. Cole, Jaclyn M. Dietrich, Molly M. Leeper, Jordan K. Putney, Maroya Spalding Walters, and Richard A. Stanton
Author affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (L. Xiaoli, A.E. James, A.L. Stahl, M.M. Leeper, J.K. Putney, M.S. Walters, R.A. Stanton); University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA (M. Okumura, S.D. Cole, J.M. Dietrich); Applied Science Research and Technology, Inc., Smyrna, Georgia, USA (J.K. Putney); US Public Health Service, Rockville, Maryland, USA (M.S. Walters)

Main Article

Table 1

Companion animal and human CP-CRE isolates included in One Health clusters in study of genetically similar high-risk strains of carbapenemase-producing Enterobacterales in humans and companion animals, United States*

Characteristic Companion animal Human
No. isolates†
 169
 393
Specimen type n = 168 n = 388
Colonization test 126 (75) 21 (5)
Clinical test
 42 (25)
 367 (95)
Source (for clinical tests) n = 42 n = 365
Respiratory Tract 14 (33) 8 (2)
Urine 11 (26) 261 (72)
Wound 12 (29) 17 (5)
Blood 0 48 (13)
Other
 5 (12)
 31 (8)
No. unique patients n = 158‡ n = 386§
Dogs 145 (92) NA
Cats
 13 (8)
 NA
Patient region of residence¶ n = 154 n = 379
Central 9 (6) 32 (8)
Mid-Atlantic 78 (51) 60 (16)
Midwest 22 (14)# 41 (11)
Mountain 1 (1) 89 (23)
Northeast 41 (27) 57 (15)
Southeast 3 (2) 36 (9)
West 0 64 (17)

*Values are no. (%) except as indicated. CP-CRE, carbapenemase-producing carbapenemase-resistant Enterobacterales; NA, not applicable. †Isolates or patients with missing data were excluded from corresponding denominators. ‡Eleven unique isolates were collected from 1 cat and 6 dogs. §Seven unique isolates were collected from 5 humans. ¶Centers for Disease Control and Prevention Antimicrobial Resistance Laboratory Network regions (24). #Includes 18 animals known to have been imported from other countries.

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References
  1. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States 2019 [cited 2025 Mar 10]. https://www.cdc.gov/antimicrobial-resistance/media/pdfs/2019-ar-threats-report-508.pdf
  2. World Health Organization. WHO bacterial priority pathogens list, 2024 [cited 2025 Mar 10]. https://iris.who.int/server/api/core/bitstreams/1a41ef7e-dd24-4ce6-a9a6-1573562e7f37/content
  3. Zhou  R, Fang  X, Zhang  J, Zheng  X, Shangguan  S, Chen  S, et al. Impact of carbapenem resistance on mortality in patients infected with Enterobacteriaceae: a systematic review and meta-analysis. BMJ Open. 2021;11:e054971. DOIPubMedGoogle Scholar
  4. Silva  JMD, Menezes  J, Marques  C, Pomba  CF. Companion animals—an overlooked and misdiagnosed reservoir of carbapenem resistance. Antibiotics (Basel). 2022;11:533. DOIPubMedGoogle Scholar
  5. Gupta  N, Limbago  BM, Patel  JB, Kallen  AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis. 2011;53:60–7. DOIPubMedGoogle Scholar
  6. Naas  T, Cuzon  G, Villegas  MV, Lartigue  MF, Quinn  JP, Nordmann  P. Genetic structures at the origin of acquisition of the β-lactamase bla KPC gene. Antimicrob Agents Chemother. 2008;52:1257–63. DOIPubMedGoogle Scholar
  7. Mathers  AJ, Cox  HL, Kitchel  B, Bonatti  H, Brassinga  AK, Carroll  J, et al. Molecular dissection of an outbreak of carbapenem-resistant enterobacteriaceae reveals Intergenus KPC carbapenemase transmission through a promiscuous plasmid. mBio. 2011;2:e00204–11. DOIPubMedGoogle Scholar
  8. Nordmann  P, Poirel  L. Epidemiology and diagnostics of carbapenem resistance in gram-negative bacteria. Clin Infect Dis. 2019;69(Suppl 7):S521–8. DOIPubMedGoogle Scholar
  9. Wise  MG, Karlowsky  JA, Mohamed  N, Hermsen  ED, Kamat  S, Townsend  A, et al. Global trends in carbapenem- and difficult-to-treat-resistance among World Health Organization priority bacterial pathogens: ATLAS surveillance program 2018-2022. J Glob Antimicrob Resist. 2024;37:168–75. DOIPubMedGoogle Scholar
  10. Sellera  FP, Da Silva  LCBA, Lincopan  N. Rapid spread of critical priority carbapenemase-producing pathogens in companion animals: a One Health challenge for a post-pandemic world. J Antimicrob Chemother. 2021;76:2225–9. DOIPubMedGoogle Scholar
  11. Shaheen  BW, Nayak  R, Boothe  DM. Emergence of a New Delhi metallo-β-lactamase (NDM-1)-encoding gene in clinical Escherichia coli isolates recovered from companion animals in the United States. Antimicrob Agents Chemother. 2013;57:2902–3. DOIPubMedGoogle Scholar
  12. Liu  X, Thungrat  K, Boothe  DM. Occurrence of OXA-48 carbapenemase and other β-lactamase genes in ESBL-producing multidrug resistant Escherichia coli from dogs and cats in the United States, 2009–2013. Front Microbiol. 2016;7:1057. DOIPubMedGoogle Scholar
  13. Daniels  JB, Chen  L, Grooters  SV, Mollenkopf  DF, Mathys  DA, Pancholi  P, et al. Enterobacter cloacae complex sequence type 171 isolates expressing KPC-4 carbapenemase recovered from canine patients in Ohio. Antimicrob Agents Chemother. 2018;62:e01161–18. DOIPubMedGoogle Scholar
  14. Cole  SD, Peak  L, Tyson  GH, Reimschuessel  R, Ceric  O, Rankin  SC. New Delhi metallo-β-lactamase-5-producing Escherichia coli in companion animals, United States. Emerg Infect Dis. 2020;26:381–3. DOIPubMedGoogle Scholar
  15. Lavigne  SH, Cole  SD, Daidone  C, Rankin  SC. Risk factors for the acquisition of a blaNDM-5 carbapenem-resistant Escherichia coli in a veterinary hospital. J Am Anim Hosp Assoc. 2021;57:101–5. DOIPubMedGoogle Scholar
  16. Dietrich  J, LeCuyer  TE, Hendrix  GK, Burbick  CR, Jacob  ME, Byrne  BA, et al. Prevalence and molecular epidemiology of carbapenemase-producing Enterobacterales isolated from dog and cat faeces submitted to veterinary laboratories in the USA. Zoonoses Public Health. 2024;71:538–48. DOIPubMedGoogle Scholar
  17. McNamara  K, Habrun  C, Wilson  W, Kollmann  L, Stapleton  G, Stanton  R, et al. New Delhi metallo-β-lactamase–producing Escherichia coli among dogs at an animal rescue facility—Wisconsin, 2022. Antimicrob Steward Health Epidemiol. 2023;3:s90. DOIGoogle Scholar
  18. DeStefano  I, Fellman  CL, Bergeron  AC, Golato  LM, Doron  S, Cumming  M, et al. Effective mitigation of an outbreak of New Delhi metallo-β-lactamase-producing Escherichia coli infections in a small animal veterinary teaching hospital. J Am Vet Med Assoc. 2025;263:1–10. DOIPubMedGoogle Scholar
  19. Grönthal  T, Österblad  M, Eklund  M, Jalava  J, Nykäsenoja  S, Pekkanen  K, et al. Sharing more than friendship - transmission of NDM-5 ST167 and CTX-M-9 ST69 Escherichia coli between dogs and humans in a family, Finland, 2015. Euro Surveill. 2018;23:1700497. DOIPubMedGoogle Scholar
  20. Endimiani  A, Brilhante  M, Bernasconi  OJ, Perreten  V, Schmidt  JS, Dazio  V, et al. Employees of Swiss veterinary clinics colonized with epidemic clones of carbapenemase-producing Escherichia coli. J Antimicrob Chemother. 2020;75:766–8. DOIPubMedGoogle Scholar
  21. DeStefano  IM, Fellman  CL, Vagnone  PMS, Cumming  MA, Dale  JL, Ruhland  A, et al. Human cases of carbapenemase-producing Escherichia coli linked to spread between animals and the environment in a veterinary facility—Massachusetts, USA, 2023. Clin Infect Dis. 2025;ciaf541. DOIGoogle Scholar
  22. Campos-Madueno  EI, Moser  AI, Jost  G, Maffioli  C, Bodmer  T, Perreten  V, et al. Carbapenemase-producing Klebsiella pneumoniae strains in Switzerland: human and non-human settings may share high-risk clones. J Glob Antimicrob Resist. 2022;28:206–15. DOIPubMedGoogle Scholar
  23. National Center for Biotechnology Information. Pathogen detection help document [cited 2025 May 2]. https://www.ncbi.nlm.nih.gov/pathogens/pathogens_help
  24. Centers for Disease Control and Prevention. Antimicrobial Resistance Laboratory Network [cited 2025 May 2]. https://www.cdc.gov/antimicrobial-resistance-laboratory-networks/php/about/domestic.html
  25. Souvorov  A, Agarwala  R, Lipman  DJ. SKESA: strategic k-mer extension for scrupulous assemblies. Genome Biol. 2018;19:153. DOIPubMedGoogle Scholar
  26. Jolley  KA, Bray  JE, Maiden  MCJ. Open-access bacterial population genomics: BIGSdb software, the PubMLST.org website and their applications. Wellcome Open Res. 2018;3:124. DOIPubMedGoogle Scholar
  27. Dyer  NP, Päuker  B, Baxter  L, Gupta  A, Bunk  B, Overmann  J, et al. EnteroBase in 2025: exploring the genomic epidemiology of bacterial pathogens. Nucleic Acids Res. 2025;53(D1):D757–62. DOIPubMedGoogle Scholar
  28. Bialek-Davenet  S, Criscuolo  A, Ailloud  F, Passet  V, Jones  L, Delannoy-Vieillard  A-S, et al. Genomic definition of hypervirulent and multidrug-resistant Klebsiella pneumoniae clonal groups. Emerg Infect Dis. 2014;20:1812–20. DOIPubMedGoogle Scholar
  29. Stanton  RA, McAllister  G, Daniels  JB, Breaker  E, Vlachos  N, Gable  P, et al. Development and application of a core genome multilocus sequence typing scheme for the health care-associated pathogen Pseudomonas aeruginosa. J Clin Microbiol. 2020;58:e00214–20. DOIPubMedGoogle Scholar
  30. Page  AJ, Cummins  CA, Hunt  M, Wong  VK, Reuter  S, Holden  MT, et al. Roary: rapid large-scale prokaryote pan genome analysis. Bioinformatics. 2015;31:3691–3. DOIPubMedGoogle Scholar
  31. Harris  CR, Millman  KJ, van der Walt  SJ, Gommers  R, Virtanen  P, Cournapeau  D, et al. Array programming with NumPy. Nature. 2020;585:357–62. DOIPubMedGoogle Scholar
  32. Sader  HS, Mendes  RE, Carvalhaes  CG, Kimbrough  JH, Castanheira  M. Changing epidemiology of carbapenemases among carbapenem-resistant Enterobacterales from United States hospitals and the activity of aztreonam-avibactam against contemporary Enterobacterales (2019–2021). Open Forum Infect Dis. 2023;10:ofad046. DOIGoogle Scholar
  33. Devinney  K, Burton  N, Alroy  KA, Crawley  A, Da Costa-Carter  CA, Kratz  MM, et al. Notes from the field: increase in New Delhi metallo-β-lactamase-producing carbapenem-resistant Enterobacterales—New York City, 2019–2024. MMWR Morb Mortal Wkly Rep. 2025;74:401–3. DOIPubMedGoogle Scholar
  34. Caddey  B, Fisher  S, Barkema  HW, Nobrega  DB. Companions in antimicrobial resistance: examining transmission of common antimicrobial-resistant organisms between people and their dogs, cats, and horses. Clin Microbiol Rev. 2025;38:e0014622. DOIPubMedGoogle Scholar
  35. de Mendieta  JM, Argüello  A, Menocal  MA, Rapoport  M, Albornoz  E, Más  J, et al. Emergence of NDM-producing Enterobacterales infections in companion animals from Argentina. BMC Vet Res. 2024;20:174. DOIPubMedGoogle Scholar
  36. Brookshire  C, Robinson  D, Seo  K. Carbapenemase-producing ST307 Klebsiella pneumoniae in dogs. Am J Med Sci. 2023;365:S313–4. DOIGoogle Scholar
  37. Brilhante  M, Gobeli Brawand  S, Endimiani  A, Rohrbach  H, Kittl  S, Willi  B, et al. Two high-risk clones of carbapenemase-producing Klebsiella pneumoniae that cause infections in pets and are present in the environment of a veterinary referral hospital. J Antimicrob Chemother. 2021;76:1140–9. DOIPubMedGoogle Scholar
  38. Garcia-Fierro  R, Drapeau  A, Dazas  M, Saras  E, Rodrigues  C, Brisse  S, et al. Comparative phylogenomics of ESBL-, AmpC- and carbapenemase-producing Klebsiella pneumoniae originating from companion animals and humans. J Antimicrob Chemother. 2022;77:1263–71. DOIPubMedGoogle Scholar
  39. Linkevicius  M, Bonnin  RA, Alm  E, Svartström  O, Apfalter  P, Hartl  R, et al. Rapid cross-border emergence of NDM-5-producing Escherichia coli in the European Union/European Economic Area, 2012 to June 2022. Euro Surveill. 2023;28:2300209. DOIPubMedGoogle Scholar
  40. Jones  S, Stanton  R, D’Angeli  M, Brezak  A, Sinkevitch  J, Sredl  M, et al. Community-associated New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales: multiple states, from September 2021 through September 2022. Infect Control Hosp Epidemiol. 2025;46:1–4. DOIPubMedGoogle Scholar
  41. Xia  C, Yan  R, Liu  C, Zhai  J, Zheng  J, Chen  W, et al. Epidemiological and genomic characteristics of global blaNDM-carrying Escherichia coli. Ann Clin Microbiol Antimicrob. 2024;23:58. DOIPubMedGoogle Scholar
  42. Centers for Disease Control and Prevention. MDRO prevention strategies [cited 2025 Aug 12]. https://www.cdc.gov/healthcare-associated-infections/php/preventing-mdros/mdro-prevention-strategies.html
  43. Dazio  V, Nigg  A, Schmidt  JS, Brilhante  M, Campos-Madueno  EI, Mauri  N, et al. Duration of carriage of multidrug-resistant bacteria in dogs and cats in veterinary care and co-carriage with their owners. One Health. 2021;13:100322. DOIPubMedGoogle Scholar
  44. Nigg  A, Brilhante  M, Dazio  V, Clément  M, Collaud  A, Gobeli Brawand  S, et al. Shedding of OXA-181 carbapenemase-producing Escherichia coli from companion animals after hospitalisation in Switzerland: an outbreak in 2018. Euro Surveill. 2019;24:1900071. DOIPubMedGoogle Scholar
  45. Schmidt  JS, Kuster  SP, Nigg  A, Dazio  V, Brilhante  M, Rohrbach  H, et al. Poor infection prevention and control standards are associated with environmental contamination with carbapenemase-producing Enterobacterales and other multidrug-resistant bacteria in Swiss companion animal clinics. Antimicrob Resist Infect Control. 2020;9:93. DOIPubMedGoogle Scholar
  46. Haenni  M, Boulouis  HJ, Lagrée  AC, Drapeau  A, Va  F, Billet  M, et al. Enterobacterales high-risk clones and plasmids spreading blaESBL/AmpC and blaOXA-48 genes within and between hospitalized dogs and their environment. J Antimicrob Chemother. 2022;77:2754–62. DOIPubMedGoogle Scholar

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