Improvements in knowledge and detection of carbapenemase-producing Enterobacterales transmission in companion animals will strengthen prevention across the One Health spectrum

Carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) represent a growing threat to veterinary patients. Although CP-CRE infections in companion animals remain relatively rare, outbreaks in veterinary hospitals are increasingly being reported. Case reports and epidemiologic studies also support CP-CRE transmission between people and animals, making emergence in companion animals both an animal health and public health problem. However, substantial knowledge gaps limit understanding of the human and animal health impacts of CP-CRE in companion animals and of effective prevention and control interventions. For example, the true prevalence of CP-CRE colonization in companion animals is unknown, longitudinal dynamics of carriage remain poorly defined, and specific risk factors for acquisition in veterinary hospitals and community settings require further study. There are also unique structural and cultural challenges to implementing veterinary infection prevention and control practices, and evidence-based best practices tailored to veterinary settings are lacking. Diagnostic and surveillance infrastructure for companion animals is also highly fragmented, with inconsistent carbapenemase testing availability, limited mandatory reporting, and minimal capacity to rapidly detect and respond to outbreaks. This review synthesizes current clinical and molecular epidemiology of CP-CRE in companion animals; identifies critical gaps in diagnostics, surveillance, and veterinary infection prevention and control implementation; and outlines research priorities needed to mitigate and control CP-CRE within veterinary facilities. The companion Currents in One Health by Granick et al, JAVMA, 2026, addresses the clinical implications of the emergence of CP-CRE in companion animals and strategies for veterinary practitioners to mitigate spread.