Validation of a LAMP assay for rapid and cost-effective detection and management of CRE colonized veterinary patients

Abstract Carbapenems are among our most precious broad-spectrum antimicrobial drugs because they are the therapy of choice for life-threatening invasive bacterial infections. Unfortunately, the increasing frequency of use of carbapenems has led to the emergence and dissemination of carbapenem-resistant Enterobacterales (CRE) in human healthcare where heavy selection pressure and population-dense environments favor the emergence and spread of highly resistant strains. CRE are now also emerging as an important antimicrobial resistance threat in veterinary medicine. Healthy companion animals in the community can become asymptomatically colonized with CRE in their enteric microbiota through normal contact with food, other animals, humans, or the natural environment including surface waters. If these animals later require veterinary care for unrelated health conditions, there is risk that their CRE colonization will be unrecognized and that the CRE will subsequently contaminate the hospital environment where other patients and staff may then be exposed. The emerging threat of CRE to hospitalized veterinary patients has been described for multiple outbreaks. Unfortunately, accurate and cost-effective rapid screening tests that can provide a result in time for colonized patients to be identified and appropriately managed during hospitalization to prevent transmission are not available. These tests will be needed in order to implement effective surveillance and CRE infection control programs in veterinary settings. We are proposing to validate a rapid screening test for CRE colonization, implement for surveillance in our hospital patient population, and share the results with the veterinary community regarding the identification and management of CRE colonized veterinary patients. To accomplish this, we propose to validate a LAMP assay as a screening test for patient CRE colonization using both experimental and observational methods. Our experimental method will utilize canine feces spiked with CRE at multiple dilutions to establish the ability and sensitivity of the LAMP assay to detect CRE in fecal samples. Observational data will be generated to validate the LAMP assay by testing OSU VMC patient fecal swabs in parallel with selective culture, and by testing blinded samples of known status provided by a collaborator. Once validated, we will then implement the LAMP assay for ongoing surveillance of CRE colonization in our patient population. That data on patient CRE colonization will allow us to make patient management and intervention decisions within 24 hours of patient admission. We will then disseminate information regarding LAMP assay performance and our implementation to other Vet-LIRN laboratories and to the veterinary community through scientific meetings and continuing education.