One Health prioritization and comparative ranking of antimicrobial-resistant organisms of concern at the human–companion animal interface in Tennessee

Antimicrobial-resistance (AMR) at the human–companion animal interface is a growing One Health concern, yet state-level prioritization to guide surveillance and response remains limited. We aimed to apply a two-stage One Health prioritization process and comparatively rank AMR organisms of increasing concern at the human-companion animal interface in Tennessee. We adapted the U.S. Centers for Disease Control and Prevention One Health Zoonotic Disease Prioritization (OHZDP) approach for a two-stage process. First, a targeted review of U.S. peer-reviewed literature was used to identify and screen 10 potential AMR organisms of concern at the human-companion animal interface. Seven candidates were retained and circulated to workshop voting members for review before the workshop. Second, during an online half-day workshop, nine voting members weighted five criteria and comparatively ranked the seven retained candidates using structured questions informed by the literature and subject-matter expertise. The tool-generated ranking was reviewed and formally approved by the voting members. Ten potential AMR organisms were considered during the pre-workshop screening, and seven were retained for workshop scoring. Carbapenem-resistant Acinetobacter baumannii , Clostridioides difficile ribotype 078, and methicillin-resistant Staphylococcus pseudintermedius were not advanced because the planning team determined that the available U.S. evidence was less directly aligned with the workshop’s companion-animal AMR scope than the evidence supporting the seven retained candidates. The final comparative ranking, from highest to lowest, was: methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase–producing (ESBL) Escherichia coli , multidrug-resistant (MDR) Pseudomonas aeruginosa , extensively drug-resistant (XDR) Campylobacter jejuni , carbapenemase-producing Enterobacterales (CPE), MDR nontyphoidal Salmonella spp., and vancomycin-resistant Enterococcus (VRE). No minimum score or exclusion threshold was applied during the workshop. Following discussion, the nine voting members formally approved the ranking and retained all seven candidates. Workshop participants proposed establishing an integrated Tennessee AMR working group, developing sentinel surveillance and a statewide veterinary antibiogram, mapping laboratory capacity for confirmatory testing, expanding veterinary workforce and stewardship partnerships, and developing risk-communication materials. This two-stage workshop process demonstrates a feasible approach for screening and comparatively ranking AMR organism-resistance threats at the human-companion animal interface at the state level as well as aligning surveillance, laboratory capacity, and preparedness planning across sectors.