Interventions to decrease CRE colonization and transmission between hospitals, households, communities and domesticated animals (I-CRECT)





In middle-income countries antibiotic resistance is increasing causing suffering and high mortality. In 12 Vietnamese hospitals half of patients were colonised with “superbugs” called carbapenem resistant Enterobacteriaceae, for short CRE , at admission 13% and after 2 weeks in hospital 89%.

CRE colonization cause hospital infections and high mortality. As many patients are CRE colonized at hospital discharge it can spread to the household members and out in community and environment. If CRE spreads in the community it will be very difficult to treat community infections as urinary tract infections and pneumonia, increasing treatment times, costs and mortality. It is hence important to stop the spread of CRE from hospitals to community.

In our research we will follow patients that are CRE colonised at discharge out to their households. The households will be randomized to intervention and control group. An intervention to improve hygiene and decrease unnecessary antibiotic use will be evaluated on CRE transmission in the household and to domesticated. Colistin, a last resort antibiotic for very ill patients, is often used for animals in feed as growth promoter, selecting for antibiotic resistance that boomerang back into hospitals. We will assess colistin resistance in households and animals and to targeted interventions to reduce transmission. Wastewater from hospitals will be tested for antibiotics and resistant bacteria. To check the relatedness of bacteria in humans, animals and environment resistance genes will be investigated.

Project partners

  • Håkan Hanberger, Linköping University, Sweden (Coordinator)
  • Phuc Duc Pham, Hanoi University of Public Health, Vietnam
  • Dien Minh Tran, Vietnam National Children’s Hospital/ Research Institute of Childrens Health, Vietnam
  • Yaovi Mahuton Gildas Hounmanou, University of Copenhagen, Denmark
  • Mattias Larsson, Karolinska Institutet, Sweden
  • P Velavan Thirumalaisamy, The Universitätsklinikum Tübingen, Germany
  • Flavie Goutard, Centre de coopération internationale en recherche agronomique pour le développement, France