Interventions to decrease CRE colonization and transmission between hospitals, households, communities and domesticated animals.
Carbapenem resistant Enterobacteriaceae (CRE) colonization of patients discharged from hospitals is a source of transmission to the community. In a cluster randomized controlled trial the effect of a bundle of interventions will be assessed on CRE transmission from CRE+ index patient discharged from hospital to HouseHold (HH) members. The districts in two provinces will be randomized to intervention or control. An information, communication, education and hygiene intervention, developed in collaboration with local health authorities, will aim to improve hygiene and decrease antibiotic (AB) use. The effect will be evaluated on CRE transmission between HH members, livestock and environment through consecutive CRE screening using fecal and hospital effluent samples cultured on carbapenem selective media. Knowledge, Attitudes, Practice surveys with smartphones will assess health seeking, AB use and hygiene adherence, hence detecting the effect of interventions. If transmission of CRE +/- Colistin Resistant Enterobacteriaceae (CoRE, common among livestocks) is detected the source will be investigated including livestock and food, targeted information will be given and evaluated. In hospitals the effect of cohort care will be assessed on CRE acquisition, hospital acquired infection, treatment outcome, cost-effectiveness and contamination in sewage water. Mechanisms of resistance, relatedness of CRE isolates in different One Health departments, and rate of CRE transmission from humans to animals and vice versa, will be assessed through Whole Genome Sequencing (WGS).
- Håkan Hanberger, Linköping University (LiU), Sweden (Coordinator)
- Phuc Duc Pham, Hanoi University of Public Health, Vietnam (Partner)
- Dien Minh Tran, Vietnam National Children's Hospital/ Research Institute of Childrens Health, Vietnam (Partner)
- Yaovi Mahuton Gildas Hounmanou, University of Copenhagen, Denmark (Partner)
- Mattias Larsson, Karolinska Institutet, Sweden (Partner)
- P Velavan Thirumalaisamy, University Hospital Tübingen, Germany (Partner)
- Flavie Goutard, CIRAD, Agricultural Research for Development, France (Partner)
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.