Interventions to Decrease Carbapenem Resistant Enterobacteriaceae Colonization and Transmission Between Hospitals, Households, Communities and Domesticated Animals

What this Trial Is About

This research aims to evaluate interventions designed to reduce the spread of carbapenem-resistant Enterobacteriaceae (CRE) from hospitalized patients to their households, communities, and domesticated animals. The study addresses how CRE colonization in discharged patients can transmit to others, including livestock, and how improved hygiene and reduced antibiotic use might lower this risk. It also investigates the genetic links of CRE bacteria between hospitals, households, animals, and wastewater. The study includes behavioral interventions such as a hospital cohort care system where patients are grouped based on CRE colonization status, with special care for those testing positive. Additionally, a household education, communication, and hygiene intervention aims to improve hygiene practices and reduce unnecessary antibiotic use in humans and animals. These interventions are implemented in collaboration with local health authorities in selected districts, with the goal of preventing CRE transmission via fecal-oral and animal routes. Participants under 2 years old from selected hospitals and provinces will be involved. Researchers will monitor CRE colonization rates over 12 months, track transmission within households, assess community awareness about antimicrobial resistance, and evaluate the effectiveness of hospital wastewater treatment over 24 months. Surveys using smartphones will assess health behaviors and antibiotic use. Whole genome sequencing will be used to study the relatedness of CRE strains to understand transmission pathways comprehensively.

Interventions to Decrease CRE Colonization and Transmission Between Hospitals, Households, Communities and Domesticated Animals