Interventions to decrease CRE colonization and transmission between hospitals, households, communities and domesticated animals.

Carbapenem resistant Enterobacteriaceae (CRE) colonization at hospital discharge is a source of transmission to the community.

In a randomized control trial the effect of an intervention will be assessed on CRE and colistin resistant Enterobacteriaceae (CoRE) transmission. Households of CRE and/or CoRE colonized patients at discharge will be randomized to intervention or control groups.

An information, communication, education and hygiene intervention, developed in collaboration with local health authorities, will aim to empower the household members to improve hygiene and decrease unindicated antibiotic use.

The effect will be evaluated on CRE transmission between household members, livestock and environment through consecutive CRE screening using fecal samples cultured on carbapenem and colistin selective media. Smartphone surveys will assess health seeking, antibiotic use and hygiene adherence.

If CoRE is detected the source will be investigated including livestock and food, targeted information will be given and evaluated.

In hospitals the effect of Infection prevention and control measures including cohort care will be assessed on CRE acquisition, hospital acquired infection, treatment outcome, cost effectiveness and contamination in sewage water.

Relatedness of isolates, resistance mechanisms and plasmids in different one health departments including transmission of colistin resistance from animals to humans will be assessed through Whole Genome Sequencing (WGS).