I-CRECT

One Health interventions to prevent or reduce the development and transmission of antimicrobial resistance

01/05/2022 to 30/04/2025

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).