The Persistence And Potential Transmission Of Carbapenem-Resistant Enterobacterales And Resistant Genes From The Gut Microbiota Of The Patients After Discharge To Their Close Household Contacts

Principal Investigators:
Dr Vu Thi Lan Huong – Project Lead/Principal Investigator
Dr Thomas Kesteman – Co-investigator
Dr Vu Thi Ngoc Bich – Co-investigator

Partners:
National Hospital for Tropical Diseases
Hospital of Post and Telecommunications

Funder
Wellcome

This study focuses on understanding how long Carbapenem-Resistant Enterobacterales (CRE) persists in people’s systems after hospital discharge and how it might spread within their households.

Background

Carbapenem-resistant bacteria are among leading causes of deaths associated with drug resistance, particularly in low and middle-income countries. These include carbapenem resistant Enterobacterales (CRE) that are one of the three ‘critical’ pathogens in WHO’s Global priority list of antibiotic-resistant bacteria.

CRE easily transfer carbapenem resistance genes (CRG) to other antibiotic classes via mobile genetic elements, such as plasmids. While Enterobacterales are part of the normal gut microbiota, prolonged carriage of CRE both in hospital and community potentially presents a substantial threat. Community-acquired CRE infections are encountered more and more and frequently pose a challenge for both diagnostics and treatment. Persistent gut carriage and time to clearance of CRG are important factors to consider to prevent transmission to the community.

Objectives

Primary Objectives:

To assess the duration of gut carriage of CRE and CRG in stool samples after hospital discharge in patients having CRE identified in the routine clinical workup during hospitalization
To evaluate the incidence of gut carriage of CRE and CRG in household members living in a shared environment with CRE carrying patients discharged from the hospital

Secondary Objectives:

To explore the factors associated with long-term gut carriage of CRE/CRGs in stool samples after hospital discharge in patients having CRE identified in the routine clinical workup during hospitalization
To explore factors impacting the risks of acquisition of CRE/CRGs among household members living in a shared environment with CRE carrying patients.
To understand transmission mechanisms of CRE/CRGs in the community and the contribution of social connectedness in the transmission pathways
To assess the feasibility of epidemiological and microbiological tracking of CRE/CRGs transmission from hospitalized patients to the community in the local context.

The research team defended the topic before the ethics committee at the Hospital of Post and Telecommunications, Hanoi on August 7, 2024.

Outputs to date:

As of the end of August 2024, the research team has successfully conducted initial meetings with the Board of Directors at two local hospitals to introduce the research. We have also finalized the contracts and are now preparing to provide training to the local research staff before data collection.