Trial reportClinical infectious diseases : an official publication of the Infectious Diseases Society of America2026
Cluster-Randomized Controlled Trial of Enhanced Carbapenem-Resistant Enterobacterales Prevention Program in General Medicine Wards, Siriraj Hospital.
Trial report in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundCarbapenem-resistant Enterobacterales (CRE) colonization is a major risk factor for infection. Most infection prevention and control (IPC) strategies rely on private-room isolation, but evidence of their effectiveness in resource-limited settings is scarce.
methodsFrom February to October 2021, we conducted a cluster-randomized controlled trial in 6 general medical wards at Siriraj Hospital, enrolling adults with ≥1 CRE risk factor. Wards were randomized to standard infection control care (sIC) or an enhanced CRE prevention program (eIC) comprising sIC plus monthly staff education, real-time notifications of CRE acquisition, and contact-precaution reminders. Active stool/rectal CRE surveillance was performed at enrollment and weekly. Primary outcomes were the CRE acquisition incidence and CRE acquisition-free time.
resultsA total of 363 patients were included: 174 in the intervention group (1684 patient-days) and 189 in the control group (1517 patient-days). The cumulative incidence of CRE acquisition was slightly lower in the intervention group (36.8% vs 46.6%; P = .06), with a significantly lower incidence rate per patient-day (0.038 vs 0.058; P = .007). In a post hoc analysis excluding acquisitions within 24 hours, the cumulative incidence was similar between groups (25.7% vs 33.6%; P = .16). The probability of remaining CRE-free showed an unadjusted hazard ratio (HR) of 0.72 [95% CI, 0.52-1.00; P = .05]. After adjusting for prior antibiotic use, the adjusted HR was 0.75 [95% CI, 0.54-1.05; P = .09]. There were no differences in all-cause mortality or length of hospital stay.
conclusionsCarbapenem-resistant Enterobacterales acquisition incidence was high in this setting. The enhanced CRE prevention program tended to reduce CRE acquisition and prolong CRE-free survival. Larger studies are needed to explore benefits on morbidity and mortality.
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