Undetected Vancomycin-Resistant Enterococcus in Surgical Intensive Care Unit Patients

1999 ◽  
Vol 20 (10) ◽  
pp. 685-686 ◽  
Author(s):  
Richard A. Zuckerman ◽  
Lynn Steele ◽  
Richard A. Venezia ◽  
Ellis H. Tobin
Keyword(s):  
Active Surveillance ◽  
High Rate ◽  
Surgical Intensive Care Unit ◽  
High Risk Population ◽  
Vancomycin Resistant Enterococcus ◽  
Surgical Intensive Care ◽  
Total Cost ◽  
Additional Costs ◽  
Surveillance Method ◽  
Vancomycin Resistant

AbstractThe rates of vancomycin-resistant Enterococcus (VRE) in a high-risk population were investigated prospectively using an active surveillance method. The costs of conducting active surveillance were calculated. Among the 10 patients found to have VRE, routine cultures identified 3 (30%); thus, 70% of the VRE-colonized patients would have gone undetected in the absence of active surveillance. The total cost for 5 weeks of active surveillance was $2,234. Although active surveillance identified a high rate of VRE-colonized patients who otherwise may not have been identified, it remains to be determined if the additional costs are justified and result in reduced transmission.

scholarly journals 1225. High Rate of Linezolid (LZD) Nonsusceptibility (LNS) Among Enteric Vancomycin-Resistant Enterococci (VRE) Recovered From Hospitalized Patients Actively Screened for VRE Rectal Colonization (VREC)

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S371-S372
Author(s):  
Thomas J Dilworth ◽  
Eric Beck ◽  
Rachel Pedersen ◽  
Waseem Al-Karkokly ◽  
Margaret Cook ◽  
...  
Keyword(s):  
Antibiotic Susceptibility ◽  
Susceptibility Testing ◽  
Hospitalized Patients ◽  
High Rate ◽  
Surgical Intensive Care Unit ◽  
Antibiotic Susceptibility Testing ◽  
Surgical Intensive Care ◽  
Logistic Regression Models ◽  
Level Data ◽  
Rectal Colonization

Abstract Background Select hospitalized patients are actively screened for VREC but VRE isolates may not undergo antibiotic susceptibility testing. We sought to identify predictors of daptomycin (DAP) nonsusceptibility (DNS, MIC > 4) and LNS (MIC > 2) among enteric VRE isolates recovered from patients actively screened for VREC for which antibiotic susceptibility testing was not preformed. Methods This was a retrospective study of consecutive adults admitted to a surgical intensive care unit (ICU) or associated medical unit between June 1, 2017 and March 1, 2018 who had a VRE isolate from active screening. Only index isolates were included. DAP and LZD MICs were determined by Etest. Patient- and antimicrobial-level data, including ambulatory prescriptions, dating back to January 1, 2016 were collected. Multivariable logistic regression models were used to determine predictors of DNS and LNS VRE. Results In total, 64 patients’ VRE rectal isolates were included. Fifty-nine (92.2%) were E. faecium and 50 (78.1%) were from ICU patients. Thirty-seven patients (57.8%) were female and the mean age ± SD was 60 ± 13 years. Five (7.8%) and 20 (31.3%) patients had previous abdominal transplant and VRE infection, respectively. DAP and LZD MIC distributions are shown in the table below. Forty-one (64.1%) VRE isolates were LNS, including five LZD-resistant isolates. Only one (1.6%) isolate was DNS precluding an analysis of DNS predictors; 12 (18.8%) isolates had a DAP MIC > 2 mg/L. Common antimicrobial exposures prior to index VRE isolate included: vancomycin (62.5%), ceftriaxone (64.1%), cefepime (53.1%), metronidazole (50%), and ciprofloxacin (50%). Previous LZD (17.2%) and DAP (15.6%) exposure were less common. In a multivariable model, number of previous cefazolin doses (adjusted odds ratio (aOR) 0.74 95% confidence interval (CI) 0.55–0.95), and previous tobramycin exposure (aOR 0.15, 95% CI 0.02–0.81) were inversely associated with LNS. Previous LZD exposure was not associated with LNS. Conclusion LNS was common amongst VRE isolates in this cohort. Previous LZD exposure was infrequent and not associated with LNS. LZD susceptibility testing among VRE isolates recovered from patients actively screened for VREC warrants clinical consideration. Disclosures All authors: No reported disclosures.

scholarly journals 817. Appropriate Sites for the Active Surveillance of Carbapenemase-producing Enterobacteriaceae

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S501-S502
Author(s):  
Joung Ha Park ◽  
Hye-Suk Choi ◽  
Hyejin Yang ◽  
Hyun-Ju Lee ◽  
Sun Hee Kwak ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Intensive Care Unit ◽  
Study Cohort ◽  
Care Hospital ◽  
Negative Group ◽  
Limited Data ◽  
Surgical Intensive Care ◽  
Transmission Rates

Abstract Background Active surveillance tests for carbapenemase-producing Enterobacteriaceae (CPE) are recommended in patients showing risk factors for colonization by these bacteria. There are limited data however on whether surveillance tests for anatomic sites other than the stool would be useful to detect CPE colonization, and we investigated this in our present study. Methods Retrospective analysis was performed on cases at our tertiary care hospital during a 5-year period. The study patients with CPE colonization had been admitted to our surgical intensive care unit (SICU) or sub-ICU for liver transplantation in this period and undergone surveillance tests for both the stool and other sites. Patients were grouped as stool CPE negative (but which included CPE positive cases from initial sputum and other site tests) or positive. Results Among the total study cohort of 158 patients, 138 (87.3%) were included in the stool CPE positive group and the remaining 20 (12.7%) in the stool CPE negative group. While the sensitivity of CPE surveillance testing of the stool was 87.3% (95% CI 81.1-92.1), the sensitivity when combining stool and sputum samples was 93.7% (88.7-96.9). The transmission rates were similar for patients showing CPE positivity in the stool, sputum and other sites, at 4.8% (27/557), 4.7% (3/64), and 6.7% (1/15), respectively (p = 0.95). Conclusion The sensitivity of CPE detection in a stool sample is suboptimal for ruling out CPE colonization and the transmission rates are similar between stool-positive or -negative cases. Combining surveillance of the stool with other sites may be needed for detecting CPE. Disclosures All Authors: No reported disclosures

scholarly journals Appropriate sites for the active surveillance of carbapenemase-producing Enterobacteriaceae

2021 ◽  
Author(s):  
Joung Ha Park ◽  
Hye-Suk Choi ◽  
Hyejin Yang ◽  
Hyun-Ju Lee ◽  
Sun Hee Kwak ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Intensive Care Unit ◽  
Study Cohort ◽  
Care Hospital ◽  
Negative Group ◽  
Limited Data ◽  
Surgical Intensive Care ◽  
Transmission Rates

Abstract Background: Active surveillance tests for carbapenemase-producing Enterobacteriaceae (CPE) are recommended in patients showing risk factors for colonization by these bacteria. There are limited data however on whether surveillance tests for anatomic sites other than the stool would be useful to detect CPE colonization, and we investigated this in our present study.Methods: Retrospective analysis was performed on cases at our tertiary care hospital during a 5-year period. Patients with CPE colonization had been admitted to our surgical intensive care unit (SICU) or sub-ICU for liver transplantation in this period and undergone surveillance tests for both the stool and other sites. Patients were grouped as stool CPE negative (but which included CPE positive cases from initial sputum and other site tests) or positive. Results: Among the total study cohort of 158 patients, 138 (87.3%) were included in the stool CPE positive group and the remaining 20 (12.7%) in the stool CPE negative group. While the sensitivity of CPE surveillance testing of the stool was 87.3% (95% CI 81.1-92.1), the sensitivity when combining stool and sputum samples was 93.7% (88.7-96.9). The transmission rates were similar for patients showing CPE positivity in the stool, sputum and other sites, at 4.8% (27/557), 4.7% (3/64), and 6.7% (1/15), respectively (p = 0.95).Conclusions: The sensitivity of CPE detection in a stool sample is suboptimal for ruling out CPE colonization and the transmission rates are similar between stool-positive or -negative cases. Thus, combining surveillance of the stool with other sites may be needed for detecting CPE.

Practical methods for effective vancomycin-resistant enterococci (VRE) surveillance: experience in a liver transplant surgical intensive care unit

2018 ◽  
Vol 39 (10) ◽  
pp. 1178-1182 ◽  
Author(s):  
Rebecca Y. Linfield ◽  
Shelley Campeau ◽  
Patil Injean ◽  
Aric Gregson ◽  
Fady Kaldas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Transplant ◽  
Tertiary Care ◽  
Point Prevalence ◽  
Surgical Intensive Care Unit ◽  
Fisher Exact Test ◽  
Surgical Intensive Care ◽  
Stool Samples ◽  
Vancomycin Resistant

AbstractObjectiveWe evaluated the utility of vancomycin-resistant Enterococcus (VRE) surveillance by varying 2 parameters: admission versus weekly surveillance and perirectal swabbing versus stool sampling.DesignProspective, patient-level surveillance program of incident VRE colonization.SettingLiver transplant surgical intensive care unit (SICU) of a tertiary-care referral medical center with a high prevalence of VRE.PatientsAll patients admitted to the SICU from June to August 2015.MethodsWe conducted a point-prevalence estimate followed by admission and weekly surveillance by perirectal swabbing and/or stool sampling. Incident colonization was defined as a negative screen followed by positive surveillance. VRE was detected by culture on Remel Spectra VRE chromogenic agar. Microbiologically-confirmed VRE bloodstream infections (BSIs) were tracked for 2 months. Statistical analyses were calculated using the McNemar test, the Fisher exact test, the t test, and the χ2 test.ResultsIn total, 91 patients underwent VRE surveillance testing. The point prevalence of VRE colonization was 60.9%; VRE prevalence on admission was 30.1%. Weekly surveillance identified an additional 7 of 28 patients (25.0%) with incident colonization. VRE BSIs were more common in VRE-colonized patients than in noncolonized patients (8 of 43 vs 2 of 48; P=.028). In a direct comparison, perirectal swabs were more sensitive than stool samples in detecting VRE (64 of 67 vs 56 of 67; P=.023). Compliance with perirectal swabbing was 89% (201 of 226) compared to 56% (127 of 226) for stool collection (P≤0.001).ConclusionsWe recommend weekly VRE surveillance over admission-only screening in high-burden units such as liver transplant SICUs. Perirectal swabs had greater collection compliance and sensitivity than stool samples, making them the preferred methodology. Further work may have implications for antimicrobial stewardship and infection control.

Vancomycin-Resistant Enterococcus (VRE) Colonization Is Associated with a High Rate of Bacteremia and Early Mortality in Transplant/Leukemia Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5315-5315 ◽  
Author(s):  
Jose F. Leis ◽  
Abby Newton ◽  
Mary T. Post ◽  
Brandon M. Hayes-Lattin ◽  
Richard Thomas Maziarz ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Active Surveillance ◽  
Census Data ◽  
Control Strategies ◽  
Positive Culture ◽  
Early Mortality ◽  
High Rate ◽  
Allogeneic Transplant ◽  
Colonization Pressure ◽  
Vancomycin Resistant

Abstract Background: Vancomycin-resistant enterococci (VRE) have become increasingly important nosocomial pathogens in very ill and immunocompromised hospitalized patients (pts). Due to an increase in VRE clinical cultures including bacteremias on our institutional transplant/leukemia service in early 2004, active surveillance for VRE among this population was instituted in June 2004. We describe here the incidence and prevalence of VRE colonization and infection in this population over a two year study period, as well as selected pt demographics and mortality associated with VRE bacteremia. Methods: Between June 2004 and July 2006, active surveillance for VRE on inpatients on the transplant/leukemia service was performed by acquiring perirectal or stool swabs for VRE culture on hospital admission and on a weekly basis while inpatient. Acquisition of VRE was determined to be nosocomial if the initial culture was negative followed by a positive culture at any time during the hospital stay. Multiple sequential interventions as recommended by the Society for Healthcare and Epidemiology (SHEA) guidelines were implemented. Pt census data and daily isolation indicators were used to help determine VRE colonization rates and the prevalence of VRE on the units. Chart reviews were performed to obtain information on clinical pts related features and mortality of bacteremic pts. Results: Nineteen percent (193/1019) of pts screened were colonized with VRE with the monthly nosocomial colonization rate ranging from 2–12% (rate/1000 patient days). Eighteen percent (31/189) of pts newly colonized with VRE became bacteremic, including 7/31 who had bacteremia as their primary presentation. Of the bacteremic pts, 24 (77.4%) died at a median of 20 days (range 2–208 days), 18 (75%) dying during their bacteremic hospitalization of multiple causes. Sixteen had acute leukemia, 11 non-Hodgkin’s lymphoma, and 3 other malignancies. Eighteen bacteremic pts had undergone allogeneic transplant & 5 autologous transplant. Fourteen of 18 allogeneic transplant pts had active GVHD and all 18 were on immune suppression therapy. Of all allogeneic transplants performed during the study period, 13% (18/140) were complicated by VRE bacteremia. Sixteen bacteremic pts required ICU stays, while 6 had C. difficile colitis and 5 mucositis during the same hospital stay. SHEA recommended interventions instituted at various times (e.g. enhanced contact and barrier precautions for colonized pts, “supercleans” of unit, written communication to staff, pts and families, gloving for all pt contacts) did not have a durable effect on these rates. However, the ratio of new nosocomial cases/overall prevalence of VRE in the units decreased 20% over the study period, suggesting some measure of control despite high colonization pressure. Assessment of response to intensive control strategies as well as delineation of risk factors for bacteremia and death in this population are ongoing and will be presented. Conclusion: Despite application of standardized guidelines for VRE control, affecting a marked and durable decrease in endemic VRE colonization on a complicated transplant/leukemia service is difficult. VRE bacteremia following colonization in transplant/leukemia pts is common and is associated with early mortality. VRE control remains critical, and new modalities and approaches are essential.

scholarly journals Epidemiology of Methicillin-Resistant Staphylococcus aureus Colonization in a Surgical Intensive Care Unit

2006 ◽  
Vol 27 (10) ◽  
pp. 1032-1040 ◽  
Author(s):  
David K. Warren ◽  
Rebecca M. Guth ◽  
Craig M. Coopersmith ◽  
Liana R. Merz ◽  
Jeanne E. Zack ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Active Surveillance ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Admission ◽  
The Past ◽  
Surgical Icu ◽  
Mrsa Colonization

Background.Methicillin-resistant Staphylococcus aureus (MRSA) is a cause of healthcare-associated infections among surgical intensive care unit (ICU) patients, though transmission dynamics are unclear.Objective.To determine the prevalence of MRSA nasal colonization at ICU admission, to identify associated independent risk factors, to determine the value of these factors in active surveillance, and to determine the incidence of and risk factors associated with MRSA acquisition.Design.Prospective cohort study.Setting.Surgical ICU at a teaching hospital.Patients.All patients admitted to the surgical ICU.Results.Active surveillance for MRSA by nasal culture was performed at ICU admission during a 15-month period. Patients who stayed in the ICU for more than 48 hours had nasal cultures performed weekly and at discharge from the ICU, and clinical data were collected prospectively. Of 1,469 patients, 122 (8%) were colonized with MRSA at admission; 75 (61%) were identified by surveillance alone. Among 775 patients who stayed in the ICU for more than 48 hours, risk factors for MRSA colonization at admission included the following: hospital admission in the past year (1-2 admissions: adjusted odds ratio [aOR], 2.60 [95% confidence interval {CI}, 1.47-4.60]; more than 2 admissions: aOR, 3.56 [95% CI, 1.72-7.40]), a hospital stay of 5 days or more prior to ICU admission (aOR, 2.54 [95% CI, 1.49-4.32]), chronic obstructive pulmonary disease (aOR, 2.16 [95% CI, 1.17-3.96]), diabetes mellitus (aOR, 1.87 [95% CI, 1.10-3.19]), and isolation of MRSA in the past 6 months (aOR, 8.18 [95% CI, 3.38-19.79]). Sixty-nine (10%) of 670 initially MRSA-negative patients acquired MRSA in the ICU (corresponding to 10.7 cases per 1,000 ICU-days at risk). Risk factors for MRSA acquisition included tracheostomy in the ICU (aOR, 2.18 [95% CI, 1.13-4.20]); decubitus ulcer (aOR, 1.72 [95% CI, 0.97-3.06]), and receipt of enteral nutrition via nasoenteric tube (aOR, 3.73 [95% CI, 1.86-7.51]), percutaneous tube (aOR, 2.35 [95% CI, 0.74-7.49]), or both (aOR, 3.33 [95% CI, 1.13-9.77]).Conclusions.Active surveillance detected a sizable proportion of MRSA-colonized patients not identified by clinical culture. MRSA colonization on admission was associated with recent healthcare contact and underlying disease. Acquisition was associated with potentially modifiable processes of care.

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