A Comparison of Multifaceted VersusClostridium difficile-Focused VRE Surveillance Strategies in a Low-Prevalence Setting

2001 ◽  
Vol 22 (4) ◽  
pp. 219-221 ◽  
Author(s):  
Kevin C. Kate ◽  
Michael A. Gardam ◽  
JoAnne Burt ◽  
John M. Conly
Keyword(s):  
Clostridium Difficile ◽  
Rectal Swab ◽  
Cost Savings ◽  
Screening Strategy ◽  
Substantial Cost ◽  
Toxin Assay ◽  
Stool Samples ◽  
Vancomycin Resistant ◽  
Low Prevalence ◽  
Current Screening

AbstractWe compared our current screening strategy for vancomycin-resistantEnterococcus(VRE) with a focused strategy that screens all stool samples sent forClostridium difficiletoxin assay but limits rectal swab screening to wards with new VRE cases detected viaC difficilesamples. The proposed strategy detects 72.7% of new VRE cases, with substantial cost savings.

scholarly journals Surveillance for Vancomycin-Resistant Enterococci: Type, Rates, Costs, and Implications

2006 ◽  
Vol 27 (10) ◽  
pp. 1068-1075 ◽  
Author(s):  
Brooke N. Shadel ◽  
Laura A. Puzniak ◽  
Kathleen N. Gillespie ◽  
Steven J. Lawrence ◽  
Marin Kollef ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Prospective Observational Study ◽  
Stool Specimen ◽  
Rectal Swab ◽  
Cost Savings ◽  
Cost Effective ◽  
Vancomycin Resistant Enterococci ◽  
Stool Samples ◽  
Surveillance Method ◽  
Vancomycin Resistant

Objective.To evaluate 2 active surveillance strategies for detection of enteric vancomycin-resistant enterococci (VRE) in an intensive care unit (ICU).Design.Thirty-month prospective observational study.Setting.ICU at a university-affiliated referral center.Patients.All patients with an ICU stay of 24 hours or more were eligible for the study.Intervention.Clinical active surveillance (CAS), involving culture of a rectal swab specimen for detection of VRE, was performed on admission, weekly while the patient was in the ICU, and at discharge. Laboratory-based active surveillance (LAS), involving culture of a stool specimen for detection of VRE, was performed on stool samples submitted forClostridium difficiletoxin detection.Results.Enteric colonization with VRE was detected in 309 (17%) of 1,872 patients. The CAS method initially detected 280 (91%) of the 309 patients colonized with VRE, compared with 25 patients (8%) detected by LAS; colonization in 4 patients (1%) was initially detected by analysis of other clinical specimens. Most patients with colonization (76%) would have gone undetected by LAS alone, whereas use of the CAS method exclusively would have missed only 3 patients (1%) who were colonized. CAS cost $1,913 per month, or $57,395 for the 30-month study period. Cost savings of CAS from preventing cases of VRE colonization and bacteremia were estimated to range from $56,258 to $303,334 per month.Conclusions.A patient-based CAS strategy for detection of enteric colonization with VRE was superior to LAS. In this high-risk setting, CAS appeared to be the most efficient and cost-effective surveillance method. The modest costs of CAS were offset by the averted costs associated with the prevention of VRE colonization and bacteremia.

scholarly journals Detection of Clostridium difficile in Feces of Asymptomatic Patients Admitted to the Hospital

2016 ◽  
Vol 55 (2) ◽  
pp. 403-411 ◽  
Author(s):  
Elisabeth M. Terveer ◽  
Monique J. T. Crobach ◽  
Ingrid M. J. G. Sanders ◽  
Margreet C. Vos ◽  
Cees M. Verduin ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Predictive Value ◽  
Health Care Facilities ◽  
Nucleic Acid Amplification ◽  
Content Type ◽  
Asymptomatic Patients ◽  
Toxigenic Culture ◽  
Stool Samples ◽  
Sensitivity Specificity ◽  
Low Prevalence

ABSTRACTRecent evidence shows that patients asymptomatically colonized withClostridium difficilemay contribute to the transmission ofC. difficilein health care facilities. Additionally, these patients may have a higher risk of developingC. difficileinfection. The aim of this study was to compare a commercially available PCR directed to both toxin A and B (artusC. difficileQS-RGQ kit CE; Qiagen), an enzyme-linked fluorescent assay to glutamate dehydrogenase (GDH ELFA) (Vidas, bioMérieux), and an in-house-developed PCR totcdB, with (toxigenic) culture ofC. difficileas the gold standard to detect asymptomatic colonization. Test performances were evaluated in a collection of 765 stool samples obtained from asymptomatic patients at admission to the hospital. TheC. difficileprevalence in this collection was 5.1%, and 3.1% contained toxigenicC. difficile. Compared toC. difficileculture, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of theC. difficileGDH ELFA were 87.2%, 91.2%, 34.7%, and 99.3%, respectively. Compared with results of toxigenic culture, the sensitivity, specificity, PPV, and NPV of the commercially available PCR and the in-house PCR were 95.8%, 93.4%, 31.9%, 99.9%, and 87.5%, 98.8%, 70%, and 99.6%, respectively. We conclude that in a low-prevalence setting of asymptomatically colonized patients, both GDH ELFA and a nucleic acid amplification test can be applied as a first screening test, as they both display a high NPV. However, the low PPV of the tests hinders the use of these assays as stand-alone tests.

scholarly journals Clearance of Vancomycin-Resistant Enterococcus Concomitant With Administration of a Microbiota-Based Drug Targeted at Recurrent Clostridium difficile Infection

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Erik R. Dubberke ◽  
Kathleen M. Mullane ◽  
Dale N. Gerding ◽  
Christine H. Lee ◽  
Thomas J. Louie ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Small Sample Size ◽  
Secondary Analysis ◽  
Small Sample ◽  
Vancomycin Resistant Enterococcus ◽  
Recurrent Clostridium Difficile Infection ◽  
Stool Samples ◽  
Vancomycin Resistant

Abstract Background.  Vancomycin-resistant Enterococcus (VRE) is a major healthcare-associated pathogen and a well known complication among transplant and immunocompromised patients. We report on stool VRE clearance in a post hoc analysis of the Phase 2 PUNCH CD study assessing a microbiota-based drug for recurrent Clostridium difficile infection (CDI). Methods.  A total of 34 patients enrolled in the PUNCH CD study received 1 or 2 doses of RBX2660 (microbiota suspension). Patients were requested to voluntarily submit stool samples at baseline and at 7, 30, and 60 days and 6 months after the last administration of RBX2660. Stool samples were tested for VRE using bile esculin azide agar with 6 µg/mL vancomycin and Gram staining. Vancomycin resistance was confirmed by Etest. Results.  VRE status (at least 1 test result) was available for 30 patients. All stool samples for 19 patients (63.3%, mean age 61.7 years, 68% female) tested VRE negative. Eleven patients (36.7%, mean age 75.5 years, 64% female) were VRE positive at the first test (baseline or 7-day follow-up). Of these patients, 72.7%, n = 8 converted to negative as of the last available follow-up (30 or 60 days or 6 months). Of the other 3: 1 died (follow-up data not available); 1 patient remained positive at all follow-ups; 1 patient retested positive at 6 months with negative tests during the interim. Conclusions.  Although based on a small sample size, this secondary analysis demonstrated the possibility of successfully converting a high percentage of VRE-positive patients to negative in a recurrent CDI population with RBX2660.

Undetected Vancomycin-Resistant Enterococcus Stool Colonization in a Veterans Affairs Hospital Using a Clostridium difficile–Focused Surveillance Strategy

2002 ◽  
Vol 23 (8) ◽  
pp. 474-477 ◽  
Author(s):  
Amy J. Ray ◽  
Claudia K. Hoyen ◽  
Sarbani M. Das ◽  
Elizabeth C. Eckstein ◽  
Curtis J. Donskey
Keyword(s):  
Clostridium Difficile ◽  
Veterans Affairs ◽  
Point Prevalence ◽  
Vancomycin Resistant Enterococcus ◽  
Surveillance Strategy ◽  
Stool Samples ◽  
Vancomycin Resistant

Abstract We examined the point prevalence of undetected vancomycin-resistant Enterococcus (VRE) stool colonization in an institution that screens stool samples submitted for Clostridium difficile testing. Of 112 patients not known to be colonized, 10 (9%) had rectal VRE colonization. A prospective algorithm was effective for identification of colonized patients.

Laboratory-Based Surveillance for Vancomycin-Resistant Enterococci: Utility of Screening Stool Specimens Submitted for Clostridium difficile Toxin Assay

2001 ◽  
Vol 22 (03) ◽  
pp. 160-164 ◽  
Author(s):  
Amy L. Leber ◽  
Janet F. Hindler ◽  
Ellen O. Kato ◽  
David A. Bruckner ◽  
David A. Pegues
Keyword(s):  
High Risk ◽  
Clostridium Difficile ◽  
Hospitalized Patients ◽  
University Teaching ◽  
Toxin A ◽  
Vancomycin Resistant Enterococci ◽  
Positive Stool ◽  
Toxin Assay ◽  
Stool Specimens ◽  
Vancomycin Resistant

AbstractObjective:To study vancomycin-resistant enterococci (VRE) gastrointestinal colonization prevalence in high-risk hospitalized patients and to assess the cost and utility of this laboratory-based surveillance.Setting:Large university teaching hospital.Design:Quarterly prevalence culture survey of 50 stool specimens submitted forClostridium difficiletoxin A assay from October 1996 through June 1999 (n=526). Screening culture survey of allC difficile-positive stool specimens from July 1998 through June 1999 (n=140).Patients:Specimens for analysis were collected from patients who were admitted to the hospital and who hadC difficiletoxin A testing ordered. Patient samples were excluded from analysis if they were obtained from patients not hospitalized at UCLA Medical Center, if theC difficiletoxin assay result was indeterminate, or if the patient was known to have previous VRE colonization or infection.Results:During quarterly surveillance, VRE was detected in 19.8%,C difficiletoxin A in 9.5%, and both VRE andC difficiletoxin A in 3.2% of stool specimens submitted forC difficiletoxin assay. Patients whose stool specimens were positive forC difficiletoxin A were significantly more likely than those whose specimens were negative to have VRE detected (odds ratio, 2.3; 95% confidence interval, 1.2-4.5). Based on these findings, in July 1998, we began routine screening of allC difficile-positive stool specimens for VRE. From July 1998 through June 1999, 58 (41.4%) of 140 patients withC difficile-positive specimens had VRE newly detected in the stool. The combined cost of the two laboratory-based surveillance strategies was approximately $62 per VRE-positive patient identified and $5,800 per year.Conclusion:Quarterly surveillance of stool submitted forC difficileassay combined with screening allC difficile-positive stools is a cost-effective and efficient strategy for detecting VRE stool colonization among high-risk hospitalized patients. Such a laboratory-based surveillance should be included as part of a comprehensive program to limit nosocomial VRE transmission.

scholarly journals Both Oral Metronidazole and Oral Vancomycin Promote Persistent Overgrowth of Vancomycin-Resistant Enterococci during Treatment of Clostridium difficile-Associated Disease

2008 ◽  
Vol 52 (7) ◽  
pp. 2403-2406 ◽  
Author(s):  
Wafa N. Al-Nassir ◽  
Ajay K. Sethi ◽  
Yuejin Li ◽  
Michael J. Pultz ◽  
Michelle M. Riggs ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Prospective Observational Study ◽  
Oral Vancomycin ◽  
The Past ◽  
Vancomycin Resistant Enterococci ◽  
Stool Samples ◽  
Vancomycin Resistant ◽  
Healthcare Associated ◽  
Vancomycin Treatment ◽  
Oral Metronidazole

ABSTRACT For treatment of mild to moderate Clostridium difficile-associated disease (CDAD), oral metronidazole has been recommended as the preferred agent, in part due to concern that vancomycin may be more likely to promote colonization by vancomycin-resistant enterococci (VRE). We performed a prospective observational study to examine the effects of oral metronidazole or vancomycin treatment of CDAD on acquisition and concentration of VRE stool colonization. Before, during, and after 90 courses of CDAD therapy, stool samples were cultured for VRE, and the concentrations were quantified. Eighty-seven subjects (97%) had received antibiotics within the past month. For 56 treatment courses in which preexisting VRE colonization was present, metronidazole (n = 37 courses) and vancomycin (n = 19 courses), each promoted persistent VRE overgrowth during therapy, and the concentration decreased significantly in both groups by ∼2 weeks after completion of treatment (P <0.049). For 34 treatment courses in which baseline cultures were negative for VRE, new detection of VRE stool colonization occurred during 3 (14%) of the 22 courses of metronidazole and 1 (8%) of the 12 courses of vancomycin (P = 1.0). These results demonstrate that both oral metronidazole and oral vancomycin promote the overgrowth of VRE during treatment of CDAD. New CDAD treatments are needed that are less likely to disrupt the intestinal microflora and promote overgrowth of healthcare-associated pathogens.

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