Three Surveillance Strategies for Vancomycin-Resistant Enterococci in Hospitalized Patients: Detection of Colonization Efficiency and a Cost-Effectiveness Model

2005 ◽  
Vol 26 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Todd A. Lee ◽  
Donna M. Hacek ◽  
Kevin T. Stroupe ◽  
Susan M. Collins ◽  
Lance R. Peterson
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Emergency Department Visits ◽  
Detection Sensitivity ◽  
Screening Cost ◽  
Vancomycin Resistant Enterococci ◽  
Number Of Patients ◽  
History Of ◽  
Stool Specimens ◽  
Vancomycin Resistant

AbstractObjective:To evaluate the cost-effectiveness and detection sensitivity associated with three active surveillance strategies for the identification of patients harboring vancomycin-resistant enterococci (VRE) to determine which is the most medically and economically useful.Design:Culture for VRE from 200 consecutive stool specimens submitted forClostridium difficileculture. Following this, risk factors were assessed for patients whose culture yielded VRE, and a cost-effectiveness evaluation was performed using a decision analytic model with a probabilistic analysis.Setting:A 688-bed, tertiary-care facility in Chicago, Illinois, with approximately 39,000 annual admissions, 7,000 newborn deliveries, 56,000 emergency department visits, and 115,000 home care and 265,000 outpatient visits.Subjects:All stool specimens submitted to the clinical microbiology laboratory forC. difficileculture from hospital inpatients.Results:From 200 stool samples submitted forC. difficiletesting, we identified 5 patients with VRE in non-high-risk areas not screened as part of our routine patient surveillance. Medical record review revealed that all 5 had been hospitalized within the prior 2 years. Three of 5 had a history of renal impairment. The strategy that would involve screening the greatest number of patients (all those with a history of hospital admission in the prior 2 years) resulted in highest screening cost per patient admitted ($2.48), lower per patient admission costs ($480), and the best survival rates.Conclusion:An expanded VRE surveillance program that encompassed all patients hospitalized within the prior 2 years was a cost-effective screening strategy compared with a more traditional one focused on high-risk units.

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 Discontinuation of Reflex Testing of Stool Samples for Vancomycin-Resistant Enterococci Resulted in Increased Prevalence

2013 ◽  
Vol 34 (8) ◽  
pp. 838-840 ◽  
Author(s):  
Mandy Bodily ◽  
Kathleen M. McMullen ◽  
Anthony J. Russo ◽  
Nupur D. Kittur ◽  
Joan Hoppe-Bauer ◽  
...  
Keyword(s):  
Cost Benefit Analysis ◽  
Hospital Costs ◽  
Cost Benefit ◽  
Benefit Analysis ◽  
Vancomycin Resistant Enterococci ◽  
Number Of Patients ◽  
Reflex Testing ◽  
Stool Samples ◽  
Vancomycin Resistant ◽  
Healthcare Associated

Discontinuation of reflex testing of stool submitted forClostridium difficiletesting for vancomycin-resistant enterococci (VRE) led to an increase in the number of patients with healthcare-associated VRE bacteremia and bacteriuria (0.21 vs 0.36 cases per 1,000 patient-days;P< .01). Cost-benefit analysis showed reflex screening and isolation of VRE reduced hospital costs.

Abstract 3772: Alternate Listing Transplantation is a Cost-Effective Treatment for End-Stage Heart Failure Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Mark J Russo ◽  
Jonathan M Chen ◽  
Kimberly N Hong ◽  
Michael Argenziano ◽  
Ryan R Davies ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Cost Model ◽  
Case Series ◽  
Cost Effective ◽  
Intention To Treat ◽  
Cost Effective Treatment ◽  
Number Of Patients ◽  
Transplant Candidates ◽  
End Stage

BACKGROUND: In order to offer the benefit of heart transplantation to a greater number of patients some centers match high-risk recipients (HR) with non-standard or ”marginal” donors (MD) in a strategy known as Alternate Listing Transplantation (ALT). However, pairing sicker recipients with lower quality donor organs remains both clinically and ethically controversial. The purpose of this study was to determine the cost-effectiveness of this strategy. METHODS: The United Network of Organ Sharing provided deidentified patient-level data. UNOS data was used to determine clinical outcomes, including waiting time, post-transplant survival, length of stay, re-hospitalizations, episodes of rejection, and infection, based on all adult heart transplant candidates (age [gt] 18 yo) and listed between 1995–2005 (n=35,049). Through a systematic literature review of randomized controlled trials and case series that estimated related costs, a cost model (see Table ) using an intention-to-treat assumption was developed to calculate the incremental cost-effectiveness ratio (ICER) for HR candidates who subsequently received marginal donor hearts (HTR) compared with candidates who were not transplanted (NTXP). High-risk recipient criteria included age [gt] 65yo, retransplantation, HepC+, HIV+, CrCl <30 ml/min, DM with PVD, DM with Crcl <40 ml/min. MD criteria included age [gt] 55yo, DM, HIV+, HepC+, EF<45%, and donor:recipient weight <0.7. RESULTS: Median survival from listing was 0.55 yrs and 5.1 yrs in the HTR and NTXP groups, respectively. The estimated ICER was $66,645($34,046–$127,491) ICER varied by HR recipient criteria. CONCLUSIONS: The ICER for ALT falls at the upper limits acceptability for being cost-effective. However, stratified analysis by HR group suggests that this strategy is not appropriate for all groups. Cost Model Assumptions

scholarly journals Natural history of pT3-4 or node positive bladder cancer treated with radical cystectomy and no neoadjuvant chemotherapy in a contemporary North-American multi-institutional cohort

2012 ◽  
Vol 6 (6) ◽  
pp. 217 ◽  
Author(s):  
Nicholas E. Power ◽  
Wassim Kassouf ◽  
David Bell ◽  
Armen Aprikian ◽  
Yves Fradet ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Natural History ◽  
Radical Cystectomy ◽  
Node Positive ◽  
Number Of Patients ◽  
History Of ◽  
Modern Era

Background: The present study documents the natural history and outcomes of high-risk bladder cancer after radical cystectomy (RC) in patients who did not receive neoadjuvant chemotherapy during a contemporary time period.Methods: We analyzed 1180 patients from 1993 to 2008 with >pT3N0 or pT0-4N+ bladder cancer who underwent RC ± standard (sLND) or extended (eLND) lymph node dissection from 8 Canadian centres.Results: Of the 1180 patients, 55% (n = 643) underwent sLND, 34% (n = 402) underwent ePLND and 11% did not undergo a formal LND. Of the total number of patients, 321 (27%) received adjuvant chemotherapy. The median follow-up was 2.1 years (range: 0.6 to 12.9). Overall 30-day mortality was 3.2%. Clinical and pathological stages T3-4 were present in 6.1% and 86.7% of the patients, respectively; this demonstrates a dramatic understaging. Overall survival (OS) at 2 and 5 years was 60% and 43%, respectively. Patients who received adjuvant chemotherapy hada 2- and 5-year disease-specific survival (DSS) of 72% and 57% versus 64% and 51% for those who did not (log-rank p = 0.0039). The 2- and 5-year OS for high-risk node-negative disease was 67%and 52%, respectively, whereas for node-positive patients, the OS was 52% and 32%, respectively (p < 0.001). The OS, DSS and RFS for patients with pN0 were significantly improved compared to those who did not undergo a LND (log-rank p = 0.0035, 0.0241 and 0.0383, respectively).Interpretation: This series suggests that bladder cancer outcomes inadvanced disease have improved in the modern era. The need for improved staging investigations, use of neoadjuvant chemotherapyand performance of complete LND is emphasized.

Sustained Reduction of Vancomycin-resistant Enterococci (VRE) Transmissions in High Risk Patient Populations

2017 ◽  
Vol 45 (6) ◽  
pp. S151
Author(s):  
Kristen Metzger ◽  
Mary Anne Sotelo ◽  
Sandra Reiner ◽  
Christina Silkaitis ◽  
Mary Mielnicki ◽  
...  
Keyword(s):  
High Risk ◽  
High Risk Patient ◽  
Risk Patient ◽  
Vancomycin Resistant Enterococci ◽  
Sustained Reduction ◽  
Vancomycin Resistant

scholarly journals Risk Factors for New Detection of Vancomycin-Resistant Enterococci in Acute-Care Hospitals That Employ Strict Infection Control Procedures

2003 ◽  
Vol 47 (8) ◽  
pp. 2492-2498 ◽  
Author(s):  
Alexander A. Padiglione ◽  
Rory Wolfe ◽  
Elizabeth A. Grabsch ◽  
Di Olden ◽  
Stephen Pearson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
High Risk ◽  
Infection Control ◽  
Broad Spectrum ◽  
Rectal Swab ◽  
High Risk Patients ◽  
Vancomycin Resistant Enterococci ◽  
Risk Patients ◽  
Vancomycin Resistant

ABSTRACT Accurate assessment of the risk factors for colonization with vancomycin-resistant enterococci (VRE) among high-risk patients is often confounded by nosocomial VRE transmission. We undertook a 15-month prospective cohort study of adults admitted to high-risk units (hematology, renal, transplant, and intensive care) in three teaching hospitals that used identical strict infection control and isolation procedures for VRE to minimize nosocomial spread. Rectal swab specimens for culture were regularly obtained, and the results were compared with patient demographic factors and antibiotic exposure data. Compliance with screening was defined as “optimal” (100% compliance) or “acceptable” (minor protocol violations were allowed, but a negative rectal swab specimen culture was required within 1 week of becoming colonized with VRE). Colonization with VRE was detected in 1.56% (66 of 4,215) of admissions (0.45% at admission and 0.83% after admission; the acquisition time was uncertain for 0.28%), representing 1.91% of patients. No patients developed infection with VRE. The subsequent rate of new acquisition of VRE was 1.4/1,000 patient days. Renal units had the highest rate (3.23/1,000 patient days; 95% confidence interval [CI], 1.54 to 6.77/1,000 patient days). vanB Enterococcus faecium was the most common species (71%), but other species included vanB Enterococcus faecalis (21%), vanA E. faecium (6%), and vanA E. faecalis (2%). The majority of isolates were nonclonal by pulsed-field gel electrophoresis analysis. Multivariate analysis of risk factors in patients with an acceptable screening suggested that being managed by a renal unit (hazard ratio [HR] compared to the results for patients managed in an intensive care unit, 4.6; 95% CI, 1.2 to 17.0 [P = 0.02]) and recent administration of either ticarcillin-clavulanic acid (HR, 3.6; 95% CI, 1.1 to 11.6 [P = 0.03]) or carbapenems (HR, 2.8; 95% CI, 1.0, 8.0 [P = 0.05]), but not vancomycin or broad-spectrum cephalosporins, were associated with acquisition of VRE. The relatively low rates of colonization with VRE, the polyclonal nature of most isolates, and the possible association with the use of broad-spectrum antibiotics are consistent with either the endogenous emergence of VRE or the amplification of previously undetectable colonization with VRE among high-risk patients managed under conditions in which the risk of nosocomial acquisition was minimized.

Absence of Rectal Colonization with Vancomycin-Resistant Enterococci among High-Risk Pediatric Patients

1998 ◽  
Vol 19 (2) ◽  
pp. 109-112 ◽  
Author(s):  
Adnan Trabulsi ◽  
Anne-Marie Glover ◽  
Shirley F. Reising ◽  
Celia D. C. Christie
Keyword(s):  
High Risk ◽  
Pediatric Patients ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Rectal Colonization
Sign in / Sign up

Export Citation Format

Share Document