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 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.

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 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.

scholarly journals Evaluation of Compliance in Control and Prevention Study of Vancomycin Resistant Enterococcus Outbreak

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Vuslat Kecik Bosnak ◽  
Mustafa Namiduru ◽  
Ilkay Karaoglan ◽  
Ayse Ozlem Mete
Keyword(s):  
Rectal Swab ◽  
Close Contact ◽  
Prevention Study ◽  
Patient Room ◽  
Contact Isolation ◽  
Vancomycin Resistant Enterococci ◽  
Isolation Methods ◽  
Control And Prevention ◽  
Vancomycin Resistant ◽  
The Impact

Objective. Vancomycin resistant enterococci (VRE) colonization and the spread decrease with compliance and isolation guidelines. For the isolation methods to succeed, compliance with the isolation guidelines needs to be overseen. In this study, VRE outbreak among the Pediatric Ward patients, the preventative efforts to control this outbreak, and the impact of scoring tables used in controlling this outbreak on the success are explained.Design. Rectal swab cultures were taken from patients who were admitted to the Ward between October and December 2010 due to diagnoses of VRE and urinary tract infection.Results. VRE were isolated in the rectal swab samples of 34 patients. VRE infection findings were clinically detected in two of the cases with VRE isolation. Two isolations of VRE were detected on cultures from patient room door handle surface and the telephone in the room for common use. Close contact isolation was achieved and barrier precautions were taken for all cases, as soon as the detections were made. A scoring system was developed to evaluate the feasibility of and the compliance with the precautions to be taken.Conclusions. With the method presented in this study, the outbreak at our hospital was under control within two months.

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.

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.

Control of Vancomycin-Resistant Enterococci in the Neonatal Intensive Care Unit

2005 ◽  
Vol 26 (7) ◽  
pp. 646-649 ◽  
Author(s):  
Nalini Singh ◽  
Marie-Michèle Léger ◽  
Joyce Campbell ◽  
Billie Short ◽  
Joseph M. Campos
Keyword(s):  
High Risk ◽  
Infection Control ◽  
Dna Fingerprinting ◽  
Active Surveillance ◽  
Genetic Relatedness ◽  
Control Measures ◽  
Infection Control Measures ◽  
Vancomycin Resistant Enterococci ◽  
Surveillance Cultures ◽  
Vancomycin Resistant

AbstractBackground and Objective:Multidrug-resistant organisms (MDROs), such as vancomycin-resistant enterococci (VRE), cause serious infections, especially among high-risk patients in NICUs. When VRE was introduced and transmitted in our NICU despite recommended infection control practices, we instituted active surveillance cultures to determine their efficacy in detecting and controlling spread of VRE among high-risk infants.Methods:Active surveillance cultures, other infection control measures, and a mandatory in-service education module on preventing MDRO transmission were implemented. Cultures were performed on NICU admission and then weekly during their stay. Molecular DNA fingerprinting of VRE isolates facilitated targeting efforts to eliminate clonal spread of VRE. Repetitive sequence PCR (rep-PCR)-based DNA fingerprinting was used to compare isolates recovered from patients with VRE infection or colonization. Environmental VRE cultures were performed around VRE-colonized or -infected patients. DNA fingerprints were prepared from the products of rep-PCR amplification and analyzed using software to determine strain genetic relatedness.Results:Active surveillance cultures identified 65 patients with VRE colonization or infection among 1,820 admitted to the NICU. Rep-PCR performed on 60 VRE isolates identified 3 clusters. Cluster 1 included isolates from 21 patients and 4 isolates from the environment of the index patient. Clusters 2 and 3 included isolates from 23 and 3 patients, respectively. Similarity coefficients among the members of each cluster were 95% or greater.Conclusions:Control of transmission of multi-clonal VRE strains was achieved. Active surveillance cultures, together with implementation of other infection control measures, combined with rep-PCR DNA fingerprinting were instrumental in controlling VRE transmission in our NICU. (Infect Control Hosp Epidemiol 2005;26:646-649)

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