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

Published online by Cambridge University Press:  21 June 2016

Brooke N. Shadel*
Affiliation:
Institute for Bio-Security, School of Public Health, Saint Louis University, Washington University School of Medicine, St. Louis, Missouri
Laura A. Puzniak
Affiliation:
Saint Louis County Health Department, Washington University School of Medicine, St. Louis, Missouri
Kathleen N. Gillespie
Affiliation:
Department of Health Management and Policy, School of Public Health, Saint Louis University, Washington University School of Medicine, St. Louis, Missouri
Steven J. Lawrence
Affiliation:
Divisions of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Marin Kollef
Affiliation:
Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri
Linda M. Mundy
Affiliation:
Institute for Bio-Security, School of Public Health, Saint Louis University, Washington University School of Medicine, St. Louis, Missouri
*
Saint Louis University, School of Public Health, Saint Louis, MO 63104, (shadebn@slu.edu)

Extract

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 for Clostridium difficile toxin 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.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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