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Evaluation of Vancomycin-Resistant Enterococci (VRE)–Associated Morbidity Following Relaxation of VRE Screening and Isolation Precautions in a Tertiary Care Hospital

Published online by Cambridge University Press:  10 May 2016

Kristin Y. Popiel  and
Mark A. Miller
Kristin Y. Popiel
Affiliation:
Division of Infectious Diseases, McGill University Health Center, Montreal, Quebec, Canada
Mark A. Miller*
Affiliation:
Division of Infectious Diseases, Jewish General Hospital, Montreal, Quebec, Canada
*
Division of Infectious Diseases, Jewish General Hospital, 3755 Chemin de la Cote-Ste-Catherine, Montreal, Québec H3T 1E2, Canada (mmiller@lab.jgh.mcgill.ca).
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Extract

Objective

To determine whether relaxing vancomycin-resistant enterococci (VRE) precautions results in an increase in the incidence of invasive VRE infections over time.

Design

Retrospective analysis of a microbiology database before and after relaxation of VRE screening and isolation precautions.

Setting

Urban tertiary care teaching hospital in Montreal, Canada.

Participants.

All hospitalized and emergency room patients over a 13-year period from January 1, 2000, to March 31, 2013.

Methods

We assessed the results of all microbiology cultures for the presence of VRE as well as the results of all polymerase chain reaction assays for vanA and vanB during the study period. Applying criteria for 4 clinical situations (bacteremia, definite infection, possible infection, and colonization with VRE), we analyzed the effects of relaxed VRE screening and isolation precautions on the incidence of each of these outcomes over the time preceding and following this change.

Results

When VRE screening and isolation precautions were relaxed, a marked rise in VRE colonization was observed, with a lesser but definite rise in the 3 other outcomes. Despite this initial rise in all measures, all incidences other than colonization plateaued during the 34 months of follow-up.

Conclusions

Relaxation of VRE screening and isolation precautions was associated with an immediate increase in colonization and infection incidence. Despite increasing colonization, infection outcomes remained infrequent and stable, suggesting a finite number of susceptible hosts at risk. Relaxation of VRE protocols may not lead to increasing infection incidence in a hospital setting, advocating that cost effectiveness exercises, with targeted screening and isolation precautions, are crucial.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 7 , July 2014 , pp. 818 - 825
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

1. Lior, L, Litt, M, Hockin, J, et al. Vancomycin-resistant enterococci on a renal ward in an Ontario hospital. Can Commun Dis Rep 1996;22(15):125–128.Google Scholar
2. Fortin, A, Milord, F, Guay, M, d’Halewyn, MA, Vigeant, P, Leblanc, G. First known outbreak of colonizing vancomycin-resistant enterococci in Quebec. Can Commun Dis Rep 1998;24(11):85–94.Google Scholar
3. Chang, S, Sievert, DM, Hageman, JC, et al. Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene. N Engl J Med 2003;348(14):1342–1347.Google Scholar
4. McCracken, M, Wong, A, Mitchell, R, et al. Molecular epidemiology of vancomycin-resistant enterococcal bacteraemia: results from the Canadian Nosocomial Infection Surveillance Program, 1999–2009. J Antimicrob Chemother 2013;68(7):1505–1509.Google Scholar
5. Sievert, DM, Rudrik, JT, Patel, JB, McDonald, LC, Wilkins, MJ, Hageman, JC. Vancomycin-resistant Staphylococcus aureus in the United States, 2002–2006. Clin Infect Dis 2008;46(5):668–674.Google Scholar
6. Zhu, W, Clark, N, Patel, JB. pSK41-like plasmid is necessary for Inc18-like vanA plasmid transfer from Enterococcus faecalis to Staphylococcus aureus in vitro. Antimicrob Agents Chemother 2013;57(1):212–219.Google Scholar
7. Foucault, ML, Courvalin, P, Grillot-Courvalin, C. Fitness cost of vanA-type vancomycin resistance in methicillin-resistant Staphylococcus aureus . Antimicrob Agents Chemother 2009;53(6):2354–2359.Google Scholar
8. Lloyd-Smith, P, Younger, J, Lloyd-Smith, E, Green, H, Leung, V, Romney, MG. Economic analysis of vancomycin-resistant enterococci at a Canadian hospital: assessing attributable cost and length of stay. J Hosp Infect 2013;85(1):54–59.CrossRefGoogle Scholar
9. Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 2003;24(5):362–386.Google Scholar
10. Escaut, L, Bouam, S, Frank-Soltysiak, M, et al. Eradication of an outbreak of vancomycin-resistant Enterococcus (VRE): the cost of a failure in the systematic screening. Antimicrob Resist Infect Control 2013;2(1):18.Google Scholar
11. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35(10 suppl 2):S165–S193.Google Scholar
12. Huskins, WC, Huckabee, CM, O’Grady, NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;364(15):1407–1418.Google Scholar
13. Derde, LP, Cooper, BS, Goossens, H, et al. Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial. Lancet 2014;14(1):31–39.Google Scholar
14. Perugini, MR, Nomi, SM, Lopes, GK, et al. Impact of the reduction of environmental and equipment contamination on vancomycin-resistant enterococcus rates. Infection 2011;39(6):587–593.Google Scholar
15. Mutters, NT, Mersch-Sundermann, V, Mutters, R, Brandt, C, Schneider-Brachert, W, Frank, U. Control of the spread of vancomycin-resistant enterococci in hospitals: epidemiology and clinical relevance. Dtsch Arztebl Int 2013;110(43):725–731.Google Scholar
16. Response to the Provincial Infectious Diseases Advisory Committee Review of Literature for Evidence-Based Best Practices for VRE Control. London, Ontario: St. Joseph’s Health Care London, 2012. http://www.sjhc.london.on.ca/sites/default/files/pdf/VRE_response.pdf. Accessed September 18, 2013.Google Scholar
17. Park, I, Park, RW, Lim, SK, et al. Rectal culture screening for vancomycin-resistant enterococcus in chronic haemodialysis patients: false-negative rates and duration of colonisation. J Hosp Infect 2011;79(2):147–150.Google Scholar
18. Mak, A, Miller, MA, Chong, G, Monczak, Y. Comparison of PCR and culture for screening of vancomycin-resistant Enterococci: highly disparate results for vanA and vanB. J Clin Microbiol 2009;47(12):4136–4137.CrossRefGoogle Scholar
19. Werner, G, Klare, I, Fleige, C, et al. Vancomycin-resistant vanB-type Enterococcus faecium isolates expressing varying levels of vancomycin resistance and being highly prevalent among neonatal patients in a single ICU. Antimicrob Resist Infect Control 2012;1(1):21.CrossRefGoogle Scholar
20. Ridwan, B, Mascini, E, van Der Reijden, N, Verhoef, J, Bonten, M. What action should be taken to prevent spread of vancomycin resistant enterococci in European hospitals? BMJ 2002;324(7338):666–668.Google Scholar
21. Edmond, MB, Ober, JF, Dawson, JD, Weinbaum, DL, Wenzel, RP. Vancomycin-resistant enterococcal bacteremia: natural history and attributable mortality. Clin Infect Dis 1996;23(6):1234–1239.Google Scholar
22. Carmeli, Y, Eliopoulos, G, Mozaffari, E, Samore, M. Health and economic outcomes of vancomycin-resistant enterococci. Arch Intern Med 2002;162(19):2223–2228.CrossRefGoogle ScholarPubMed
23. Muto, CA, Giannetta, ET, Durbin, LJ, Simonton, BM, Farr, BM. Cost-effectiveness of perirectal surveillance cultures for controlling vancomycin-resistant Enterococcus. Infect Control Hosp Epidemiol 2002;23(8):429–435.Google Scholar
24. Stosor, V, Peterson, LR, Postelnick, M, Noskin, GA. Enterococcus faecium bacteremia: does vancomycin resistance make a difference? Arch Intern Med 1998;158(5):522–527.Google Scholar
25. Zaas, AK, Song, X, Tucker, P, Perl, TM. Risk factors for development of vancomycin-resistant enterococcal bloodstream infection in patients with cancer who are colonized with vancomycin-resistant enterococci. Clin Infect Dis 2002;35(10):1139–1146.Google Scholar
26. Stroud, L, Edwards, J, Danzing, L, Culver, D, Gaynes, R. Risk factors for mortality associated with enterococcal bloodstream infections. Infect Control Hosp Epidemiol 1996;17(9):576–580.Google Scholar
27. Matar, MJ, Tarrand, J, Raad, I, Rolston, KV. Colonization and infection with vancomycin-resistant Enterococcus among patients with cancer. Am J Infect Control 2006;34(8):534–536.Google Scholar
28. Miller, M, Bernard, L, Thompson, M, Grima, D, Pepin, J. Lack of increased colonization with vancomycin-resistant enterococci during preferential use of vancomycin for treatment during an outbreak of healthcare-associated Clostridium difficile infection. Infect Control Hosp Epidemiol 2010;31(7):710–715.Google Scholar
29. Almyroudis, NG, Lesse, AJ, Hahn, T, et al. Molecular epidemiology and risk factors for colonization by vancomycin-resistant Enterococcus in patients with hematologic malignancies. Infect Control Hosp Epidemiol 2011;32(5):490–496.CrossRefGoogle ScholarPubMed
30. Donskey, CJ, Chowdhry, TK, Hecker, MT, et al. Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med 2000;343(26):1925–1932.Google Scholar
31. Bar, K, Wisplinghoff, H, Wenzel, RP, Bearman, GM, Edmond, MB. Systemic inflammatory response syndrome in adult patients with nosocomial bloodstream infections due to enterococci. BMC Infect Dis 2006;6:145.Google Scholar
32. Perencevich, EN, Fisman, DN, Lipsitch, M, Harris, AD, Morris, JG Jr, Smith, DL. Projected benefits of active surveillance for vancomycin-resistant enterococci in intensive care units. Clin Infect Dis 2004;38(8):1108–1115.Google Scholar
33. Tacconelli, E, Cataldo, MA. Vancomycin-resistant enterococci (VRE): transmission and control. Int J Antimicrob Agents 2008;31(2):99–106.CrossRefGoogle ScholarPubMed
34. Price, CS, Paule, S, Noskin, GA, Peterson, LR. Active surveillance reduces the incidence of vancomycin-resistant enterococcal bacteremia. Clin Infect Dis 2003;37(7):921–928.CrossRefGoogle ScholarPubMed
35. Saint, S, Higgins, LA, Nallamothu, BK, Chenoweth, C. Do physicians examine patients in contact isolation less frequently? a brief report. Am J Infect Control 2003;31(6):354–356.Google Scholar
36. Catalano, G, Houston, SH, Catalano, MC, et al. Anxiety and depression in hospitalized patients in resistant organism isolation. South Med J 2003;96(2):141–145.Google Scholar
37. Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA 2003;290(14):1899–1905.CrossRefGoogle ScholarPubMed
38. Calderwood, MS, Mauer, A, Tolentino, J, et al. Epidemiology of vancomycin-resistant enterococci among patients on an adult stem cell transplant unit: observations from an active surveillance program. Infect Control Hosp Epidemiol 2008;29(11):1019–1025.Google Scholar
39. Yoo, SJ, Sung, H, Cho, YU, Kim, MN, Pai, CH, Kim, YS. Role of horizontal transfer of the transposon Tn1546 in the nosocomial spread of vanA vancomycin-resistant enterococci at a tertiary care hospital in Korea. Infect Control Hosp Epidemiol 2006;27(10):1081–1087.Google Scholar
40. Rice, LB, Lakticova, V, Carias, LL, Rudin, S, Hutton, R, Marshall, SH. Transferable capacity for gastrointestinal colonization in Enterococcus faecium in a mouse model. J Infect Dis 2009;199(3):342–349.Google Scholar
41. Miller, MA. Revised VRE Protocol. Montreal: Jewish General Hospital, 2010.Google Scholar