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Cost-Effectiveness of Perirectal Surveillance Cultures for Controlling Vancomycin-Resistant Enterococcus

Published online by Cambridge University Press:  02 January 2015

Carlene A. Muto ,
Eve T. Giannetta ,
Lisa J. Durbin ,
Barbara M. Simonton  and
Barry M. Farr
Carlene A. Muto
Affiliation:
University of Virginia Health System, Charlottesville, Viriginia
Eve T. Giannetta
Affiliation:
University of Virginia Health System, Charlottesville, Viriginia
Lisa J. Durbin
Affiliation:
University of Virginia Health System, Charlottesville, Viriginia
Barbara M. Simonton
Affiliation:
University of Virginia Health System, Charlottesville, Viriginia
Barry M. Farr*
Affiliation:
University of Virginia Health System, Charlottesville, Viriginia
*
Box 473, University of Virginia Health System, Charlottesville, VA 22908
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Abstract

Background:

Several hospitals opting not to use active surveillance cultures to identify carriers of vancomycin-resistant Enterococcus (VRE) have reported that adoption of other parts of the Centers for Disease Control and Prevention guideline for controlling VRE has had little to no impact. Because use of surveillance cultures and contact isolation controlled a large outbreak at this hospital, their costs were estimated for comparison with the excess costs of VRE bacteremias occurring at a higher rate at a hospital not employing these measures.

Setting:

Two university hospitals.

Methods:

Inpatients deemed high risk for VRE acquisition at this hospital underwent weekly perirectal surveillance cultures. Estimated costs of cultures and resulting isolation during a 2-year period were compared with the estimated excess costs of more frequent VRE bacteremias at another hospital of similar size and complexity not using surveillance cultures to control spread throughout the hospital.

Results:

Of 54,052 patients admitted, 10,400 had perirectal swabs taken. Cultures and isolation cost an estimated $253,099. VRE culture positivity was limited to 193 (0.38%) and VRE bacteremia to 1 (0.002%) as compared with 29 bacteremias at the comparison hospital. The estimated attributable cost of VRE bacteremia at the comparison hospital of $761,320 exceeded the cost of the control program at this hospital by threefold.

Conclusions:

The excess costs of VRE bacteremia may justify the costs of preventive measures. The costs of VRE infections at other body sites, of deaths from untreatable infections, and of dissemination of genes for vancomycin resistance also help to justify the costs of implementing an effective control program.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 8 , August 2002 , pp. 429 - 435
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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