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VanA rectal swab screening as a predictor of subsequent vancomycin-resistant enterococcal bloodstream infection in critically ill adults

Published online by Cambridge University Press:  15 October 2020

Shawn J. Kram Open the ORCID record for Shawn J. Kram [Opens in a new window] ,
Bridgette L. Kram Open the ORCID record for Bridgette L. Kram [Opens in a new window] ,
Jennifer M. Schultheis ,
Michelle M. Kuhrt ,
Andrew S. McRae  and
Deverick J. Anderson
Shawn J. Kram*
Affiliation:
Department of Pharmacy, Duke University Hospital, Durham, North Carolina
Bridgette L. Kram
Affiliation:
Department of Pharmacy, Duke University Hospital, Durham, North Carolina
Jennifer M. Schultheis
Affiliation:
Department of Pharmacy, Duke University Hospital, Durham, North Carolina
Michelle M. Kuhrt
Affiliation:
Department of Pharmacy, Duke University Hospital, Durham, North Carolina
Andrew S. McRae
Affiliation:
Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
Deverick J. Anderson
Affiliation:
Department of Infectious Diseases, Duke University Hospital, Durham, North Carolina Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
*
Author for correspondence: Shawn Kram, E-mail: shawn.kram@duke.edu
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Abstract

Objective:

To evaluate whether vanA rectal screening for vancomycin-resistant Enterococcus (VRE) predicts vancomycin resistance for patients with enterococcal bloodstream infection (BSI).

Design:

A retrospective cohort study.

Setting:

Large academic medical center.

Methods:

The predictive performance of a vanA rectal swab was evaluated in 161 critically ill adults with an enterococcal BSI from January 1, 2007, to September 1, 2014, and who had a vanA rectal swab screening obtained within 14 days prior to blood culture.

Results:

Of the patients meeting inclusion criteria, 83 (51.6%) were vanA swab positive. Rectal-swab–positive patients were more likely to be younger, to be immunocompromised, to have an indwelling central vascular catheter, and to have a history of MDR bacteria. The vanA rectal swab had sensitivity and negative predictive values of 83.6% and 85.9%, respectively, and specificity and positive predictive values of 71.3% and 67.5%, respectively, for predicting a vancomycin-resistant enterococcal BSI in critically ill adults.

Conclusions:

VanA rectal swabs may be useful for antimicrobial stewardship at institutions with VRE screening already in place for infection control purposes. A higher PPV would be warranted to implement a universal vanA screen on all ICU patients.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 4 , April 2021 , pp. 411 - 416
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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