Improving the assessment of vancomycin-resistant enterococci by routine screening

Susan S Huang; Sheryl L Rifas-Shiman; Jean M Pottinger; Loreen A Herwaldt; Teresa R Zembower; Gary A Noskin; Sara E Cosgrove; Trish M Perl; Amy B Curtis; Jerome L Tokars; Daniel J Diekema; John A Jernigan; Virginia L Hinrichsen; Deborah S Yokoe; Richard Platt

doi:10.1086/510624

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Improving the assessment of vancomycin-resistant enterococci by routine screening

Journal article

Open access

Peer reviewed

Improving the assessment of vancomycin-resistant enterococci by routine screening

Susan S Huang, Sheryl L Rifas-Shiman, Jean M Pottinger, Loreen A Herwaldt, Teresa R Zembower, Gary A Noskin, Sara E Cosgrove, Trish M Perl, Amy B Curtis, Jerome L Tokars, …

The Journal of infectious diseases, Vol.195(3), pp.339-346

02/01/2007

DOI: 10.1086/510624

PMID: 17205471

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Abstract

As infection with vancomycin-resistant enterococci (VRE) increases in hospitals, knowledge about VRE reservoirs and improved accuracy of epidemiologic measures are needed. Many assessments underestimate incidence by including prevalent carriers in at-risk populations. Routine surveillance cultures can substantially improve prevalence and incidence estimates, and assessing the range of improvement across diverse units is important. We performed a retrospective cohort study using accurate at-risk populations to evaluate the range of benefit of admission and weekly surveillance cultures in detecting unrecognized VRE in 14 patient-care units. We assessed 165 unit-months. The admission prevalence of VRE was 2.2%-27.2%, with admission surveillance providing 2.2-17-fold increased detection. Medical units were significantly more likely to admit VRE carriers than were surgical units. Monthly incidence was 0.8%-9.7%, with weekly surveillance providing 3.3-15.4-fold increased detection. The common practice of reporting incidence using the total number of patients, rather than patients at risk, underestimated incidence by one-third. Overall, routine surveillance prevented the misclassification of 43.0% (unit range, 0%-85.7%) of "incident" carriers on the basis of clinical cultures alone and increased VRE precaution days by 2.4-fold (unit range, 2.0-2.6-fold). Routine surveillance markedly increases the detection of VRE, despite variability across patient-care units. Correct denominators prevent the substantial underestimation of incidence.

United States - epidemiology

Humans

Patient-Centered Care

Vancomycin Resistance

Gram-Positive Bacterial Infections - diagnosis

Diagnostic Tests, Routine - standards

Academic Medical Centers

Incidence

Disease Notification - standards

Carrier State - prevention & control

Enterococcus - isolation & purification

Vancomycin - pharmacology

Carrier State - diagnosis

Adult

Anti-Bacterial Agents - pharmacology

Enterococcus - drug effects

Retrospective Studies

Gram-Positive Bacterial Infections - prevention & control

Cohort Studies

Details

Title: Subtitle: Improving the assessment of vancomycin-resistant enterococci by routine screening
Creators: Susan S Huang
Sheryl L Rifas-Shiman
Jean M Pottinger
Loreen A Herwaldt
Teresa R Zembower
Gary A Noskin
Sara E Cosgrove
Trish M Perl
Amy B Curtis
Jerome L Tokars
Daniel J Diekema
John A Jernigan
Virginia L Hinrichsen
Deborah S Yokoe
Richard Platt
Contributors: Centers for Disease Control and Prevention Epicenters Program (Institution)
Resource Type: Journal article
Publication Details: The Journal of infectious diseases, Vol.195(3), pp.339-346
Publisher: United States
DOI: 10.1086/510624
PMID: 17205471
ISSN: 0022-1899
eISSN: 1537-6613
Grant note: K23 AI64161-01 / NIAID NIH HHS
Language: English
Date published: 02/01/2007
Academic Unit: Infectious Diseases; Epidemiology; Pathology; Internal Medicine
Record Identifier: 9983986261202771

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