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Infect Control Hosp Epidemiol. 2006 Oct;27(10):1068-75. Epub 2006 Sep 21.

Surveillance for vancomycin-resistant enterococci: type, rates, costs, and implications.

Author information

1
Institute for Bio-Security, School of Public Health, Saint Louis University, Saint Louis, MO 63104, USA. shadebn@slu.edu

Abstract

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 Dollars 1,913 per month, or Dollars 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 Dollars 56,258 to Dollars 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.

PMID:
17006814
DOI:
10.1086/507960
[Indexed for MEDLINE]

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