Shadel BN, Puzniak LA, Gillespie KN, Lawrence SJ, Kollef M, Mundy LM. Surveillance for vancomycin-resistant enterococci: type, rates, costs, and implications.
Infect Control Hosp Epidemiol 2006;
27:1068-75. [PMID:
17006814 DOI:
10.1086/507960]
[Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Accepted: 12/29/2005] [Indexed: 11/03/2022]
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.
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