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MacDougall C, Johnstone J, Prematunge C, Adomako K, Nadolny E, Truong E, Saedi A, Garber G, Sander B. Economic evaluation of vancomycin-resistant enterococci (VRE) control practices: a systematic review. J Hosp Infect 2020; 105:53-63. [DOI: 10.1016/j.jhin.2019.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/06/2019] [Indexed: 11/13/2022]
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Mac S, Fitzpatrick T, Johnstone J, Sander B. Vancomycin-resistant enterococci (VRE) screening and isolation in the general medicine ward: a cost-effectiveness analysis. Antimicrob Resist Infect Control 2019; 8:168. [PMID: 31687132 PMCID: PMC6820905 DOI: 10.1186/s13756-019-0628-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background Vancomycin-resistant enterococci (VRE) are a serious antimicrobial resistant threat in the healthcare setting. We assessed the cost-effectiveness of VRE screening and isolation for patients at high-risk for colonisation on a general medicine ward compared to no VRE screening and isolation from the healthcare payer perspective. Methods We developed a microsimulation model using local data and VRE literature, to simulate a 20-bed general medicine ward at a tertiary-care hospital with up to 1000 admissions, approximating 1 year. Primary outcomes were accrued over the patient's lifetime, discounted at 1.5%, and included expected health outcomes (VRE colonisations, VRE infections, VRE-related bacteremia, and deaths subsequent to VRE infection), quality-adjusted life years (QALYs), healthcare costs, and incremental cost-effectiveness ratio (ICER). Probabilistic sensitivity analysis (PSA) and scenario analyses were conducted to assess parameter uncertainty. Results In our base-case analysis, VRE screening and isolation prevented six healthcare-associated VRE colonisations per 1000 admissions (6/1000), 0.6/1000 VRE-related infections, 0.2/1000 VRE-related bacteremia, and 0.1/1000 deaths subsequent to VRE infection. VRE screening and isolation accrued 0.0142 incremental QALYs at an incremental cost of $112, affording an ICER of $7850 per QALY. VRE screening and isolation practice was more likely to be cost-effective (> 50%) at a cost-effectiveness threshold of $50,000/QALY. Stochasticity (randomness) had a significant impact on the cost-effectiveness. Conclusion VRE screening and isolation can be cost-effective in majority of model simulations at commonly used cost-effectiveness thresholds, and is likely economically attractive in general medicine settings. Our findings strengthen the understanding of VRE prevention strategies and are of importance to hospital program planners and infection prevention and control.
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Affiliation(s)
- Stephen Mac
- 1Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6 Canada.,2Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, 10th Floor, Room 247, Toronto, ON M5G 2C4 Canada
| | - Tiffany Fitzpatrick
- 3Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7 Canada
| | - Jennie Johnstone
- 3Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7 Canada.,4Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8 Canada.,5Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2 Canada
| | - Beate Sander
- 1Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6 Canada.,2Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, 10th Floor, Room 247, Toronto, ON M5G 2C4 Canada.,5Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2 Canada.,6ICES, G1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
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Defining the Role of the Environment in the Emergence and Persistence of vanA Vancomycin-Resistant Enterococcus (VRE) in an Intensive Care Unit: A Molecular Epidemiological Study. Infect Control Hosp Epidemiol 2018; 39:668-675. [PMID: 29611491 DOI: 10.1017/ice.2018.29] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVETo describe the transmission dynamics of the emergence and persistence of vanA vancomycin-resistant enterococcus (VRE) in an intensive care unit (ICU) using whole-genome sequencing of patient and environmental isolates.DESIGNRetrospective cohort study.SETTINGICU in a tertiary referral center.PARTICIPANTSPatients admitted to the ICU over an 11-month period.METHODS VanA VRE isolated from patients (n=31) were sequenced using the Illumina MiSeq platform. Environmental samples from bed spaces, equipment, and waste rooms were collected. All vanA VRE-positive environmental samples (n=14) were also sequenced. Data were collected regarding patient ward and bed movements.RESULTSThe 31 patient vanA VRE isolates were from screening (n=19), urine (n=4), bloodstream (n=3), skin/wound (n=3), and intra-abdominal (n=2) sources. The phylogeny from sequencing data confirmed several VRE clusters, with 1 group accounting for 38 of 45 isolates (84%). Within this cluster, cross-transmission was extensive and complex across the ICU. Directionality indicated that colonized patients contaminated environmental sites. Similarly, environmental sources not only led to patient colonization but also to infection. Notably, shared equipment acted as a conduit for transmission between different ICU areas. Infected patients, however, were not linked to further VRE transmission.CONCLUSIONSGenomic sequencing confirmed a predominantly clonal outbreak of VRE with complex transmission dynamics. The environmental reservoir, particularly from shared equipment, played a key role in ongoing VRE spread. This study provides evidence to support the use of multifaceted strategies, with an emphasis on measures to reduce bacterial burden in the environment, for successful VRE control.Infect Control Hosp Epidemiol 2018;39:668-675.
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Munigala S, McMullen KM, Russo AJ, Jafarzadeh SR, Hoppe-Bauer J, Burnham CAD, Warren DK. Reinstatement of Reflex Testing of Stool Samples for Vancomycin-Resistant Enterococci (VRE) Resulted in Decreased Incidence of Hospital-Associated VRE. Infect Control Hosp Epidemiol 2017; 38:619-621. [PMID: 28219459 PMCID: PMC5412709 DOI: 10.1017/ice.2017.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Re-institution of reflex testing of stool submitted for Clostridium difficile testing for vancomycin-resistant enterococci (VRE) reduced the incidence of healthcare-associated VRE bacteremia and bacteriuria compared to when testing was not in place (1.9 versus 3.3 cases per 10,000 patient days when testing was not in use).
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Affiliation(s)
- Satish Munigala
- Division of Infectious Diseases, Washington University in Saint Louis, Missouri USA
| | - Kathleen M. McMullen
- Christian Hospital Department of Infection Prevention, Saint Louis, Missouri, USA
| | - Anthony J. Russo
- Barnes-Jewish Hospital, Infection Prevention Department, Saint Louis, Missouri, USA
| | - S. Reza Jafarzadeh
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Joan Hoppe-Bauer
- Clinical Microbiology Laboratory, Barnes-Jewish Hospital, Saint Louis, Missouri, USA
| | - Carey-Ann D. Burnham
- Department of Pathology & Immunology, Division of Laboratory and Genomic Medicine, Washington University in Saint Louis, Missouri USA
| | - David K. Warren
- Division of Infectious Diseases, Washington University in Saint Louis, Missouri USA
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Resistance Mechanisms, Epidemiology, and Approaches to Screening for Vancomycin-Resistant Enterococcus in the Health Care Setting. J Clin Microbiol 2016; 54:2436-47. [PMID: 27147728 DOI: 10.1128/jcm.00211-16] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Infections attributable to vancomycin-resistant Enterococcus (VRE) strains have become increasingly prevalent over the past decade. Prompt identification of colonized patients combined with effective multifaceted infection control practices can reduce the transmission of VRE and aid in the prevention of hospital-acquired infections (HAIs). Increasingly, the clinical microbiology laboratory is being asked to support infection control efforts through the early identification of potential patient or environmental reservoirs. This review discusses the factors that contribute to the rise of VRE as an important health care-associated pathogen, the utility of laboratory screening and various infection control strategies, and the available laboratory methods to identify VRE in clinical specimens.
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Bactéries hautement résistantes émergentes en pédiatrie. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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