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Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis

Published online by Cambridge University Press:  09 November 2016

Hsiu-Yin Chiang
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa
Eli N. Perencevich
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Rajeshwari Nair
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Richard E. Nelson
Affiliation:
Department of Clinical Epidemiology, University of Utah, Salt Lake City, Utah
Matthew Samore
Affiliation:
Department of Clinical Epidemiology, University of Utah, Salt Lake City, Utah
Karim Khader
Affiliation:
Department of Clinical Epidemiology, University of Utah, Salt Lake City, Utah
Margaret L. Chorazy
Affiliation:
University of Iowa College of Public Health, Iowa City, Iowa
Loreen A. Herwaldt
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa University of Iowa College of Public Health, Iowa City, Iowa
Amy Blevins
Affiliation:
Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana
Melissa A. Ward
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa
Marin L. Schweizer
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa Iowa City Veterans Affairs Health Care System, Iowa City, Iowa University of Iowa College of Public Health, Iowa City, Iowa
Corresponding
E-mail address:

Abstract

BACKGROUND

Information about the health and economic impact of infections caused by vancomycin-resistant enterococci (VRE) can inform investments in infection prevention and development of novel therapeutics.

OBJECTIVE

To systematically review the incidence of VRE infection in the United States and the clinical and economic outcomes.

METHODS

We searched various databases for US studies published from January 1, 2000, through June 8, 2015, that evaluated incidence, mortality, length of stay, discharge to a long-term care facility, readmission, recurrence, or costs attributable to VRE infections. We included multicenter studies that evaluated incidence and single-center and multicenter studies that evaluated outcomes. We kept studies that did not have a denominator or uninfected controls only if they assessed postinfection length of stay, costs, or recurrence. We performed meta-analysis to pool the mortality data.

RESULTS

Five studies provided incidence data and 13 studies evaluated outcomes or costs. The incidence of VRE infections increased in Atlanta and Detroit but did not increase in national samples. Compared with uninfected controls, VRE infection was associated with increased mortality (pooled odds ratio, 2.55), longer length of stay (3-4.6 days longer or 1.4 times longer), increased risk of discharge to a long-term care facility (2.8- to 6.5-fold) or readmission (2.9-fold), and higher costs ($9,949 higher or 1.6-fold more).

CONCLUSIONS

VRE infection is associated with large attributable burdens, including excess mortality, prolonged in-hospital stay, and increased treatment costs. Multicenter studies that use suitable controls and adjust for time at risk or confounders are needed to estimate the burden of VRE infections.

Infect Control Hosp Epidemiol. 2017;38:203–215

Type
Original Articles
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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