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Reporting of Vancomycin-Resistant Enterococci in Connecticut: Implementation and Validation of a State-Based Surveillance System

Published online by Cambridge University Press:  02 January 2015


Zygmunt F. Dembek
Affiliation:
Epidemiology Program, Connecticut Department of Public Health, Hartford, Connecticut
Scott E. Kellerman
Affiliation:
Investigation and Prevention Branch, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Lisa Ganley
Affiliation:
Department of Pathobiology, the University of Connecticut, Storrs, Connecticut
Constance M. Capacchione
Affiliation:
Department of Nutritional Sciences, the University of Connecticut, Storrs, Connecticut
Fred C. Tenover
Affiliation:
Nosocomial Pathogens Laboratory Branch, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Matthew L. Cartter
Affiliation:
Epidemiology Program, Connecticut Department of Public Health, Hartford, Connecticut
Herbert J. Van Kruiningen
Affiliation:
Department of Pathobiology, the University of Connecticut, Storrs, Connecticut
William R. Jarvis
Affiliation:
Investigation and Prevention Branch, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
James L. Hadler
Affiliation:
Epidemiology Program, Connecticut Department of Public Health, Hartford, Connecticut

Abstract

Objective:

To assess state-based surveillance for isolation from a sterile site of vancomycin-resistant enterococci (VRE) in Connecticut.

Design:

Clinical laboratory reporting (passive surveillance) of VRE isolates to the Connecticut Department of Public Health (CDPH) was followed by state-initiated validation, laboratory proficiency testing, and review of hospital demographic characteristics.

Settings:

All 45 clinical laboratories and all 37 (36 for 1995 and 1996) acute-care hospitals in Connecticut were included in the study.

Main Outcome Measures:

The outcome measures included determination of the statewide incidence of VRE and the accuracy of passive reporting, determination of clinical laboratory proficiency in detecting VRE, and analysis of hospital characteristics that might be associated with an increased incidence of VRE.

Results:

During 1994 through 1996, 29 (78%) of 37 hospital-affiliated clinical laboratories and 1 (11%) of 9 commercial or other laboratories in Connecticut reported to the CDPH the isolation of VRE from sterile sites; 158 isolates were reported for these 3 years. Based on verification, we discovered that these laboratories actually detected 58 VRE isolates in 1994, 104 in 1995, and 104 in 1996 (total, 266). The age-standardized incidence rate of VRE was 14.1 cases per million population in 1994 and 26.8 cases per million population for both 1995 and 1996. Laboratory proficiency testing revealed that high-level vancomycin resistance was identified accurately and that low- and moderate-level resistance was not detected. The incidence of VRE isolates was three times greater in hospitals with over 300 beds compared with categories of hospitals with fewer beds. Increases in the number of VRE isolates were at least twice as likely in hospitals located in areas with a higher population density, or with a residency program or trauma center in the hospital.

Conclusions:

Passive reporting of VRE isolates from sterile sites markedly underestimated the actual number of isolates, as determined in a statewide reporting system. Statewide passive surveillance systems for routine or emerging pathogens must be validated and laboratory proficiency ensured if results are to be accurate and substantial underreporting is to be corrected.


Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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