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Longitudinal Multicenter Analysis of Outcomes After Cessation of Control Measures for Vancomycin-Resistant Enterococci

Published online by Cambridge University Press:  02 November 2016

Camille Lemieux ,
Michael Gardam ,
Gerald Evans ,
Michael John ,
Kathryn N. Suh ,
Carl vanWalraven ,
Elisa Vicencio ,
Cameron Coulby ,
Virginia Roth  and
Susy Hota
Camille Lemieux*
Affiliation:
University Health Network, Department of Infection Prevention and Control, Toronto, Canada University of Toronto, Department of Family and Community Medicine, Toronto, Canada
Michael Gardam
Affiliation:
University Health Network, Department of Infection Prevention and Control, Toronto, Canada University of Toronto, Department of Medicine, Division of Infectious Diseases, Toronto, Canada
Gerald Evans
Affiliation:
Queen’s University, Departments of Medicine, Biomedical and Molecular Sciences, and Pathology and Molecular Medicine, Kingston, Canada
Michael John
Affiliation:
Schulich School of Medicine and Dentistry, Department of Pathology and Laboratory Medicine, Western University, London, Canada
Kathryn N. Suh
Affiliation:
University of Ottawa, Department of Medicine, Ottawa, Canada Ottawa Hospital Research Institute, Ottawa, Canada
Carl vanWalraven
Affiliation:
University of Ottawa, Department of Medicine/School of Epidemiology, Public Health and Preventive Medicine, Ottawa, Canada Ottawa Hospital Research Institute, Ottawa, Canada
Elisa Vicencio
Affiliation:
University Health Network, Department of Infection Prevention and Control, Toronto, Canada
Cameron Coulby
Affiliation:
University Health Network, Department of Infection Prevention and Control, Toronto, Canada
Virginia Roth
Affiliation:
University of Ottawa, Department of Medicine, Ottawa, Canada Ottawa Hospital Research Institute, Ottawa, Canada
Susy Hota
Affiliation:
University Health Network, Department of Infection Prevention and Control, Toronto, Canada University of Toronto, Department of Medicine, Division of Infectious Diseases, Toronto, Canada
*
Address correspondence to Camille Lemieux, 200 Elizabeth Street, Toronto, ON M5T 2S8, (camille.lemieux@uhn.ca).
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Abstract

OBJECTIVE

To assess clinically relevant outcomes after complete cessation of control measures for vancomycin-resistant enterococci (VRE).

DESIGN

Quasi-experimental ecological study over 3.5 years.

METHODS

All VRE screening and isolation practices at 4 large academic hospitals in Ontario, Canada, were stopped on July 1, 2012. In total, 618 anonymized abstracted charts of patients with VRE-positive clinical isolates identified between July 1, 2010, and December 31, 2013, were reviewed to determine whether the case was a true VRE infection, a VRE colonization or contaminant, or a true VRE bacteremia. All deaths within 30 days of the last VRE infection were also reviewed to determine whether the death was fully or partially attributable to VRE. All-cause mortality was evaluated over the study period. Generalized estimating equation methods were used to cluster outcome rates within hospitals, and negative binomial models were created for each outcome.

RESULTS

The incidence rate ratio (IRR) for VRE infections was 0.59 and the associated P value was .34. For VRE bacteremias, the IRR was 0.54 and P=.38; for all-cause mortality the IRR was 0.70 and P=.66; and for VRE attributable death, the IRR was 0.35 and P=.49. VRE control measures were not significantly associated with any of the outcomes. Rates of all outcomes appeared to increase during the 18-month period after cessation of VRE control measures, but none reached statistical significance.

CONCLUSION

Clinically significant VRE outcomes remain rare. Cessation of all control measures for VRE had no significant attributable adverse clinical impact.

Infect Control Hosp Epidemiol 2016;1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 1 , January 2017 , pp. 24 - 30
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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