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Impact of Surveillance for Vancomycin-Resistant Enterococci on Controlling a Bloodstream Outbreak Among Patients With Hematologic Malignancy

Published online by Cambridge University Press:  02 January 2015

Ray Hachem*
Affiliation:
Department of Infectious Diseases, Houston, Texas
Linda Graviss
Affiliation:
Department of Infectious Diseases, Houston, Texas
Hend Hanna
Affiliation:
Department of Infectious Diseases, Houston, Texas
Rebecca Arbuckle
Affiliation:
Pharmacy Department, Houston, Texas
Tanya Dvorak
Affiliation:
Department of Infectious Diseases, Houston, Texas
Brenda Hackett
Affiliation:
Department of Infectious Diseases, Houston, Texas
Virginia Gonzalez
Affiliation:
Department of Infectious Diseases, Houston, Texas
Cheryl Perego
Affiliation:
Department of Infectious Diseases, Houston, Texas
Jeffrey Tarrand
Affiliation:
Department of Laboratory Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas
Issam Raad
Affiliation:
Department of Infectious Diseases, Houston, Texas
*
Anderson Cancer Center, Department of Infectious Diseases, Unit 402, 1515 Holcombe Blvd., Houston, TX 77030

Abstract

Objective:

To determine the impact of stool surveillance cultures of critically ill patients on controlling vancomycin-resistant enterococci (VRE) outbreak bacteremia.

Design:

Stool surveillance cultures were performed on patients who had hematologic malignancy or were critically ill at the time of hospital admission to identify those colonized with VRE. Hence, contact isolation was initiated.

Setting:

A tertiary-care cancer center with a high prevalence of VRE.

Participants:

All patients with hematologic malignancy who were admitted to the hospital as well as all of those admitted to the intensive care unit were eligible.

Results:

Active stool surveillance cultures performed between 1997 and 2001 decreased the incidence density of VRE bacteremias eightfold while vancomycin use remained constant. In fiscal year (FY) 1997 and FY 1998, there were five and three VRE outbreak bacteremias, respectively. The outbreak clones were responsible for infection in 69% of those patients with VRE bacteremia. However, the stool surveillance program resulted in the complete control of VRE bacteremia by FY 1999 until the end of the study.

Conclusion:

Despite the steady use of vancomycin, the active surveillance program among high-risk patients with hematologic malignancy and those who were critically ill resulted in the complete control of VRE outbreak bacteremia at our institution.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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Impact of Surveillance for Vancomycin-Resistant Enterococci on Controlling a Bloodstream Outbreak Among Patients With Hematologic Malignancy
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