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Practical methods for effective vancomycin-resistant enterococci (VRE) surveillance: experience in a liver transplant surgical intensive care unit

Published online by Cambridge University Press:  05 September 2018

Rebecca Y. Linfield
Affiliation:
David Geffen School of Medicine at University of California–Los Angeles (UCLA), Los Angeles, California
Shelley Campeau
Affiliation:
UCLA Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
Patil Injean
Affiliation:
Department of Medicine, Western University of Health Sciences, Pomona, California
Aric Gregson
Affiliation:
David Geffen School of Medicine at University of California–Los Angeles (UCLA), Los Angeles, California
Fady Kaldas
Affiliation:
David Geffen School of Medicine at University of California–Los Angeles (UCLA), Los Angeles, California
Zachary Rubin
Affiliation:
David Geffen School of Medicine at University of California–Los Angeles (UCLA), Los Angeles, California
Tae Kim
Affiliation:
Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Division of Infectious Disease, Los Angeles Biomedical Research Institute at Harbor—UCLA Medical Center, Torrance, California
Danielle Kunz
Affiliation:
Expert Stewardship, Newport, California
Alfred Chan
Affiliation:
Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Division of Infectious Disease, Los Angeles Biomedical Research Institute at Harbor—UCLA Medical Center, Torrance, California
Delphine J. Lee
Affiliation:
Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Division of Infectious Disease, Los Angeles Biomedical Research Institute at Harbor—UCLA Medical Center, Torrance, California
Romney M. Humphries
Affiliation:
UCLA Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
James A. McKinnell
Affiliation:
David Geffen School of Medicine at University of California–Los Angeles (UCLA), Los Angeles, California Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Division of Infectious Disease, Los Angeles Biomedical Research Institute at Harbor—UCLA Medical Center, Torrance, California Expert Stewardship, Newport, California
Corresponding
E-mail address:

Abstract

Objective

We evaluated the utility of vancomycin-resistant Enterococcus (VRE) surveillance by varying 2 parameters: admission versus weekly surveillance and perirectal swabbing versus stool sampling.

Design

Prospective, patient-level surveillance program of incident VRE colonization.

Setting

Liver transplant surgical intensive care unit (SICU) of a tertiary-care referral medical center with a high prevalence of VRE.

Patients

All patients admitted to the SICU from June to August 2015.

Methods

We conducted a point-prevalence estimate followed by admission and weekly surveillance by perirectal swabbing and/or stool sampling. Incident colonization was defined as a negative screen followed by positive surveillance. VRE was detected by culture on Remel Spectra VRE chromogenic agar. Microbiologically-confirmed VRE bloodstream infections (BSIs) were tracked for 2 months. Statistical analyses were calculated using the McNemar test, the Fisher exact test, the t test, and the χ2 test.

Results

In total, 91 patients underwent VRE surveillance testing. The point prevalence of VRE colonization was 60.9%; VRE prevalence on admission was 30.1%. Weekly surveillance identified an additional 7 of 28 patients (25.0%) with incident colonization. VRE BSIs were more common in VRE-colonized patients than in noncolonized patients (8 of 43 vs 2 of 48; P=.028). In a direct comparison, perirectal swabs were more sensitive than stool samples in detecting VRE (64 of 67 vs 56 of 67; P=.023). Compliance with perirectal swabbing was 89% (201 of 226) compared to 56% (127 of 226) for stool collection (P≤0.001).

Conclusions

We recommend weekly VRE surveillance over admission-only screening in high-burden units such as liver transplant SICUs. Perirectal swabs had greater collection compliance and sensitivity than stool samples, making them the preferred methodology. Further work may have implications for antimicrobial stewardship and infection control.

Type
Original Article
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

6

Present affiliation: Accelerate Diagnostics, 13 Tucson, Arizona

References

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