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• W2096392014 abstract "Vancomycin-resistant enterococci (VRE) are significant causes of healthcare-acquired infections. Active screening, i.e. the use of rectal swabs or faeces to detect carriage in at-risk patients, has been described as contributing to prevention by identifying previously unrecognized cases. The aim of this review was to determine the impact of screening for VRE on prevention and control, its cost-effectiveness and recent approaches to laboratory detection. A review of published studies in English from 2000 was undertaken. Whereas various guidelines were accessed and reviewed, the emphasis was on original reports and studies. It was determined that the patient groups who may need screening are those admitted to critical care units, haematology/oncology and transplant wards, patients on chronic dialysis and patients admitted to acute hospitals from long-stay units. Active screening is associated with reduced VRE colonization and infection and cost savings in some studies, even if these fall short of randomized trials. Selective media increase sensitivity and reduce the time to detection but the role of molecular methods remains to be determined. In conclusion, active screening contributes to VRE prevention probably by heightening awareness of control measures, including isolation. However, further studies are required to: better define high-risk groups that warrant screening; quantify the clinical and economic benefit; and determine the optimal laboratory methods in a range of different patient populations. Vancomycin-resistant enterococci (VRE) are significant causes of healthcare-acquired infections. Active screening, i.e. the use of rectal swabs or faeces to detect carriage in at-risk patients, has been described as contributing to prevention by identifying previously unrecognized cases. The aim of this review was to determine the impact of screening for VRE on prevention and control, its cost-effectiveness and recent approaches to laboratory detection. A review of published studies in English from 2000 was undertaken. Whereas various guidelines were accessed and reviewed, the emphasis was on original reports and studies. It was determined that the patient groups who may need screening are those admitted to critical care units, haematology/oncology and transplant wards, patients on chronic dialysis and patients admitted to acute hospitals from long-stay units. Active screening is associated with reduced VRE colonization and infection and cost savings in some studies, even if these fall short of randomized trials. Selective media increase sensitivity and reduce the time to detection but the role of molecular methods remains to be determined. In conclusion, active screening contributes to VRE prevention probably by heightening awareness of control measures, including isolation. However, further studies are required to: better define high-risk groups that warrant screening; quantify the clinical and economic benefit; and determine the optimal laboratory methods in a range of different patient populations. Enterococci are part of the normal bacterial flora of the gastrointestinal tract of humans. The most important species are Enterococcus faecalis and Enterococcus faecium, which may cause significant infections including bloodstream infection (BSI).1Arias C.A. Murray B. The rise of the Enterococcus: beyond vancomycin resistance.Nat Rev Med. 2012; 10: 266-278Google Scholar Enterococci are considered intrinsically resistant to some antibiotics such as the cephalosporins; consequently glycopeptides have been the mainstay of treatment as there are few other options for treatment. Vancomycin-resistant enterococci (VRE) were first isolated in the late 1980s and they have spread rapidly throughout the USA, Europe, and beyond.2Reik R. Tenover F.C. Klein E. McDonald C.L. The burden of vancomycin-resistant enterococcal infections in US hospitals, 2003 to 2004.Diagn Microbiol Infect Dis. 2008; 62: 81-85Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar, 3Deshpande L.M. Fritsche T.R. Moet G.J. Biedenbach D.J. Jones R.N. Antimicrobial resistance and molecular epidemiology of vancomycin-resistant enterococci from North America and Europe: a report from the SENTRY antimicrobial surveillance program.Diag Microbiol Infect Dis. 2007; 58: 163-170Abstract Full Text Full Text PDF PubMed Scopus (249) Google Scholar Vancomycin-resistant enterococci are important causes of healthcare-associated infection (HCAI), often affect the most vulnerable patient groups, and cause considerable mortality with additional healthcare costs. Recent data from the National Healthcare Safety Network in the USA indicate that enterococci were the second most frequent cause of HCAIs after Staphylococcus aureus and that 89% of E. faecium isolates causing central line-associated BSI were vancomycin resistant.4Sievert D.M. Ricks P. Edwards J.R. et al.Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010.Infect Control Hosp Epidemiol. 2013; 34: 1-14Crossref PubMed Scopus (1159) Google Scholar In a recent European survey of >230,000 patients in nearly 1000 acute hospitals, enterococci were the third most common cause, of which 10% were VRE.5European Centre for Disease Prevention and Control Surveillance Report Point prevalence survey of healthcare-associated infections and antimicrobial use in European hospitals, 2011–2012. ECDC, StockholmJuly 2013Google Scholar Patients with BSI due to VRE are more likely to die than are those with BSI caused by vancomycin-susceptible enterococci (VSE), vancomycin resistance is an independent predictor of mortality, the median duration of BSI is longer for VRE compared with VSE, and VRE acquisition is associated with a longer duration of hospital stay.6DiazGranados C.A. Zimmer S.M. Klein M. Jernigan J.A. Comparison of mortality associated with vancomycin-resistant and vancomycin-susceptible enterococcal bloodstream infections: a meta-analysis.Clin Infect Dis. 2005; 41: 327-333Crossref PubMed Scopus (336) Google Scholar, 7DiazGranados C.A. Jernigan J.A. Impact of vancomycin resistance on mortality among patients with neutropenia and enterococcal bloodstream infection.J Infect Dis. 2005; 191: 588-595Crossref PubMed Scopus (127) Google Scholar, 8Carmeli Y. Eliopoulos G. Mozaffari E. Samore M. Health and economic outcomes of vancomycin-resistant enterococci.Archs Intern Med. 2002; 162: 2223-2228Crossref PubMed Scopus (200) Google Scholar In Canada the mean total costs and length of stay (LOS) for patients with VRE have been calculated to be significantly higher compared to those for VRE-negative patients, i.e. C$46,924 and 34 days versus C$13,069 and 10.9 days, respectively.9Lloyd-Smith P. Younger J. Lloyd-Smith E. Green H. Leung V. Romney M.G. Economic analysis of vancomycin-resistant enterococci at a Canadian hospital: assessing attributable cost and length of stay.J Hosp Infect. 2013; 85: 54-59Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar The US Centers for Disease Control and Prevention have recently highlighted VRE as resistant bacteria of serious concern that require prompt and sustained action.10US Department of Health and Human Services, Centers for Disease Control and Prevention Antibiotic resistance threats in the United States.2013http://www.cdc.gov/drugresistance/threat-report-2013/Google Scholar Whereas there has been a much-needed emphasis in recent years on the importance of Clostridium difficile infection and the threat posed by multidrug-resistant Gram-negative bacilli, such as carbapenem-resistant Enterobacteriaceae, VRE remain important. Hence it is opportune to review the indications for, and value of, screening for VRE. The purpose of screening is to identify carriers during outbreaks to assist in outbreak management, and in non-outbreak settings to prevent onward transmission, especially to vulnerable patient groups. The scientific literature on the prevention and control of VRE published in English since 2000 until June 2014 was reviewed with searches conducted in PubMed, EMBASE, and CINAHL to access studies and other reports on VRE screening and the identification of risk factors that would inform screening strategies. Search terms used in addition to VRE included glycopeptide-resistant enterococci, antibiotic-resistant enterococci, including E. faecalis and E. faecium, epidemiology, clinical impact, risk factors, screening and surveillance, laboratory methods and diagnosis, individually as well as in combination. General terms such as infection prevention and control were also used. Emphasis was placed on sourcing and reviewing original papers describing controlled clinical trials or quasi-experimental studies involving screening, to prevent and control spread, and methods for laboratory detection. The reference list of papers obtained from the literature search was also reviewed to determine whether there were other relevant studies that should be assessed and included, but which were not detected in the original literature search. However, many reports describe multiple interventions during outbreaks and therefore it can be difficult to quantify or estimate the impact of screening compared with other measures, such as improved environmental hygiene and better antimicrobial stewardship. Strategies to prevent and control VRE have been reviewed in the recent literature and in several guidelines and studies.11Muto C.A. Jernigan J.A. Ostrowsky B.E. et al.SHEA guideline for preventing nosocomial transmission of multi-drug resistant strains of Staphylococcus aureus and Enterococcus.Infect Control Hosp Epidemiol. 2003; 24: 362-386Crossref PubMed Scopus (1096) Google Scholar, 12Cookson B.D. Macrae M.B. Barrett S.P. et al.Guidelines for the control of glycopeptide-resistant enterococci in hospitals.J Hosp Infect. 2006; 62: 6-21Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar, 13Ofner-Agostina M. Varia M. Johnston L. et al.Infection control and antimicrobial restriction practices for antimicrobial-resistant organisms in Canadian tertiary care hospital.Am J Infect Control. 2007; 35: 563-568Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, 14Tacconelli E. Cataldo M.A. Vancomycin-resistant (VRE): transmission and control.Int J Antimicrob Agents. 2008; 31: 99-106Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar, 15Armeanu E. Bonten M.J.M. Control of vancomycin-resistant enterococci. One size fits all?.Clin Infect Dis. 2005; 41: 210-216Crossref PubMed Scopus (30) Google Scholar These recommend a multi-pronged approach that includes screening, improved professional practice such as hand hygiene, patient isolation, antibiotic stewardship, and enhanced environmental hygiene. Screening strategies should be devised to maximize the detection of carriers and should be informed by a knowledge of risk factors for VRE. Intrinsic risk factors associated with the patient include underlying illnesses, whereas extrinsic factors include exposure to a VRE-positive environment. However, many of these risk factors have been determined in studies that have varied considerably in size, population studied, and design. Nonetheless, some important and clinically relevant factors that predispose to VRE have been clearly recognized (Table I). As with other multidrug-resistant bacteria such as meticillin-resistant Staphylococcus aureus (MRSA), immunocompromised patients and those with significant underlying conditions are at greatest risk. A point prevalence survey of VRE, which detected vancomycin-resistant E. faecium in 32% of stool specimens, found that previous hospitalization, chronic renal failure, and length of hospital stay were associated with a patient being VRE positive.16Cohen M.J. Adler A. Block C. et al.Acquisition of vancomycin-resistant enterococci in internal medicine wards.Am J Infect Control. 2009; 37: 111-116Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Screening of patients before admission to an intensive care unit (ICU) identified a higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, having being resident in an acute or long-term care facility (LTCF), and previous antibiotic exposure as significant predictors of positive VRE status.17Pan S.-C. Wang J.-T. Chen Y.-C. Chang Y.-Y. Chen M.-L. Chang S.-C. Incidence of and risk factors for infection or colonisation of vancomycin-resistant enterococci in patients in the intensive care unit.Plos ONE. 2012; 7: e47297Crossref PubMed Scopus (43) Google Scholar In a 15-month prospective cohort study from Australia, VRE was independently associated with being managed in a renal unit and the recent administration of ticarcillin–clavulanic acid or carbapenems.18Padiglione A.A. Wolfe R. Grabsch E.A. et al.Risk factors for new detection of vancomycin-resistant enterococci in acute-care hospitals that employ strict infection control procedures.Antimicrob Agents Chemother. 2003; 47: 2492-2498Crossref PubMed Scopus (60) Google Scholar In a study that followed up 199 patients after hospital discharge, multivariate analysis indicated that a haematological malignancy was significantly associated with VRE infection.19Datta R. Huang S.S. Risk of post discharge infection with vancomycin-resistant Enterococcus after initial infection or colonisation.Infect Control Hosp Epidemiol. 2010; 31: 1290-1293Crossref PubMed Scopus (7) Google Scholar In hospitalized children, screening identified 3% of the population screened as positive but 95% of these had underlying chronic illnesses.20Weddle G. Jackson M.A. Selvarangan R. Utility of a focused vancomycin-resistant enterococci screening protocol to identify colonisation in hospitalised children.Am J Infect Control. 2012; 40: 891-892Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar The authors recommended an initial screening test in otherwise healthy children with a second screening test reserved only for high-risk groups, i.e. those with chronic illnesses.20Weddle G. Jackson M.A. Selvarangan R. Utility of a focused vancomycin-resistant enterococci screening protocol to identify colonisation in hospitalised children.Am J Infect Control. 2012; 40: 891-892Abstract Full Text Full Text PDF PubMed Scopus (4) Google ScholarTable IRisk factors for the acquisition of vancomycin-resistant enterococciRisk factorCommentReferenceIntrinsic ImmunosuppressionIncludes haematology/oncology conditions, solid organ transplantation, and neutropenia18Padiglione A.A. Wolfe R. Grabsch E.A. et al.Risk factors for new detection of vancomycin-resistant enterococci in acute-care hospitals that employ strict infection control procedures.Antimicrob Agents Chemother. 2003; 47: 2492-2498Crossref PubMed Scopus (60) Google Scholar, 19Datta R. Huang S.S. Risk of post discharge infection with vancomycin-resistant Enterococcus after initial infection or colonisation.Infect Control Hosp Epidemiol. 2010; 31: 1290-1293Crossref PubMed Scopus (7) Google Scholar Renal dialysisMay relate to underlying renal disease or regular healthcare contact16Cohen M.J. Adler A. Block C. et al.Acquisition of vancomycin-resistant enterococci in internal medicine wards.Am J Infect Control. 2009; 37: 111-116Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Recent/current antibiotic useThird-generation cephalosporin, fluoroquinolones and β-lactam/β-lactamase inhibitors17Pan S.-C. Wang J.-T. Chen Y.-C. Chang Y.-Y. Chen M.-L. Chang S.-C. Incidence of and risk factors for infection or colonisation of vancomycin-resistant enterococci in patients in the intensive care unit.Plos ONE. 2012; 7: e47297Crossref PubMed Scopus (43) Google Scholar, 18Padiglione A.A. Wolfe R. Grabsch E.A. et al.Risk factors for new detection of vancomycin-resistant enterococci in acute-care hospitals that employ strict infection control procedures.Antimicrob Agents Chemother. 2003; 47: 2492-2498Crossref PubMed Scopus (60) Google Scholar, 23Carmeli Y. Eliopoulos G.M. Samore M.H. Antecedent treatment with different antibiotic agents as a risk factor for vancomcyin-resistant Enterococcus.Emerg Infect Dis. 2002; 8: 802-807Crossref PubMed Scopus (134) Google Scholar, 24Hayakawa K. Marchaim D. Palla M. et al.Epidemiology of vancomycin-resistant Enterococcus faecalis: a case–control study.Antimicrob Agents Chemother. 2013; 57: 49-55Crossref PubMed Scopus (27) Google Scholar, 27Stiefel U. Paterson D.L. Pultz N.J. Gordon S.M. Aron D.C. Donskey C.J. Effect of the increasing use of piperacillin-tazobactam on the incidence of vancomycin-resistant enterococci in four academic medical centres.Infect Control Hosp Epidemiol. 2004; 25: 380-383Crossref PubMed Scopus (40) Google Scholar, 28Paterson D.L. Muto C.A. Ndirangu M. et al.Acquisition of rectal colonisation by vancomycin-resistant Enterococcus among intensive care unit patients treated with piperacillin–tazobactam versus those receiving cefepime-containing antibiotic regimens.Antimicrob Agents Chemother. 2008; 52: 465-469Crossref PubMed Scopus (25) Google Scholar Chronic underlying disease, previous hospitalizationA variety of conditions cited but may reflect regular contact with healthcare and/or exposure to antibiotics16Cohen M.J. Adler A. Block C. et al.Acquisition of vancomycin-resistant enterococci in internal medicine wards.Am J Infect Control. 2009; 37: 111-116Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 20Weddle G. Jackson M.A. Selvarangan R. Utility of a focused vancomycin-resistant enterococci screening protocol to identify colonisation in hospitalised children.Am J Infect Control. 2012; 40: 891-892Abstract Full Text Full Text PDF PubMed Scopus (4) Google ScholarExtrinsic Intensive care unitMany studies on risk factors focus on intensive care unit rather than all hospital patients17Pan S.-C. Wang J.-T. Chen Y.-C. Chang Y.-Y. Chen M.-L. Chang S.-C. Incidence of and risk factors for infection or colonisation of vancomycin-resistant enterococci in patients in the intensive care unit.Plos ONE. 2012; 7: e47297Crossref PubMed Scopus (43) Google Scholar Transfer from LTCFMay reflect underlying disease and lack of focused preventive measures in LTCF17Pan S.-C. Wang J.-T. Chen Y.-C. Chang Y.-Y. Chen M.-L. Chang S.-C. Incidence of and risk factors for infection or colonisation of vancomycin-resistant enterococci in patients in the intensive care unit.Plos ONE. 2012; 7: e47297Crossref PubMed Scopus (43) Google Scholar Previous patient in single room, VRE positiveMay reflect inadequate terminal decontamination21Drees M. Snydman D.R. Schmid C.H. et al.Prior environmental contamination increases the risk of vancomycin-resistant enterococci.Clin Infect Dis. 2008; 46: 678-685Crossref PubMed Scopus (203) Google Scholar, 22Zhou Q. Moore C. Eden S. Tong A. McGeer A. Factors associated with acquisition of vancomycin-resistant enterococci (VRE) in roommate contacts of patients colonized or infected with VRE in a tertiary care hospital.Infect Control Hosp Epidemiol. 2008; 29: 398-403Crossref PubMed Scopus (29) Google Scholar Prior hospitalization/transfer from another hospitalMany studies carried out in larger referral hospitals receiving patients from other institutions19Datta R. Huang S.S. Risk of post discharge infection with vancomycin-resistant Enterococcus after initial infection or colonisation.Infect Control Hosp Epidemiol. 2010; 31: 1290-1293Crossref PubMed Scopus (7) Google ScholarLTCF, long-term care facility. Open table in a new tab LTCF, long-term care facility. The risk of acquiring VRE in a patient room is higher if the previous patient had been positive.21Drees M. Snydman D.R. Schmid C.H. et al.Prior environmental contamination increases the risk of vancomycin-resistant enterococci.Clin Infect Dis. 2008; 46: 678-685Crossref PubMed Scopus (203) Google Scholar, 22Zhou Q. Moore C. Eden S. Tong A. McGeer A. Factors associated with acquisition of vancomycin-resistant enterococci (VRE) in roommate contacts of patients colonized or infected with VRE in a tertiary care hospital.Infect Control Hosp Epidemiol. 2008; 29: 398-403Crossref PubMed Scopus (29) Google Scholar In a 14-month study in two ICUs, multivariate analyses showed that a room previously colonized with a VRE patient in the last two weeks, and a previously positive environmental sample for VRE, were independent predictors of VRE acquisition.21Drees M. Snydman D.R. Schmid C.H. et al.Prior environmental contamination increases the risk of vancomycin-resistant enterococci.Clin Infect Dis. 2008; 46: 678-685Crossref PubMed Scopus (203) Google Scholar In another study of patients who shared a room with a VRE-positive patient, 21% became positive and these patients were more likely to be exposed to the VRE-positive source patient for longer than VRE-negative contacts.22Zhou Q. Moore C. Eden S. Tong A. McGeer A. Factors associated with acquisition of vancomycin-resistant enterococci (VRE) in roommate contacts of patients colonized or infected with VRE in a tertiary care hospital.Infect Control Hosp Epidemiol. 2008; 29: 398-403Crossref PubMed Scopus (29) Google Scholar This emphasizes the need for effective decontamination of clinical areas occupied by VRE-positive patients after hospital discharge. Previous exposure to antibiotics has been the subject of several studies but there are variations in the findings of these.23Carmeli Y. Eliopoulos G.M. Samore M.H. Antecedent treatment with different antibiotic agents as a risk factor for vancomcyin-resistant Enterococcus.Emerg Infect Dis. 2002; 8: 802-807Crossref PubMed Scopus (134) Google Scholar, 24Hayakawa K. Marchaim D. Palla M. et al.Epidemiology of vancomycin-resistant Enterococcus faecalis: a case–control study.Antimicrob Agents Chemother. 2013; 57: 49-55Crossref PubMed Scopus (27) Google Scholar, 25Rice L.B. Hutton-Thomas R. Lakitcova V. Helfand M.S. Donskey C.J. Β-lactam antibiotics and gastrointestinal colonization with vancomycin-resistant enterococci.J Infect Dis. 2004; 189: 1113-1118Crossref PubMed Scopus (61) Google Scholar, 26Paterson D.L. Stiefel U. Donskey C.J. Effect of selective decontamination of the digestive tract regimen including parenteral cefepime on establishment of intestinal colonization and vancomycin-resistant Enterococcus spp. and Klebsiella pneumoniae in mice.Antimicrob Agents Chemother. 2006; 50: 2537-2540Crossref PubMed Scopus (2) Google Scholar, 27Stiefel U. Paterson D.L. Pultz N.J. Gordon S.M. Aron D.C. Donskey C.J. Effect of the increasing use of piperacillin-tazobactam on the incidence of vancomycin-resistant enterococci in four academic medical centres.Infect Control Hosp Epidemiol. 2004; 25: 380-383Crossref PubMed Scopus (40) Google Scholar, 28Paterson D.L. Muto C.A. Ndirangu M. et al.Acquisition of rectal colonisation by vancomycin-resistant Enterococcus among intensive care unit patients treated with piperacillin–tazobactam versus those receiving cefepime-containing antibiotic regimens.Antimicrob Agents Chemother. 2008; 52: 465-469Crossref PubMed Scopus (25) Google Scholar For example, in a matched case–control study of 880 inpatients, 233 with VRE, treatment with third generation cephalosporins, metronizadole, and fluroquinolones were positively identified as risk factors for VRE acquisition, but not treatment with vancomycin.23Carmeli Y. Eliopoulos G.M. Samore M.H. Antecedent treatment with different antibiotic agents as a risk factor for vancomcyin-resistant Enterococcus.Emerg Infect Dis. 2002; 8: 802-807Crossref PubMed Scopus (134) Google Scholar Another study of vancomycin-resistant E. faecalis identified six independent risk factors, one being exposure to cephalosporins and fluoroquinolones in the previous three months.24Hayakawa K. Marchaim D. Palla M. et al.Epidemiology of vancomycin-resistant Enterococcus faecalis: a case–control study.Antimicrob Agents Chemother. 2013; 57: 49-55Crossref PubMed Scopus (27) Google Scholar This suggests that the contribution of antibiotics to VRE acquisition is complex. However, many of the clinical studies were hampered by design, e.g. they were retrospective and not prospective, and a failure to allow for other variables. Passive screening refers to the detection of VRE from specimens routinely submitted to the microbiology laboratory for the diagnosis of active infection, e.g. wound swabs to diagnose surgical site infection. This is likely to miss a considerable proportion of VRE-positive patients who are asymptomatically colonized but who may transmit VRE to other patients. Active screening includes the regular or periodic screening of stool samples submitted for C. difficile analysis, as well as admission and subsequent regular screening of patients admitted to specific clinical areas such as ICUs, organ transplantation wards or haematology/oncology units. The samples taken to screen for VRE may be stool samples or rectal swabs; the frequency of sampling may vary, as may the laboratory methods. There is some evidence supporting the role of active screening in certain patient groups as an effective infection prevention and control measure, and such screening may be cost-effective (Table II).Table IIStudies demonstrating the impact and cost-effectiveness of active screening in preventing and controlling vancomycin-resistant enterococci (VRE)SettingDesignScreening strategyOutcomeComment/caveatsReferenceKyoto Prefecture, JapanObservational study in response to outbreakScreened all hospital admissions and transfersNo. of faecal carriers rose from 0.71% to 1.2% but then fell to 0.17%78% of total beds in 177 hospitals; other measures introduced, e.g. hand hygiene36Matushima A. Takakura S. Yamamoto M. et al.Regional spread and control of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in Kyoto, Japan.Eur J Clin Microbiol Infect Dis. 2012; 31: 1095-1100Crossref PubMed Scopus (27) Google ScholarTertiary care hospitals, USARetrospective review of VRE bloodstream infectionHospital A: no routine screeningHospital B: weekly rectal swabs in high-risk patientsHigher VRE bloodstream infections in Hospital A with clonal isolates and longer hospital stayHospitals similar in location and patient categories but not a controlled trial31Price C.S. Paule S. Noskin G.A. Peterson L.R. Active surveillance reduces the incidence of vancomycin-resistant enterococcal bacteremia.Clin Infect Dis. 2003; 37: 921-928Crossref PubMed Scopus (56) Google ScholarICUs, USAMathematical model of three strategiesStandard precautions versus screening of known previously positive patients versus screening of all ICU patients on admission (active surveillance)Active surveillance annually prevented 46 cases of VRE in a 10-bed ICU. Passive surveillance only prevented five cases per yearActive surveillance recommended by most guidelines for ICU setting35Perencevich E.N. Fisman D.N. Lipsitch M. Harris A.D. Morris Lr J.G. Smith D.L. Projected benefits of active surveillance for vancomycin-resistant enterococci in intensive care units.Clin Infect Dis. 2004; 38: 1108-1115Crossref PubMed Scopus (86) Google ScholarCancer centre, USARetrospective review of VRE bloodstream infection ratesStool cultures from all patients admitted to ICU or who had leukaemia/bone marrow transplantIncidence of VRE bloodstream infection fell eight-foldNo decrease in vancomycin use and not a controlled trial32Hackem R. Graviss L. Hanna H. et al.Impact of surveillance for vancomycin-resistant enterococci on controlling a bloodstream outbreak among patients with haematologic malignancy.Infect Control Hosp Epidemiol. 2004; 25: 391-394Crossref PubMed Scopus (40) Google ScholarFour US academic centres involving 14 adult ICUsMulticentre retrospective review of data from each centreAdmission and weekly rectal cultures in ICU82–88% compliance.Increased VRE detection by 2.2–17-fold.Only 13% of VRE-positive patients subsequently positive from clinical sampleProbably provides truer range of VRE incidence29Huang S.S. Rifas-Shiman S.L. Pottinger J.M. et al.Improving the assessment of vancomycin-resistant enterococci by routine screening.J Infect Dis. 2007; 195: 339-346Crossref PubMed Scopus (49) Google ScholarMedical ICU, USAProspective, single centre observational studyAdmission, weekly and discharge rectal swab for VRE compared with culture for VRE if stool sent for Clostridium difficile and detection of VRE from clinical samplesActive screening detected 91% of VRE, 8% detected from stool sent for C. difficile and only 1% from clinical specimens. Total cost savings from active screening were calculated to range from US$56,258 to US$303,334 per month due to reduced transmission and bloodstream infectionEstimated, not actual, cost savings. Only 53% and 41% of patients had discharge and one surveillance sample taken, respectively54Shadel B.N. Puzniak L.A. Gillespie K.N. Lawrence S.J. Kollef M. Mundy L.M. Surveillance for vancomycin-resistant enterococci: type, rates, costs and implications.Infect Control Hosp Epidemiol. 2006; 27: 1068-1075Crossref PubMed Scopus (33) Google ScholarTwo tertiary care hospitals, USAProspective observational study of active screening in one hospital compared with published data in another hospitalInpatients deemed high risk (e.g. in ICU more than four days, co-colonization with MRSA), screened weeklyReduced VRE bloodstream infections from 0.05 to 0.002% of patients. Approximately US$500,000 in savings from reduced infections, allowing for cost of screening/isolationComparison of two different hospitals55Muto C.A. Giannetta E.T. Durbin L.J. Simonton B.M. Farr B.M. Cost-effectiveness of perirectal surveillance cultures for controlling vancomycin-resistant enterococci.Infect Control Hosp Epidemiol. 2002; 23: 429-435Crossref PubMed Scopus (79) Google ScholarAdult onc" @default.
• W2096392014 created "2016-06-24" @default.
• W2096392014 creator A5081903810 @default.
• W2096392014 date "2014-12-01" @default.
• W2096392014 modified "2023-10-11" @default.
• W2096392014 title "Controlling the spread of vancomycin-resistant enterococci. Is active screening worthwhile?" @default.
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