2004 Lowbury Lecture: the Western Australian experience with vancomycin-resistant enterococci – from disaster to ongoing control

Pearman, J.W.

doi:10.1016/j.jhin.2005.10.017

Cited by 43 publications

(29 citation statements)

References 25 publications

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“…Reports of interhospital outbreaks (2,41) have shown that after a period of rapid intrahospital spread (typically 1 or 2 mo), pathogens spread to other hospitals on time scales under 1 y. Moreover, mathematical models including within-hospital dynamics show that colonized patients are able to spread the pathogen to other hospitals within days (20,24).…”

Section: Methodsmentioning

confidence: 99%

Efficient surveillance for healthcare-associated infections spreading between hospitals

Ciccolini

Donker

Grundmann

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

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Early detection of new or novel variants of nosocomial pathogens is a public health priority. We show that, for healthcare-associated infections that spread between hospitals as a result of patient movements, it is possible to design an effective surveillance system based on a relatively small number of sentinel hospitals. We apply recently developed mathematical models to patient admission data from the national healthcare systems of England and The Netherlands. Relatively short detection times are achieved once 10-20% hospitals are recruited as sentinels and only modest reductions are seen as more hospitals are recruited thereafter. Using a heuristic optimization approach to sentinel selection, the same expected time to detection can be achieved by recruiting approximately half as many hospitals. Our study provides a robust evidence base to underpin the design of an efficient sentinel hospital surveillance system for novel nosocomial pathogens, delivering early detection times for reduced expenditure and effort.patient referrals | network T here is a worldwide concern about the recent emergence, and rapid widespread dissemination, of novel strains of existing nosocomial pathogens as well as of new genetic determinants of virulence and resistance (1-5). Local and national surveillance is considered an important component of the strategy to control these strains (6-8). However, surveillance is costly in monetary terms, effort, and facilities and it is important to consider ways in which surveillance systems can be made more efficient both at the hospital and the national level. Although this is widely recognized (9, 10), there is still no good evidence base to inform the design of efficient surveillance systems at the national level. A key question is how many hospitals should be included in enhanced surveillance programs.Reflecting this, existing surveillance programs are markedly diverse. For example, in The Netherlands the national antibiotic resistance surveillance system (11) consists of 30 participating laboratories serving ∼50% of hospitals beds in the country. In Britain, the most prominent surveillance schemes include the voluntary reporting of all bacteraemias (90% of clinical laboratories in England, Wales, and Northern Ireland), mandatory bacteraemia surveillance (all acute health trusts in England), and the British Society for Antimicrobial Chemotherapy Resistance Surveillance Project (20-25 collecting laboratories covering the United Kingdom and Ireland) (12). Here, we consider a single, simple, generic approach to this problem that is applicable to a range of nosocomial pathogens including, importantly, novel pathogens or variants whose epidemiology is, by definition, unknown. The only condition is that the major transmission route is the movement of patients between hospitals.The movement of patients between hospitals in a national healthcare system plays an important role in the spread of healthcare-associated infections (HCAIs) (13-17). Patient movements have also been suggested as an important...

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Section: Methodsmentioning

confidence: 99%

Efficient surveillance for healthcare-associated infections spreading between hospitals

Ciccolini

Donker

Grundmann

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

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“…VanB-type resistance is only highly prevalent in certain parts of the world, for instance, in Australia (Christiansen et al, 2004;Pearman 2006;Worth et al, 2008;Pendle et al, 2008;Johnson et al, 2010) or Singapore Koh et al, 2009) where vanB-type vancomycin resistance among clinical E. faecium is more prevalent than the vanA-type. The reason(s) for this remain unknown and are not linked to a supposed larger reservoir of the vanB cluster in commensal intestinal colonizers (Padiglione et al, 2000), rates of which were similar in Australian, US-American and European studies (Stamper et al, 2007;Graham et al, 2008;Grabsch et al, 2008b;Bourdon et al, 2010;Werner et al, 2011c).…”

Section: Asia Australia and New Zealandmentioning

confidence: 99%

Current Trends of Emergence and Spread of Vancomycin-Resistant Enterococci

Werner¹

2012

Antibiotic Resistant Bacteria - A Continuous Challenge in the New Millennium

184

229

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“…Apart from threatening patient health, these pathogens have an unfavorable economic impact on resources for healthcare in general. Control of VRE has proven to be costly and time-consuming (6). We therefore examined to what extent early implementation of control measures could have prevented these undesirable consequences in an outbreak of VRE at a university hospital in southwestern Germany.…”

Section: R Ecently Vancomycin-resistant Enterococcus Faeciummentioning

confidence: 99%

“…It is suffi cient to calculate the severe loss of income to illustrate that the economic effects of a large outbreak of VRE in a hospital can reach a loss of ≈1 million Euros. In a recent analysis of a VRE outbreak in Australia that resulted in the colonization of 64 patients, the costs were calculated at 2.7 million Australian dollars (6). From our experience, we recommend making use of easy-to-use statistical models to detect and prevent imminent outbreaks as soon as possible.…”

Section: R Ecently Vancomycin-resistant Enterococcus Faeciummentioning

confidence: 99%

Vancomycin-Resistant Enterococci Outbreak, Germany, and Calculation of Outbreak Start

Sagel¹,

Schulte

Heeg

et al. 2008

Emerg. Infect. Dis.

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On the basis of a large outbreak of vancomycin-resistant Enterococcus faecium in a German university hospital, we estimated costs (≈1 million Euros) that could have been avoided by early detection of the imminent outbreak. For this purpose, we demonstrate an easy-to-use statistical method. R ecently, vancomycin-resistant Enterococcus faecium (VRE) has been detected with increasing frequency in Germany (1). Although some hospitals have reported only sporadic fi ndings, others have been faced with extended outbreaks (2-5). Apart from threatening patient health, these pathogens have an unfavorable economic impact on resources for healthcare in general. Control of VRE has proven to be costly and time-consuming (6). We therefore examined to what extent early implementation of control measures could have prevented these undesirable consequences in an outbreak of VRE at a university hospital in southwestern Germany.At this hospital ≈68,000 inpatients and 220,000 outpatients are treated each year. In 2003, 5 VRE-colonized patients were identifi ed. In 2004, VRE were fi rst detected in April. While at most 3 cases per month were observed through July, 8 colonized patients were found in August (Figure 1, panel A). The number of colonized patients remained relatively high in the following months. By the end of December, the cumulative number of patients with VRE was 48 (Figure 1, panel B). Although medical microbiologists were concerned about a possible outbreak as early as August, decision makers were reluctant to acknowledge a situation that needed action to be taken until January 2005. At that time, an infection control program was implemented. It included VRE screening in stool and anal/rectal swab samples from patients exhibiting an increased risk for VRE carriage (2). This program resulted in a sharp increase of detected cases to a total of 105 patients for February and March 2005 (Figure 1, panel A).Retrospectively, we examined whether comprehensible proof of an imminent outbreak could have been given early enough to have convinced decision makers of the need for control measures. For early outbreak detection, we have chosen a simple approach that can be easily adopted by infection control nurses dealing with multiresistant patho-

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2004 Lowbury Lecture: the Western Australian experience with vancomycin-resistant enterococci – from disaster to ongoing control

Cited by 43 publications

References 25 publications

Efficient surveillance for healthcare-associated infections spreading between hospitals

Efficient surveillance for healthcare-associated infections spreading between hospitals

Current Trends of Emergence and Spread of Vancomycin-Resistant Enterococci

Vancomycin-Resistant Enterococci Outbreak, Germany, and Calculation of Outbreak Start

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