A Comparison of Multifaceted Versus<i>Clostridium difficile</i>-Focused VRE Surveillance Strategies in a Low-Prevalence Setting

Katz, Kevin; Gardam, Michael; Burt, J.; Conly, John

doi:10.1086/501896

Cited by 11 publications

(12 citation statements)

References 8 publications

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“…6,38 In contrast, the C. difficile specimenassociated LAS missed most cases of colonization (76%) in patients colonized with VRE. 31,32,34 We propose that the focused screening of submitted C. difficile specimens for VRE may be appropriate for institutions or units within institutions with historically low rates of VRE colonization and limited resources. 43 In such algorithms, if LAS determines an increase in the prevalence of VRE colonization, then endemicity may indicate a need for transition to a CAS method.…”

Section: Discussionmentioning

confidence: 99%

“…5,6,23,[25][26][27][28] A variety of active and passive surveillance methods have been used for detection of enteric VRE. 5,15,22,24,[29][30][31][32][33][34] A few studies have compared active surveillance methods but were unable to conclude which method was superior. 31,32,34 The objectives of this study were to compare the performance of 2 active surveillance strategies for detection of enteric VRE and to describe the associated costs and implications of these strategies.…”

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confidence: 99%

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Surveillance for Vancomycin-Resistant Enterococci: Type, Rates, Costs, and Implications

Shadel

Puzniak

Gillespie

et al. 2006

Infect. Control Hosp. Epidemiol.

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Objective.To evaluate 2 active surveillance strategies for detection of enteric vancomycin-resistant enterococci (VRE) in an intensive care unit (ICU).Design.Thirty-month prospective observational study.Setting.ICU at a university-affiliated referral center.Patients.All patients with an ICU stay of 24 hours or more were eligible for the study.Intervention.Clinical active surveillance (CAS), involving culture of a rectal swab specimen for detection of VRE, was performed on admission, weekly while the patient was in the ICU, and at discharge. Laboratory-based active surveillance (LAS), involving culture of a stool specimen for detection of VRE, was performed on stool samples submitted forClostridium difficiletoxin detection.Results.Enteric colonization with VRE was detected in 309 (17%) of 1,872 patients. The CAS method initially detected 280 (91%) of the 309 patients colonized with VRE, compared with 25 patients (8%) detected by LAS; colonization in 4 patients (1%) was initially detected by analysis of other clinical specimens. Most patients with colonization (76%) would have gone undetected by LAS alone, whereas use of the CAS method exclusively would have missed only 3 patients (1%) who were colonized. CAS cost $1,913 per month, or $57,395 for the 30-month study period. Cost savings of CAS from preventing cases of VRE colonization and bacteremia were estimated to range from $56,258 to $303,334 per month.Conclusions.A patient-based CAS strategy for detection of enteric colonization with VRE was superior to LAS. In this high-risk setting, CAS appeared to be the most efficient and cost-effective surveillance method. The modest costs of CAS were offset by the averted costs associated with the prevention of VRE colonization and bacteremia.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Surveillance for Vancomycin-Resistant Enterococci: Type, Rates, Costs, and Implications

Shadel

Puzniak

Gillespie

et al. 2006

Infect. Control Hosp. Epidemiol.

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“…Screening of a specimen already submitted to the laboratory for other purposes requires no extra nursing time to obtain a specimen for culture. Also, screening of stool specimens submitted for C. difficile toxin assays has been found to be a practical and simple method for identifying patients with unrecognized colonization by multidrug-resistant pathogens such as vancomycin-resistant enterococci (11,15,18). Furthermore, patients with gastrointestinal colonization by health care-associated pathogens (e.g., C. difficile or vancomycin-resistant enterococci) may serve as important sources of transmission, since they often contaminate adjacent environmental surfaces that may serve as a source from which health care workers contaminate their hands or gloves (2,3,6,22,26,30).…”

Section: Discussionmentioning

confidence: 99%

Frequency and Possible Infection Control Implications of Gastrointestinal Colonization with Methicillin-Resistant Staphylococcus aureus

2005

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Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of health care-associated infections. Multiple factors, including transmission from unrecognized reservoirs of MRSA, are responsible for failure to control the spread of MRSA. We conducted prospective surveillance to determine the frequency of gastrointestinal colonization with MRSA among patients and its possible impact on nosocomial transmission of MRSA. Stool specimens submitted for Clostridium difficile toxin A/B assays were routinely inoculated on colistinnaladixic acid agar plates, and S. aureus was identified by using standard methods. Methicillin resistance was confirmed by growth on oxacillin-salt screening agar. For patients whose stool yielded MRSA, information regarding any previous cultures positive for MRSA or other organisms that would require contact precautions was obtained from the laboratory's computer system. During a 1-year period, 151 (9.8%) of 1,543 patients who had one or more stool specimens screened had MRSA in their stool. Ninety-three ( Screening of patients at high risk of colonization by methicillin-resistant Staphylococcus aureus (MRSA) has been recommended as a measure for controlling transmission of the organism in health care settings (24). Culture of specimens from the anterior nares and other body sites, such as wounds from high-risk individuals, often identifies patients with unrecognized MRSA colonization (9,12,19,38). Although gastrointestinal tract colonization by MRSA has been reported previously (4, 10, 29), culturing the stool specimens of patients who have been hospitalized for more than 3 days for potential pathogens is generally not recommended (33, 39). We conducted prospective surveillance of stool specimens in a hospital where MRSA is highly endemic to determine the frequency of MRSA gastrointestinal colonization among high-risk patients. A secondary aim of the study was to determine if recognition of gastrointestinal colonization by MRSA would affect the implementation of barrier precautions designed to reduce the spread of MRSA. MATERIALS AND METHODSAs part of ongoing surveillance for MRSA in a 450-bed university-affiliated teaching hospital, all stool specimens submitted to the clinical microbiology laboratory for Clostridium difficile toxin A/B testing were inoculated onto colistinnaladixic acid (CNA) agar plates that were incubated under aerobic conditions at 36°C overnight. This approach was taken because it seemed likely that patients at risk of antibiotic-associated diarrhea due to C. difficile would also be at increased risk of carrying other resistant pathogens such as MRSA. Colonies growing on CNA agar with morphology characteristic of S. aureus were identified by using coagulase tests. Those identified as S. aureus were inoculated onto commercially available oxacillin-salt screening agar (BBL, Cockeysville, MD), and those capable of growing on oxacillin-salt screening agar were classified as MRSA. The number of colonies of MRSA growing on CNA plates was recorded as 1ϩ to 4ϩ, with 4ϩ re...

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“…71 In the USA and Canada, several workers have suggested that, as many of the antimicrobials that select for C. difficile also select for GRE, faecal specimens submitted for C. difficile toxin testing might also be examined for GRE. 72,73 This approach is interesting although it is no substitute for screening of patients during outbreaks. 73 In a recent study, 32% of stool specimens from hospitalized patients submitted to a diagnostic laboratory in the UK yielded GRE, with carriage increasing with age.…”

Section: The Epidemiology Of Glycopeptide-resistant Enterococcimentioning

confidence: 99%

“…72,73 This approach is interesting although it is no substitute for screening of patients during outbreaks. 73 In a recent study, 32% of stool specimens from hospitalized patients submitted to a diagnostic laboratory in the UK yielded GRE, with carriage increasing with age. 74 The carriage rate in community specimens, made up of general practice patients and food handlers, was 2.3%.…”

Section: The Epidemiology Of Glycopeptide-resistant Enterococcimentioning

confidence: 99%

Guidelines for the control of glycopeptide-resistant enterococci in hospitals

Cookson¹,

Macrae

Barrett

et al. 2006

Journal of Hospital Infection

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A Comparison of Multifaceted VersusClostridium difficile-Focused VRE Surveillance Strategies in a Low-Prevalence Setting

Cited by 11 publications

References 8 publications

Surveillance for Vancomycin-Resistant Enterococci: Type, Rates, Costs, and Implications

Surveillance for Vancomycin-Resistant Enterococci: Type, Rates, Costs, and Implications

Frequency and Possible Infection Control Implications of Gastrointestinal Colonization with Methicillin-Resistant Staphylococcus aureus

Guidelines for the control of glycopeptide-resistant enterococci in hospitals

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