Effect of Nosocomial Vancomycin-Resistant Enterococcal Bacteremia on Mortality, Length of Stay, and Costs

Abstract

Vancomycin-resistant enterococcal bacteremia contributes significantly to excess mortality and economic loss, once severity of illness is considered. Efforts to prevent these infections will likely be cost-effective.

Novel Chromogenic Medium for Detection of Vancomycin-Resistant Enterococcus faecium and Enterococcus faecalis

“…Hospital outbreaks of VRE have been reported extensively in the United States (14,22) and in recent years have been increasingly reported in European hospitals, with observed prevalences of 10.4% in the United Kingdom and up to 19.6% in Italy (8,22). The most notable consequences of VRE infection are increases in mortality and the length and cost of hospital stays (2,19,21).Management of a VRE outbreak requires strategies to contain cases and decrease rates of transmission, including isolation of VRE-infected or colonized patients (14, 23). VRE colonization can be monitored by screening cultures of stool or rectal swabs using differential and/or selective media.…”

“…Hospital outbreaks of VRE have been reported extensively in the United States (14,22) and in recent years have been increasingly reported in European hospitals, with observed prevalences of 10.4% in the United Kingdom and up to 19.6% in Italy (8,22). The most notable consequences of VRE infection are increases in mortality and the length and cost of hospital stays (2,19,21).…”

Evaluation of a Novel Chromogenic Agar Medium for Isolation and Differentiation of Vancomycin-Resistant Enterococcus faecium and Enterococcus faecalis Isolates

“…The clinical impact of infection by vancomycin-resistant enterococci (VRE) has been examined in several studies (2,3,8,9,(14)(15)(16)19), with the most notable consequences being increases in mortality, length of hospital stay, and cost of hospitalization. While a clear link between colonization with glycopeptide-resistant Enterococcus and increased mortality has not been clearly established (12), antimicrobial therapy does promote selection and proliferation of VRE in the hospital environment (11,12).…”

More Is More

“…In yet another article in this issue, Song et al provide more evidence of both the clinical significance and the economic burden of infections caused by VRE. 22 In their large study, hospitalized patients with nosocomial VRE bacteremia had significantly greater mortality (22.6% attributable mortality), longer hospital (median, 25 days) and ICU (median, 17 days) stays, and greater hospital charges ($81,208 in excess charges per patient) than did non-bacteremic patients matched for severity of illness and other clinical factors, In regression analyses, VRE bacteremia was an independent risk factor for harm to patients: death, excess length of hospital stay, and excess charges. Data from studies in this issue confirm that infection is common among patients colonized with resistant organisms and that VRE is a pathogen of consequence, not merely a marker for severity of illness.…”