Eradication of an outbreak of vancomycin-resistant Enterococcus (VRE): the cost of a failure in the systematic screening

Abstract

BackgroundVancomycin-resistant enterococci (VRE) are still a concern in hospital units tending to seriously ill patients. However, the cost-effectiveness of active surveillance program to identify asymptomatically VRE colonized patient remains debatable. This work aims at evaluating the cost of a failure in the active surveillance of VRE that had resulted in an outbreak in a French University Hospital.FindingsA VRE outbreak was triggered by a failure in the systematic VRE screening in a medico-surgical ward specialised in liver transplantation as a patient was not tested for VRE. This failure was likely caused by the reduction of healthcare resource. The outbreak involved 13 patients. Colonized patients were grouped in a dedicated part of the infectious diseases unit and tended by a dedicated staff. Transmission was halted within two months after discovery of the index case.The direct cost of the outbreak was assessed as the cost of staffing, disposable materials, hygiene procedures, and surveillance cultures.The loss of income from spare isolation beds was computed by difference with the same period in the preceding year. Payments were drawn from the hospital database. The direct cost of the outbreak (2008 Euros) was €60 524 and the loss of income reached €110 915.ConclusionsDespite this failure, the rapid eradication of the VRE outbreak was a consequence of the rapid isolation of colonized patient. Yet, eradicating even a limited outbreak requires substantial efforts and resources. This underlines that special attention has to be paid to strictly adhere to active surveillance program.

Measures to eradicate multidrug-resistant organism outbreaks: how much do they cost?

“…Two further articles were identified by manually searching the reference lists. Of these 36 articles, four concerned in an endemic situation, five were unrelated to costs, 13 did not provide original data, and one could not be interpreted, leaving 13 studies for analysis [14][15][16][17][18][19][20][21][22][23][24][25][26] (Appendix 1).…”

“…The calculated cost per screening culture varied by organism: for GRE from V3.7 to V55.8 [15,17], for CPE V44.2 [19], and for MRSA from V11.5 to V21 [21,23]; for the one study estimating the cost of environmental surveillance of CRAB, a cost of V26.1 per surface swabbed was cited [26]. Three studies on GRE included molecular typing [15,17,18]. Finally, one study gave an overall cost including laboratory, contact precautions, decolonization, and staff costs [20].…”

“…Seven studies assessed extra costs for staffing during the MDRO outbreaks. These costs included: additional nursing personnel for cohorting (n = 4) [15,18,19,21], laboratory staff/ administrative support and contracting cleaners (n = 1) [14], additional infection control staff [23], and the absence of personnel during MRSA personnel screening and decolonization (n = 1) [20]. One study reported that the control of a GRE outbreak lasting for 40 days required 1663 extra hours of nursing staff for 16 positive cases [19].…”

Antibody-Based Therapy for Enterococcal Catheter-Associated Urinary Tract Infections

“…Enterococcal HAI isolates are most commonly Enterococcus faecalis and Enterococcus faecium , whose ability to withstand heat, UV radiation, and aseptic solutions (14–16) allows them to persist in the hospital ecology (14, 16). Treatment is increasingly challenging because of their intrinsic and acquired resistance to recently introduced antibiotics (15–17), and vancomycin-resistant enterococci (VRE) along with multiply resistant enterococcus (MRE) strains are now common in CAUTI (18). Complete recovery from VRE infection may be prolonged and in some cases requires >3 years (19).…”

Vancomycin-Resistant Enterococci Colonization Among Dialysis Patients: A Meta-analysis of Prevalence, Risk Factors, and Significance

“…[1][2][3][4] Because of concordant resistance of VRE to other antibiotics, VRE infections pose a therapeutic challenge in daily clinical practice and are characterized by increased morbidity and mortality. 5,6 The potential of VRE to transfer antibiotic resistance to other Grampositive bacteria, 7,8 survive for a prolonged time on the environmental surfaces, [9][10][11] and cause prolonged colonization 12,13 highlights other aspects of the importance of preventing the dissemination of VRE in the hospital setting.…”