Prolonged Colonization with Vancomycin‐Resistant<i>Enterococcus faecium</i>in Long‐Term Care Patients and the Significance of “Clearance”

Baden, LR; Thiemke, W.; Skolnik, A.; Chambers, Reid; Strymish, Judith; Gold, Howard S.; Moellering, Robert C.; Eliopoulos, George M.

doi:10.1086/323762

Cited by 83 publications

(46 citation statements)

References 39 publications

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“…20 One institution, which defined VRE clearance as 3 negative stool cultures more than 3 weeks apart, found in subsequent, prospective surveillance testing that VRE recolonization occurred in 5 of 21 patients (24%) who had "cleared." 14 The same authors identified 12 patients who had at least 2 VRE-positive cultures more than 1 year apart, supporting concern for prolonged colonization. 14 Donskey et al 15 demonstrated that individuals who had cleared VRE colonization with 3 negative stool cultures collected at least 1 week apart had a high recurrence rate (62%) if they were exposed to antibiotics in the following year.…”

Section: Vancomycin-resistant Enterococcus (Vre)mentioning

confidence: 90%

“…14 The same authors identified 12 patients who had at least 2 VRE-positive cultures more than 1 year apart, supporting concern for prolonged colonization. 14 Donskey et al 15 demonstrated that individuals who had cleared VRE colonization with 3 negative stool cultures collected at least 1 week apart had a high recurrence rate (62%) if they were exposed to antibiotics in the following year. Individuals with risk factors for VRE colonization have demonstrated recurrence, 16 and recent studies suggest that a strategy of 3 weekly consecutive surveillance cultures to identify VRE clearance results in recurrence rates of 11%.…”

Section: Vancomycin-resistant Enterococcus (Vre)mentioning

confidence: 90%

“…Data on duration of VRE colonization indicate that colonization may be prolonged, with high rates of relapse after multiple consecutive negative surveillance cultures. [14][15][16] Factors associated with prolonged VRE carriage include immunocompromising conditions and concomitant antibiotic exposure. [16][17][18][19] Additionally, patients with diarrhea and uncontrolled respiratory secretions and draining wounds may pose the highest risk for transmission in the healthcare environment.…”

Section: Vancomycin-resistant Enterococci (Vre)mentioning

confidence: 99%

“…Most frequently, 3 consecutive negative cultures performed weekly have been studied, although hospitals may consider other strategies. 14,20 Given the limitations of sequential culture strategies in documenting VRE eradication, prolonging CP may be an effective enhanced measure in preventing VRE transmission in high-risk settings, though evidence does not exist to identify the optimal period of prolongation.…”

Section: Vancomycin-resistant Enterococci (Vre)mentioning

confidence: 99%

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Duration of Contact Precautions for Acute-Care Settings

Banach

Bearman

Barnden³

et al. 2018

Infect. Control Hosp. Epidemiol.

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purposeThis expert guidance document (EG) provides recommendations regarding discontinuation of contact precautions (CP) at the individual patient level in acute-care hospitals employing CP for 1 or more of the following organisms: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Clostridium difficile, and multidrug-resistant Enterobacteriaceae (MDR-E), including carbapenem-resistant Enterobacteriaceae (CRE) and extended-spectrum β-lactamase (ESBL)-producing organisms. This document also provides a review of the role of molecular testing in guiding decisions pertaining to duration of CP for patients with these organisms. The guidance does not address decisions regarding the initiation of CP for any specific organism.Previously published guidelines describe components of CP and identify situations in which CP should be used; currently, however, few publications address the issue of how long CP should be maintained. At the time of publication, decisions related to implementation of CP for select, endemic organisms are made by individual facilities based on factors such as institutional epidemiology, resources, organizational priorities, and previously published guidance, and these vary widely. The SHEA Guidelines Committee (GLC) selected this topic to address when CP should be discontinued for individual patients in acute-care settings that employ CP for the aforementioned organisms.Although the organisms addressed are frequently encountered in other settings (eg, nursing homes, long-term acute-care facilities, rehabilitation centers, outpatient medical care settings), additional considerations may affect the application of these recommendations outside the acute-care hospital environment. authorsThe authors consist of current and past members of the SHEA Guidelines Committee (GLC), who serve as volunteers. All authors are involved at their respective institutions in the development of policies pertaining to CP, either directly or in an advisory role. intended useSpecial-topic EG documents are developed to address areas of relatively narrow scope that lack the level of evidence required for a formal guideline but are important for the provision of safe and effective healthcare. As such, systematic grading of evidence level is not provided for individual recommendations. Each EG is based on a synthesis of limited evidence, theoretical rationale, current practices, practical considerations, the opinion of the writing group, and consideration of potential harms where applicable. Within the EG, a summary list of recommendations is provided, along with their respective rationales. We also conducted a survey of the SHEA Research Network (SRN).No EG can anticipate all situations and this EG is not meant to be a substitute for individual judgment by qualified professionals. methods Expert Guidance DevelopmentThis EG follows the process outlined in the Handbook for SHEA-Sponsored Guidelines and Expert Guidance Documents. 10 The topic of duration of CP was among those proposed and ...

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Section: Vancomycin-resistant Enterococcus (Vre)mentioning

confidence: 90%

Section: Vancomycin-resistant Enterococcus (Vre)mentioning

confidence: 90%

Section: Vancomycin-resistant Enterococci (Vre)mentioning

confidence: 99%

Section: Vancomycin-resistant Enterococci (Vre)mentioning

confidence: 99%

See 2 more Smart Citations

Duration of Contact Precautions for Acute-Care Settings

Banach

Bearman

Barnden³

et al. 2018

Infect. Control Hosp. Epidemiol.

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show abstract

“…are part of the gastrointestinal microbiota, supercolonization by resistant strains can occur with relative ease 4 . The limited current evidence suggests that patients colonized with VRE cannot be colonized by nonresistant strains 5,6 . The contamination of the hospital environment and the ability of enterococci to survive outside the human body for prolonged periods are factors for the occurrence of cross-contamination, either through the hands of health care workers, equipment, or surfaces 7 .…”

Section: Introductionmentioning

confidence: 95%

Successful prevention of the transmission of vancomycin-resistant enterococci in a Brazilian public teaching hospital

Rossini

Fagnani

Leichsenring

et al. 2012

Rev. Soc. Bras. Med. Trop.

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INTRODUCTION: Vancomycin-resistant enterococci (VRE) can colonize or cause infections in high-risk patients and contaminate the environment. Our objective was to describe theepidemiological investigation of an outbreak of VRE, the interventions made, and their impact on its control. METHODS: We conducted a retrospective, descriptive, non-comparative study by reviewing the charts of patients with a VRE-positive culture in the University Hospital of Campinas State University, comprising 380 beds, 40 of which were in intensive care units (ICUs), who were admitted from February 2008-January 2009. Interventions were divided into educational activity, reviewing the workflow processes, engineering measures, and administrative procedures. RESULTS: There were 150 patients, 139 (92.7%) colonized and 11 (7.3%) infected. Seventy-three percent were cared for in non-ICUs (p = 0.028). Infection was more frequent in patients with a central-line (p = 0.043), mechanical ventilation (p = 0.013), urinary catheter (p = 0.049), or surgical drain (p = 0.049). Vancomycin, metronidazole, ciprofloxacin, and third-generation cephalosporin were previously used by 47 (31.3%), 31 (20.7%), 24 (16%), and 24 (16%) patients, respectively. Death was more frequent in infected (73%) than in colonized (17%) patients (p < 0.001). After the interventions, the attack rate fell from 1.49 to 0.33 (p < 0.001). CONCLUSIONS: Classical risk factors for VRE colonization or infection, e.g., being cared for in an ICU and previous use of vancomycin, were not found in this study. The conjunction of an educational program, strict adhesion to contact precautions, and reinforcement of environmental cleaning were able to prevent the dissemination of VRE.

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2008

Infection Prevention and Control

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Prolonged Colonization with Vancomycin‐ResistantEnterococcus faeciumin Long‐Term Care Patients and the Significance of “Clearance”

Cited by 83 publications

References 39 publications

Duration of Contact Precautions for Acute-Care Settings

Duration of Contact Precautions for Acute-Care Settings

Successful prevention of the transmission of vancomycin-resistant enterococci in a Brazilian public teaching hospital

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