Costs and Savings Associated With Infection Control Measures That Reduced Transmission of Vancomycin-Resistant Enterococci in an Endemic Setting

Montecalvo, Marisa A.; Jarvis, William R.; Uman, Jane; Shay, David K.; Petrullo, Coleen; Horowitz, Harold W.; Wormser, Gary P.

doi:10.1086/501931

Cited by 73 publications

(58 citation statements)

References 9 publications

(9 reference statements)

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“…Implementation of additional infection control practices based on a positive screen result increases the overall cost to the hospital as well. In one study, this cost was estimated at $116,515 ($224/patient) annually for additional infection control measures in a 22-bed adult oncology unit (56). However, implementation of this program resulted in a net savings of $189,318 annually ($294,433 in 2015), based on a reduction in VRE BSI from 2.1/1,000 patientdays to 0.45/1,000 patient-days (estimated $123,081), reduced VRE colonization (estimated $2,755), and reductions in antimicrobial use (estimated $179,997).…”

Section: Approaches To Screening and Impact For Control Of Vrementioning

confidence: 99%

Resistance Mechanisms, Epidemiology, and Approaches to Screening for Vancomycin-Resistant Enterococcus in the Health Care Setting

2016

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bInfections attributable to vancomycin-resistant Enterococcus (VRE) strains have become increasingly prevalent over the past decade. Prompt identification of colonized patients combined with effective multifaceted infection control practices can reduce the transmission of VRE and aid in the prevention of hospital-acquired infections (HAIs). Increasingly, the clinical microbiology laboratory is being asked to support infection control efforts through the early identification of potential patient or environmental reservoirs. This review discusses the factors that contribute to the rise of VRE as an important health care-associated pathogen, the utility of laboratory screening and various infection control strategies, and the available laboratory methods to identify VRE in clinical specimens. Hospital-acquired infections (HAIs) are a serious threat for patient care and carry a significant cost to hospitals, since treatment of these infections is no longer reimbursable. In addition, regulations requiring hospitals to report HAIs creates further pressure to reduce incidence rates. Screening patients at admission for methicillin-resistant Staphylococcus aureus (MRSA) has been a successful approach in reducing MRSA HAIs in some health care systems and may be a successful strategy for controlling other health care-associated pathogens, including Clostridium difficile, carbapenem-resistant Enterobacteriaceae (CRE), and vancomycin-resistant Enterococcus (VRE) (1). However, there is debate about the optimal approach to screening and infection control, which may differ between pathogens of interest.Members of the genus Enterococcus are well-documented pathogens associated with various clinical manifestations, including bacteremia, infective endocarditis, intra-abdominal and pelvic infections, urinary tract infections, and, in rare cases, central nervous system infections (2-4). Infection with vancomycin-resistant Enterococcus is associated with an increased mortality rate, illustrated by a 2.5-fold increase in mortality for patients suffering from VRE bacteremia (5). Vancomycin resistance in Enterococcus spp. has been increasing in prevalence since it was first encountered in 1986 (6, 7). Currently, 30% of Enterococcus species isolates from the United States are vancomycin resistant, and infection with these organisms causes an estimated 1,300 deaths each year (8). The majority of VRE are associated with the species E. faecium (77%) and E. faecalis (9%), with the remaining 14% of isolates representing species less frequently implicated in serious infections, including E. gallinarum, E. casseliflavus, E. avium, and E. raffinosus (8).The optimal approach to reducing VRE infections is multifactorial, requiring antimicrobial stewardship to reduce the selection of VRE in colonized patients, appropriate infection control practices to reduce transmission, and reliable sensitive laboratory methods for the detection of VRE in a timely manner. ANTIMICROBIAL RESISTANCE MECHANISMS AND APPROACHES TO THERAPYUnderstanding the mechanism be...

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Section: Approaches To Screening and Impact For Control Of Vrementioning

confidence: 99%

Resistance Mechanisms, Epidemiology, and Approaches to Screening for Vancomycin-Resistant Enterococcus in the Health Care Setting

2016

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“…nfections with antimicrobial-resistant pathogens are a significant and increasing cause of morbidity, mortality, increased cost, and longer stay among hospitalized patients (1)(2)(3)(4)(5)(6). Intestinal colonization is often a precursor to the development of clinical infection (7,8), and patients who are at risk are often cocolonized with multiple pathogens concomitantly (9)(10)(11).…”

mentioning

confidence: 99%

Gastrointestinal Colonization with a Cephalosporinase-Producing Bacteroides Species Preserves Colonization Resistance against Vancomycin-Resistant Enterococcus and Clostridium difficile in Cephalosporin-Treated Mice

Stiefel

Nerandzic

Pultz

et al. 2014

Antimicrob Agents Chemother

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Antibiotics that are excreted into the intestinal tract may disrupt the indigenous intestinal microbiota and promote colonization by health care-associated pathogens. ␤-Lactam, or penicillin-type, antibiotics are among the most widely utilized antibiotics worldwide and may also adversely affect the microbiota. Many bacteria are capable, however, of producing ␤-lactamase enzymes that inactivate ␤-lactam antibiotics. We hypothesized that prior establishment of intestinal colonization with a ␤-lactamaseproducing anaerobe might prevent these adverse effects of ␤-lactam antibiotics, by inactivating the portion of antibiotic that is excreted into the intestinal tract. Here, mice with a previously abolished microbiota received either oral normal saline or an oral cephalosporinase-producing strain of Bacteroides thetaiotaomicron for 3 days. Mice then received 3 days of subcutaneous ceftriaxone, followed by either oral administration of vancomycin-resistant Enterococcus (VRE) or sacrifice and assessment of in vitro growth of epidemic and nonepidemic strains of Clostridium difficile in murine cecal contents. Stool concentrations of VRE and ceftriaxone were measured, cecal levels of C. difficile 24 h after incubation were quantified, and denaturing gradient gel electrophoresis (DGGE) of microbial 16S rRNA genes was performed to evaluate the antibiotic effect on the microbiota. The results demonstrated that establishment of prior colonization with a ␤-lactamase-producing intestinal anaerobe inactivated intraintestinal ceftriaxone during treatment with this antibiotic, allowed recovery of the normal microbiota despite systemic ceftriaxone, and prevented overgrowth with VRE and epidemic and nonepidemic strains of C. difficile in mice. These findings describe a novel probiotic strategy to potentially prevent pathogen colonization in hospitalized patients.

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“…Advanced age, severity of illness, inter-institutional transfer of the patient, prolonged hospital stay, gastrointestinal surgery, transplantation, exposure to medical devices, especially central venous catheters, and heavy exposure to broad-spectrum antimicrobial drugs are risk factors for colonization and infection with VRE 4 . In addition, contact with contaminated health care workers, patients, attendants, environmental surfaces and equipment promotes VRE colonization 5 . Colonization of the rectum with VRE was reported to be a more important predictor than colonization of other regions 6 .…”

Section: Introductionmentioning

confidence: 99%

Vancomycin-resistant enterococci colonization in patients with hematological malignancies: screening and its cost-effectiveness

Gedık¹,

Şimşek²,

Kantürk³

et al. 2015

Afr H. Sci.

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Abstract:Background and objective: We evaluated the rates of vancomycin-resistant enterococci (VRE) colonization and VRErelated bacteremia in patients with hematological malignancies in terms of routine screening culture and its cost-effectiveness. Materials and Methods: All patients of the hematology department who were older than 14 years of age and who developed at least one febrile neutropenia episode during chemotherapy for hematological cancers between November 2010 and November 2012 were evaluated retrospectively. Results: We retrospectively analyzed 282 febrile episodes in 126 neutropenic patients during a two-year study period. The study included 65 cases in the first study-year and 78 cases in the second study-year. The numbers of colonization days and colonized patient were748 days of colonization in 29 patients (44%) in the first study-year and 547 colonization days in 21 patients (26%) in the second study-year, respectively. Routine screening culture for VRE cost $4516,4 (427 cultures) in the first study-year, $5082,7 (504 cultures) in the second study-year depending on the number of patients and their length of stay. Conclusion:In line with our study results, routine screening of hematological patients for VRE colonization is not costeffective. Routine surveillance culture for VRE should be considered with respect to the conditions of health care setting.

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Costs and Savings Associated With Infection Control Measures That Reduced Transmission of Vancomycin-Resistant Enterococci in an Endemic Setting

Cited by 73 publications

References 9 publications

Resistance Mechanisms, Epidemiology, and Approaches to Screening for Vancomycin-Resistant Enterococcus in the Health Care Setting

Resistance Mechanisms, Epidemiology, and Approaches to Screening for Vancomycin-Resistant Enterococcus in the Health Care Setting

Gastrointestinal Colonization with a Cephalosporinase-Producing Bacteroides Species Preserves Colonization Resistance against Vancomycin-Resistant Enterococcus and Clostridium difficile in Cephalosporin-Treated Mice

Vancomycin-resistant enterococci colonization in patients with hematological malignancies: screening and its cost-effectiveness

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