Predictive utility of swab screening for vancomycin-resistant Enterococcus in selection of empiric antibiotics for Enterococcus sterile-site infections: a retrospective cohort study

Brasg, Ian; Elligsen, Marion; MacFadden, Derek R.; Daneman, Nick

doi:10.9778/cmajo.20170034

Cited by 12 publications

(13 citation statements)

References 30 publications

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“…20 Previously, most studies involving the use of VRE colonization status in predicting vancomycin resistance in clinical isolates have involved the role of VRE colonization as a risk factor for eventual VRE infection. 21,22 To our knowledge, apart from Brasg et al 13 and Webb et al, 14 no other study has analyzed the predictive accuracy of VRE screening tests to guide empiric therapy when an enterococcal infection is known or suspected. Although the conclusions of other studies were similar, their study designs differed in multiple ways, which significantly limits their generalizability.…”

Section: Discussionmentioning

confidence: 99%

“…Third, their VRE screening protocols differed greatly. In Brasg et al, 13 the protocol began with VRE specific agar with confirmation of vanA and/or vanB gene carriage by PCR. By performing PCR first, our protocol may have achieved higher sensitivity.…”

Section: Discussionmentioning

confidence: 99%

“…The choice to add empiric VRE coverage entails a careful balancing of the harms and benefits of a therapy. Because VRE colonization is a major risk factor for infection, and based on previous work on MRSA 11,12 and VRE 13,14 prediction using screening swabs, we postulated that a patient's VRE status could be used to identify those least and most likely to benefit from empiric VRE coverage in the context of enterococcal bacteremia. a population of 850,000).…”

mentioning

confidence: 99%

“…To allow for comparison with other studies, we also used the method from Brasg et al 13 in which only the last available screening swab result was considered (most recent criteria). We then pooled our results with theirs to obtain the overall sensitivity, specificity, likelihood ratios, and predictive values as functions of prevalence.…”

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confidence: 99%

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Using VRE screening tests to predict vancomycin resistance in enterococcal bacteremia

Butler‐Laporte

Cheng

McDonald

et al. 2020

Infect. Control Hosp. Epidemiol.

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Background and objective:Enterococcus causes clinically significant bloodstream infections (BSIs). In centers with a higher prevalence of vancomycin resistant enterococcus (VRE) colonization, a common clinical question is whether empiric treatment directed against VRE should be initiated in the setting of a suspected enterococcal BSI. Unfortunately, VRE treatment options are limited, and relatively expensive, and subject patients to the risk of adverse reactions. We hypothesized that the results of VRE colonization screening could predict vancomycin resistance in enterococcal BSI.Methods:We reviewed 370 consecutive cases of enterococcal BSI over a 7-year period at 2 tertiary-care hospitals to determine whether vancomycin-resistant BSIs could be predicted based on known colonization status (ie, patients with swabs performed within 30 days, more remotely, or never tested). We calculated sensitivity and specificity, and we plotted negative predictives values (NPVs) and positive predictive values (PPVs) as a function of prevalence.Results:A negative screening swab within 30 days of infection yielded NPVs of 90% and 95% in settings where <27.0% and 15.0% of enterococcal BSI are resistant to vancomycin, respectively. In patients with known VRE colonization, the PPV for VRE in enterococcal BSI was >50% at any prevalence exceeding 25%.Conclusions:The results of a negative VRE screening test result performed within 30 days can help eliminate unnecessary empiric therapy in patients with suspected enterococcal BSI. Conversely, patients with positive VRE screening swabs require careful consideration of empiric VRE-directed therapy when enterococcal BSI appears likely.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Using VRE screening tests to predict vancomycin resistance in enterococcal bacteremia

Butler‐Laporte

Cheng

McDonald

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…2 We hypothesized that ESBL screening swab cultures would demonstrate high specificity for predicting antimicrobial resistance in subsequent sterile site infections. 3,4…”

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confidence: 99%

Predictive utility of swab screening for extended-spectrum beta-lactamase-producing organisms in selection of empiric antibiotics for Gram-negative sterile-site infections: A retrospective cohort study

Brasg

Elligsen

Daneman

et al. 2019

Infect. Control Hosp. Epidemiol.

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Implications of Veterinary Medicine in the comprehension and stewardship of antimicrobial resistance phenomenon. From the origin till nowadays.

Vercelli

Gambino

Amadori³

2022

Veterinary and Animal Science

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Predictive utility of swab screening for vancomycin-resistant Enterococcus in selection of empiric antibiotics for Enterococcus sterile-site infections: a retrospective cohort study

Cited by 12 publications

References 30 publications

Using VRE screening tests to predict vancomycin resistance in enterococcal bacteremia

Using VRE screening tests to predict vancomycin resistance in enterococcal bacteremia

Predictive utility of swab screening for extended-spectrum beta-lactamase-producing organisms in selection of empiric antibiotics for Gram-negative sterile-site infections: A retrospective cohort study

Implications of Veterinary Medicine in the comprehension and stewardship of antimicrobial resistance phenomenon. From the origin till nowadays.

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