The impact of vancomycin-resistant Enterococcus (VRE) screening policy change on the incidence of healthcare-associated VRE bacteremia

Abstract

Objective: To evaluate the impact of a vancomycin-resistant Enterococcus (VRE) screening policy change on the incidence of healthcare-associated (HA)-VRE bacteremia in an endemic hospital setting. Design: A quasi-experimental before-and-after study. Setting: A 1,989-bed tertiary-care referral center in Seoul, Republic of Korea. Methods: Since May 2010, our hospital has diminished VRE screening for admitted patients transferred from other healthcare facilities. We assessed the impact of this policy change on the incidence of HA-VRE bacteremia using segmented autoregression analysis of interrupted time series from January 2006 to December 2014 at the hospital and unit levels. In addition, we compared the molecular characteristics of VRE blood isolates collected before and after the screening policy change using multilocus sequence typing and pulsed-field gel electrophoresis. Results: After the VRE screening policy change, the incidence of hospital-wide HA-VRE bacteremia increased, although no significant changes of level or slope were observed. In addition, a significant slope change in the incidence of HA-VRE bacteremia (change in slope, 0.007; 95% CI, 0.001–0.013; P = .02) was observed in the hemato-oncology department. Molecular analysis revealed that various VRE sequence types appeared after the policy change and that clonally related strains became more predominant (increasing from 26.1% to 59.3%). Conclusions: The incidence of HA-VRE bacteremia increased significantly after VRE screening policy change, and this increase was mainly driven by high-risk patient populations. When planning VRE control programs in hospitals, different approaches that consider risk for severe VRE infection in patients may be required.

Impact of change in vancomycin-resistant Enterococcus infection prevention policy

“…1 online). These findings contrast with those of Cho et al, 5 which demonstrated a significant increase in hospital-acquired VRE bacteremia following cessation of surveillance cultures on interhospital transfers. However, our findings support those of other studies that did not observe increased VRE infection rates following cessation of VRE specific interventions.…”

Cessation of Rectal Screening for Vancomycin-Resistant Enterococci: Experience from a Tertiary Care Hospital from Türkiye

“…In some studies where both screening and isolation practices were discontinued, an increase in the rate of VRE infections was observed [18,19]. In a multicenter study from Canada, 23 hospitals that discontinued contact precautions and routine rectal screening were compared with 77 hospitals that did not change their VRE control policies.…”

“…However, several recent studies showed that relaxing or discontinuing VRE control programs did not result in an increase in VRE infections, particularly in settings where compliance rates for hand hygiene was high [3,[14][15][16][17]. In comparison, some studies reported an increase in VRE infections after routine screening was discontinued [18,19].…”

Machine Learning Assisted MALDI Mass Spectrometry for Rapid Antimicrobial Resistance Prediction in Clinicals

“…19 Early identification of VRE strains and effective surveillance are crucial for mitigate the impact of VRE infections and prevent further spreading within clinical facilities. 20 Hence, developing a sensitive method to rapidly differentiate VRE strains is highly necessary and is of practical clinical need.…”

“…VRE infections have become globally prevalent across various strains, leading to reduced available treatment options and increased risk of complications . Early identification of VRE strains and effective surveillance are crucial for mitigate the impact of VRE infections and prevent further spreading within clinical facilities . Hence, developing a sensitive method to rapidly differentiate VRE strains is highly necessary and is of practical clinical need.…”