Improving the assessment of vancomycin-resistant enterococci by routine screening

Susan S. Huang, Sheryl L. Rifas-Shiman, Jean M. Pottinger, Loreen A. Herwaldt, Teresa B. Zembower, Gary A. Noskin, Sara E. Cosgrove, Trish M. Perl, Amy B. Curtis, Jerome L. Tokars, Daniel J. Diekema, John A. Jernigan, Virginia L. Hinrichsen, Deborah S. Yokoe, Richard Platt

Research output: Contribution to journalArticle

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Abstract

Background. As infection with vancomycin-resistant enterococci (VRE) increases in hospitals, knowledge about VRE reservoirs and improved accuracy of epidemiologic measures are needed. Many assessments underestimate incidence by including prevalent carriers in at-risk populations. Routine surveillance cultures can substantially improve prevalence and incidence estimates, and assessing the range of improvement across diverse units is important. Methods. We performed a retrospective cohort study using accurate at-risk populations to evaluate the range of benefit of admission and weekly surveillance cultures in detecting unrecognized VRE in 14 patient-care units. Results. We assessed 165 unit-months. The admission prevalence of VRE was 2.2%-27.2%, with admission surveillance providing 2.2-17-fold increased detection. Medical units were significantly more likely to admit VRE carriers than were surgical units. Monthly incidence was 0.8%-9.7%, with weekly surveillance providing 3.3-15.4-fold increased detection. The common practice of reporting incidence using the total number of patients, rather than patients at risk, underestimated incidence by one-third. Overall, routine surveillance prevented the misclassification of 43.0% (unit range, 0%-85.7%) of "incident" carriers on the basis of clinical cultures alone and increased VRE precaution days by 2.4-fold (unit range, 2.0-2.6-fold). Conclusions. Routine surveillance markedly increases the detection of VRE, despite variability across patient-care units. Correct denominators prevent the substantial underestimation of incidence.

Original languageEnglish (US)
Pages (from-to)339-346
Number of pages8
JournalJournal of Infectious Diseases
Volume195
Issue number3
StatePublished - Feb 1 2007

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Incidence
Patient Care
Vancomycin-Resistant Enterococci
Cohort Studies
Retrospective Studies
Infection

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

Cite this

Huang, S. S., Rifas-Shiman, S. L., Pottinger, J. M., Herwaldt, L. A., Zembower, T. B., Noskin, G. A., ... Platt, R. (2007). Improving the assessment of vancomycin-resistant enterococci by routine screening. Journal of Infectious Diseases, 195(3), 339-346.

Improving the assessment of vancomycin-resistant enterococci by routine screening. / Huang, Susan S.; Rifas-Shiman, Sheryl L.; Pottinger, Jean M.; Herwaldt, Loreen A.; Zembower, Teresa B.; Noskin, Gary A.; Cosgrove, Sara E.; Perl, Trish M.; Curtis, Amy B.; Tokars, Jerome L.; Diekema, Daniel J.; Jernigan, John A.; Hinrichsen, Virginia L.; Yokoe, Deborah S.; Platt, Richard.

In: Journal of Infectious Diseases, Vol. 195, No. 3, 01.02.2007, p. 339-346.

Research output: Contribution to journalArticle

Huang, SS, Rifas-Shiman, SL, Pottinger, JM, Herwaldt, LA, Zembower, TB, Noskin, GA, Cosgrove, SE, Perl, TM, Curtis, AB, Tokars, JL, Diekema, DJ, Jernigan, JA, Hinrichsen, VL, Yokoe, DS & Platt, R 2007, 'Improving the assessment of vancomycin-resistant enterococci by routine screening', Journal of Infectious Diseases, vol. 195, no. 3, pp. 339-346.
Huang SS, Rifas-Shiman SL, Pottinger JM, Herwaldt LA, Zembower TB, Noskin GA et al. Improving the assessment of vancomycin-resistant enterococci by routine screening. Journal of Infectious Diseases. 2007 Feb 1;195(3):339-346.
Huang, Susan S. ; Rifas-Shiman, Sheryl L. ; Pottinger, Jean M. ; Herwaldt, Loreen A. ; Zembower, Teresa B. ; Noskin, Gary A. ; Cosgrove, Sara E. ; Perl, Trish M. ; Curtis, Amy B. ; Tokars, Jerome L. ; Diekema, Daniel J. ; Jernigan, John A. ; Hinrichsen, Virginia L. ; Yokoe, Deborah S. ; Platt, Richard. / Improving the assessment of vancomycin-resistant enterococci by routine screening. In: Journal of Infectious Diseases. 2007 ; Vol. 195, No. 3. pp. 339-346.
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AU - Huang, Susan S.

AU - Rifas-Shiman, Sheryl L.

AU - Pottinger, Jean M.

AU - Herwaldt, Loreen A.

AU - Zembower, Teresa B.

AU - Noskin, Gary A.

AU - Cosgrove, Sara E.

AU - Perl, Trish M.

AU - Curtis, Amy B.

AU - Tokars, Jerome L.

AU - Diekema, Daniel J.

AU - Jernigan, John A.

AU - Hinrichsen, Virginia L.

AU - Yokoe, Deborah S.

AU - Platt, Richard

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N2 - Background. As infection with vancomycin-resistant enterococci (VRE) increases in hospitals, knowledge about VRE reservoirs and improved accuracy of epidemiologic measures are needed. Many assessments underestimate incidence by including prevalent carriers in at-risk populations. Routine surveillance cultures can substantially improve prevalence and incidence estimates, and assessing the range of improvement across diverse units is important. Methods. We performed a retrospective cohort study using accurate at-risk populations to evaluate the range of benefit of admission and weekly surveillance cultures in detecting unrecognized VRE in 14 patient-care units. Results. We assessed 165 unit-months. The admission prevalence of VRE was 2.2%-27.2%, with admission surveillance providing 2.2-17-fold increased detection. Medical units were significantly more likely to admit VRE carriers than were surgical units. Monthly incidence was 0.8%-9.7%, with weekly surveillance providing 3.3-15.4-fold increased detection. The common practice of reporting incidence using the total number of patients, rather than patients at risk, underestimated incidence by one-third. Overall, routine surveillance prevented the misclassification of 43.0% (unit range, 0%-85.7%) of "incident" carriers on the basis of clinical cultures alone and increased VRE precaution days by 2.4-fold (unit range, 2.0-2.6-fold). Conclusions. Routine surveillance markedly increases the detection of VRE, despite variability across patient-care units. Correct denominators prevent the substantial underestimation of incidence.

AB - Background. As infection with vancomycin-resistant enterococci (VRE) increases in hospitals, knowledge about VRE reservoirs and improved accuracy of epidemiologic measures are needed. Many assessments underestimate incidence by including prevalent carriers in at-risk populations. Routine surveillance cultures can substantially improve prevalence and incidence estimates, and assessing the range of improvement across diverse units is important. Methods. We performed a retrospective cohort study using accurate at-risk populations to evaluate the range of benefit of admission and weekly surveillance cultures in detecting unrecognized VRE in 14 patient-care units. Results. We assessed 165 unit-months. The admission prevalence of VRE was 2.2%-27.2%, with admission surveillance providing 2.2-17-fold increased detection. Medical units were significantly more likely to admit VRE carriers than were surgical units. Monthly incidence was 0.8%-9.7%, with weekly surveillance providing 3.3-15.4-fold increased detection. The common practice of reporting incidence using the total number of patients, rather than patients at risk, underestimated incidence by one-third. Overall, routine surveillance prevented the misclassification of 43.0% (unit range, 0%-85.7%) of "incident" carriers on the basis of clinical cultures alone and increased VRE precaution days by 2.4-fold (unit range, 2.0-2.6-fold). Conclusions. Routine surveillance markedly increases the detection of VRE, despite variability across patient-care units. Correct denominators prevent the substantial underestimation of incidence.

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