Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-21T04:34:33.480Z Has data issue: false hasContentIssue false
  • English
  • Français

Practical methods for effective vancomycin-resistant enterococci (VRE) surveillance: experience in a liver transplant surgical intensive care unit

Published online by Cambridge University Press:  05 September 2018

Rebecca Y. Linfield ,
Shelley Campeau ,
Patil Injean ,
Aric Gregson ,
Fady Kaldas ,
Zachary Rubin ,
Tae Kim ,
Danielle Kunz ,
Alfred Chan  and
Delphine J. Lee
...Show all authors
Rebecca Y. Linfield
Affiliation:
David Geffen School of Medicine at University of California–Los Angeles (UCLA), Los Angeles, California
Shelley Campeau
Affiliation:
UCLA Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
Patil Injean
Affiliation:
Department of Medicine, Western University of Health Sciences, Pomona, California
Aric Gregson
Affiliation:
David Geffen School of Medicine at University of California–Los Angeles (UCLA), Los Angeles, California
Fady Kaldas
Affiliation:
David Geffen School of Medicine at University of California–Los Angeles (UCLA), Los Angeles, California
Zachary Rubin
Affiliation:
David Geffen School of Medicine at University of California–Los Angeles (UCLA), Los Angeles, California
Tae Kim
Affiliation:
Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Division of Infectious Disease, Los Angeles Biomedical Research Institute at Harbor—UCLA Medical Center, Torrance, California
Danielle Kunz
Affiliation:
Expert Stewardship, Newport, California
Alfred Chan
Affiliation:
Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Division of Infectious Disease, Los Angeles Biomedical Research Institute at Harbor—UCLA Medical Center, Torrance, California
Delphine J. Lee
Affiliation:
Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Division of Infectious Disease, Los Angeles Biomedical Research Institute at Harbor—UCLA Medical Center, Torrance, California
Romney M. Humphries
Affiliation:
UCLA Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
James A. McKinnell*
Affiliation:
David Geffen School of Medicine at University of California–Los Angeles (UCLA), Los Angeles, California Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Division of Infectious Disease, Los Angeles Biomedical Research Institute at Harbor—UCLA Medical Center, Torrance, California Expert Stewardship, Newport, California
*
Author for correspondence: James A. McKinnell, 1124 West Carson Street Torrance, CA 90502. E-mail: dr.mckinnell@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

We evaluated the utility of vancomycin-resistant Enterococcus (VRE) surveillance by varying 2 parameters: admission versus weekly surveillance and perirectal swabbing versus stool sampling.

Design

Prospective, patient-level surveillance program of incident VRE colonization.

Setting

Liver transplant surgical intensive care unit (SICU) of a tertiary-care referral medical center with a high prevalence of VRE.

Patients

All patients admitted to the SICU from June to August 2015.

Methods

We conducted a point-prevalence estimate followed by admission and weekly surveillance by perirectal swabbing and/or stool sampling. Incident colonization was defined as a negative screen followed by positive surveillance. VRE was detected by culture on Remel Spectra VRE chromogenic agar. Microbiologically-confirmed VRE bloodstream infections (BSIs) were tracked for 2 months. Statistical analyses were calculated using the McNemar test, the Fisher exact test, the t test, and the χ2 test.

Results

In total, 91 patients underwent VRE surveillance testing. The point prevalence of VRE colonization was 60.9%; VRE prevalence on admission was 30.1%. Weekly surveillance identified an additional 7 of 28 patients (25.0%) with incident colonization. VRE BSIs were more common in VRE-colonized patients than in noncolonized patients (8 of 43 vs 2 of 48; P=.028). In a direct comparison, perirectal swabs were more sensitive than stool samples in detecting VRE (64 of 67 vs 56 of 67; P=.023). Compliance with perirectal swabbing was 89% (201 of 226) compared to 56% (127 of 226) for stool collection (P≤0.001).

Conclusions

We recommend weekly VRE surveillance over admission-only screening in high-burden units such as liver transplant SICUs. Perirectal swabs had greater collection compliance and sensitivity than stool samples, making them the preferred methodology. Further work may have implications for antimicrobial stewardship and infection control.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 10 , October 2018 , pp. 1178 - 1182
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

6

Present affiliation: Accelerate Diagnostics, 13 Tucson, Arizona

References

1. Chiang, HY, Perencevich, EN, Nair, R, et al. Incidence and outcomes associated with infections caused by vancomycin-resistant Enterococci in the United States: systematic literature review and meta-analysis. Infect Control Hosp Epidemiol 2017;38:203–215.Google Scholar
2. Russell, DL, Flood, A, Zaroda, TE, et al. Outcomes of colonization with MRSA and VRE among liver transplant candidates and recipients. Am J Transplant 2008;8:1737–1743.Google Scholar
3. Kamboj, M, Chung, D, Seo, SK, et al. The changing epidemiology of vancomycin-resistant Enterococcus (VRE) bacteremia in allogeneic hematopoietic stem cell transplant (HSCT) recipients. Biol Blood Marrow Transplant 2010;16:1576–1581.Google Scholar
4. https://data.chhs.ca.gov/dataset/vancomycin-resistant-enterococci-vre-bloodstream-infections-in-healthcare.Google Scholar
5. Popiel, KY, Miller, MA. Evaluation of vancomycin-resistant enterococci (VRE)-associated morbidity following relaxation of VRE screening and isolation precautions in a tertiary care hospital. Infect Control Hosp Epidemiol 2014;35:818–825.Google Scholar
6. Perencevich, EN, Fisman, DN, Lipsitch, M, Harris, AD, Morris, JG Jr, Smith, DL. Projected benefits of active surveillance for vancomycin-resistant enterococci in intensive care units. Clin Infect Dis 2004;38:1108–1115.Google Scholar
7. Wong, T, Woznow, T, Petrie, M, et al. Postdischarge decontamination of MRSA, VRE, and Clostridium difficile isolation rooms using 2 commercially available automated ultraviolet-C-emitting devices. Am J Infect Control 2016;44:416–420.Google Scholar
8. Rakoczy, T, Hendrickson, C, Kline, S, Streifel, A, Guspiel, A, Gross, A. Investigation of vancomycin resistant Enterococcus and extended spectrum beta-lactamase infections in end stage liver disease after endoscopic retrograde cholangiopancreatography. Am J Infect Control 2014;42:S154.Google Scholar
9. Olivier, CN, Blake, RK, Steed, LL, Salgado, CD. Risk of vancomycin-resistant Enterococcus (VRE) bloodstream infection among patients colonized with VRE. Infect Control Hosp Epidemiol 2008;29:404–409.Google Scholar
10. Britt, NS, Potter, EM, Patel, N, Steed, ME. Comparison of the effectiveness and safety of linezolid and daptomycin in vancomycin-resistant enterococcal bloodstream infection: a national cohort study of Veterans Affairs patients. Clin Infect Dis 2015;61:871–878.Google Scholar
11. McKinnell, JA, Arias, CA. Editorial commentary. Linezolid vs daptomycin for vancomycin-resistant enterococci: the evidence gap between trials and clinical experience. Clin Infect Dis 2015;61:879–882.Google Scholar
12. D’Agata, EM, Gautam, S, Green, WK, Tang, YW. High rate of false-negative results of the rectal swab culture method in detection of gastrointestinal colonization with vancomycin-resistant enterococci. Clin Infect Dis 2002;34:167–172.Google Scholar
13. McKinnell, JA, Kunz, DF, Moser, SA, et al. Patient-level analysis of incident vancomycin-resistant enterococci colonization and antibiotic days of therapy. Epidemiol Infect 2016;144:1748–1755.Google Scholar
14. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing, M100S. 26th ed. Wayne, PA: CLSI; 2016.Google Scholar
15. Russell, DL, Flood, A, Zaroda, TE, et al. Outcomes of colonization with MRSA and VRE among liver transplant candidates and recipients. Am J Transplant 2008;8:1737–1743.Google Scholar
16. Huang, HP, Chen, B, Wang, HY, He, M. The efficacy of daily chlorhexidine bathing for preventing healthcare-associated infections in adult intensive care units. Korean J Intern Med 2016;31:1159–1170.Google Scholar
17. Lautenbach, E, Harris, AD, Perencevich, EN, et al. Test characteristics of perirectal and rectal swab compared to stool sample for detection of fluoroquinolone-resistant Escherichia coli in the gastrointestinal tract. Antimicrob Agents Chemother 2005;49:798–800.Google Scholar
18. Kotton, CN, Lankowski, AJ, Hohmann, EL. Comparison of rectal swabs with fecal cultures for detection of Salmonella typhimurium in adult volunteers. Diagn Microbiol Infect Dis 2006;56:123–126.Google Scholar
19. Jenkins, SG, Raskoshina, L, Schuetz, AN. Comparison of performance of the novel chromogenic spectra VRE agar to that of bile esculin azide and Campylobacter agars for detection of vancomycin-resistant enterococci in fecal samples. J Clin Microbiol 2011;49:3947–3949.Google Scholar
20. Kuch, A, Stefaniuk, E, Ozorowski, T, Hryniewicz, W. New selective and differential chromogenic agar medium, chromID VRE, for screening vancomycin-resistant Enterococcus species. J Microbiol Methods 2009;77:124–126.Google Scholar
21. Stamper, PD, Shulder, S, Bekalo, P, et al. Evaluation of BBL CHROMagar VanRE for detection of vancomycin-resistant Enterococci in rectal swab specimens. J Clin Microbiol 2010;48:4294–4297.Google Scholar
22. Taur, Y, Xavier, JB, Lipuma, L, et al. Intestinal domination and the risk of bacteremia in patients undergoing allogeneic hematopoietic stem cell transplantation. Clin Infect Dis 2012;55:905–914.Google Scholar
23. Donskey, CJ, Deshpande, A. Effect of chlorhexidine bathing in preventing infections and reducing skin burden and environmental contamination: a review of the literature. Am J Infect Control 2016;44:e17–e21.Google Scholar