Surveillance for vancomycin-resistant enterococci: type, rates, costs, and implications.

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Healthcare Epidemiology

Background:

• Vancomycin-resistant enterococci (VRE) pose a significant threat in intensive care units (ICUs).
• Effective surveillance is crucial for controlling VRE transmission and preventing outbreaks.
• Existing surveillance methods have varying levels of sensitivity and cost-effectiveness.

Purpose of the Study:

• To compare the effectiveness of two active surveillance strategies for detecting enteric VRE colonization in an ICU setting.
• To evaluate the cost-effectiveness of clinical active surveillance (CAS) versus laboratory-based active surveillance (LAS).

Main Methods:

• A 30-month prospective observational study was conducted in a university-affiliated ICU.
• Clinical active surveillance (CAS) involved rectal swab cultures on admission, weekly, and at discharge.
• Laboratory-based active surveillance (LAS) utilized stool samples submitted for Clostridium difficile toxin testing.

Main Results:

• VRE colonization was detected in 17% of 1,872 patients.
• CAS identified 91% of VRE-colonized patients, while LAS identified only 8%.
• CAS was estimated to prevent significant costs associated with VRE colonization and bacteremia, ranging from $56,258 to $303,334 per month.

Conclusions:

• Patient-based CAS is a superior strategy for detecting enteric VRE colonization compared to LAS.
• CAS is an efficient and cost-effective surveillance method in high-risk ICU settings.
• The implementation costs of CAS are offset by substantial savings from preventing VRE-related complications.