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Utility of a focused vancomycin-resistant enterococci screening protocol to identify colonization in hospitalized
Gina Weddle1, Mary Anne Jackson, Rangaraj Selvarangan
1Children's Mercy Hospitals and Clinics, Kansas City, MO 64108, USA. gweddle@cmh.edu
Insights
Screening for vancomycin-resistant enterococci (VRE) in children rarely yields positive results after the initial test. A single rectal screening is often sufficient for VRE detection, especially in healthy pediatric patients.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Pediatric Healthcare
Background:
- Vancomycin-resistant enterococci (VRE) screening is a debated practice in healthcare settings.
- Policies for VRE screening implementation lack universal agreement.
- Understanding the yield of multiple screenings is crucial for optimizing VRE surveillance.
Purpose of the Study:
- To determine the likelihood of detecting vancomycin-resistant enterococci (VRE) colonization with one, two, or three rectal screenings.
- To evaluate the diagnostic yield of serial VRE screening in a pediatric population.
- To assess the cost-effectiveness of VRE screening protocols.
Main Methods:
- Descriptive study analyzing positive VRE screening cultures.
- Retrospective review of 1211 VRE screening cultures from pediatric patients.
- Calculation of the probability of positive VRE screens after initial negative results.
Main Results:
- Out of 1211 VRE screens, 41 were positive (3.4%).
- The majority of positive VRE results (36/41) were identified on the first screening.
- The likelihood of a subsequent positive VRE screen after an initial negative screen was low (0.43%).
- Patients with positive VRE screens frequently had chronic illnesses (39/41), prematurity, or NICU history.
Conclusions:
- A single rectal screening for VRE colonization appears to have a high yield in pediatric patients.
- The probability of detecting VRE after an initial negative screen is minimal, suggesting limited benefit from multiple screenings.
- VRE screening protocols may need re-evaluation, particularly for otherwise healthy children, to improve efficiency and reduce costs.
Abstract:
Screening for vancomycin-resistant enterococci (VRE) is controversial, and disagreement exists on policy implementation. This study investigated the likelihood of a positive test using 1, 2, or 3 rectal screenings for VRE colonization. In this descriptive study of positive VRE screening cultures, a total of 1211 VRE screens identified 41 positive results. The mean age of these positive patients was 5.7 years. Thirty-nine of the 41 had a chronic illness, and only 2 were healthy. Diagnoses included pulmonary disease in 11 patients and chronic gastrointestinal abnormality in 7. Six patients had been born preterm, and 12 had been treated in a neonatal intensive care unit within the previous 6 months. Thirty-six of the 41 positive results were identified on the first screen. The likelihood of subsequently having a positive screen after a negative screen was 0.43% (95% confidence interval, 0.15%-1.02%). The cost of cultures plus isolation was $50,000 for the study period. Our data show that the likelihood of detecting a positive VRE culture after an initial negative was low, particularly in otherwise healthy children.
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