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Using VRE screening tests to predict vancomycin resistance in enterococcal bacteremia.

Guillaume Butler-Laporte1,2, Matthew P Cheng1,2,3, Emily G McDonald3,4,5

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Summary

Negative vancomycin-resistant Enterococcus (VRE) screening within 30 days effectively predicts the absence of VRE bloodstream infections (BSIs). Positive VRE screening warrants careful consideration for empiric VRE-directed therapy in suspected enterococcal BSIs.

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Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Hospital Epidemiology

Background:

  • Enterococcus species are a significant cause of bloodstream infections (BSIs).
  • High prevalence of vancomycin-resistant Enterococcus (VRE) colonization complicates empiric treatment decisions for enterococcal BSIs.
  • Limited VRE treatment options and associated costs necessitate predictive strategies.

Purpose of the Study:

  • To evaluate if VRE colonization screening can predict vancomycin resistance in enterococcal BSIs.
  • To assess the utility of VRE screening status in guiding empiric VRE-directed therapy for enterococcal BSIs.

Main Methods:

  • Retrospective review of 370 enterococcal BSI cases over 7 years at two tertiary-care hospitals.
  • Analysis of VRE colonization status (swabs within 30 days, remotely, or never tested).
  • Calculation of sensitivity, specificity, negative predictive values (NPVs), and positive predictive values (PPVs) as a function of prevalence.

Main Results:

  • A negative VRE screening swab within 30 days yielded NPVs of 90% and 95% when VRE resistance in enterococcal BSIs was <27.0% and <15.0%, respectively.
  • In patients with known VRE colonization, the PPV for VRE in enterococcal BSI exceeded 50% at prevalences above 25%.

Conclusions:

  • Negative VRE screening results within 30 days can safely de-escalate empiric therapy for suspected enterococcal BSIs.
  • Positive VRE screening results necessitate careful consideration of empiric VRE-directed therapy when enterococcal BSI is suspected.