【JID】Improving the Assessment of Vancomycin-Resistant Enterococci by Routine S

蓝鱼o_0

Improving the Assessment of Vancomycin-Resistant Enterococci by Routine Screening

The Journal of Infectious Diseases 2007; 195:339–46

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 patientcare
units. Correct denominators prevent the substantial underestimation of incidence.