Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2025-01-03T20:23:33.909Z Has data issue: false hasContentIssue false
  • English
  • Français

Discontinuation of Systematic Surveillance and Contact Precautions for Vancomycin-Resistant Enterococcus (VRE) and Its Impact on the Incidence of VRE faecium Bacteremia in Patients with Hematologic Malignancies

Published online by Cambridge University Press:  11 January 2016

Nikolaos G. Almyroudis ,
Ryosuke Osawa ,
George Samonis ,
M. Wetzler ,
Eunice S. Wang ,
Philip L. McCarthy Jr.  and
Brahm H. Segal
Nikolaos G. Almyroudis*
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, United States Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, United States
Ryosuke Osawa
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, United States Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, United States
George Samonis
Affiliation:
Medical School of the University of Crete, Heraklion, Greece
M. Wetzler
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, United States Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, United States
Eunice S. Wang
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, United States Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, United States
Philip L. McCarthy Jr.
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, United States Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, United States
Brahm H. Segal
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, United States Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, United States Department of Immunology, Roswell Park Cancer Institute, Buffalo, New York, United States.
*
Address correspondence to Nikolaos G. Almyroudis, MD, FACP, Associate Professor of Medicine, State University of New York at Buffalo, Division of Infectious Diseases, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To study the effect of discontinuation of systematic surveillance for vancomycin-resistant Enterococcus (VRE) and contact isolation of colonized patients on the incidence of VRE bacteremia

SETTING

A hematology-oncology unit with high prevalence of VRE colonization characterized by predominantly sporadic molecular epidemiology

PARTICIPANTS

Inpatients with hematologic malignancies and recipients of hematopoietic stem cell transplantation

METHODS

The incidence of VRE bacteremia was measured prospectively during 2 different 3-year time periods; the first during active VRE surveillance and contact precautions and the second after discontinuation of these policies. We assessed the collateral impact of this policy change on the incidence of bacteremia due to methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infection even though we maintained contact precautions for these organisms. Incidence of infectious events was measured as number of events per 1,000 patients days per month. Time series analysis was used to evaluate trends.

RESULTS

The incidence of VRE bacteremia remained stable after discontinuation of VRE surveillance and contact precautions. The incidence of MRSA bacteremia and Clostridium difficile infection for which we continued contact precautions also remained stable. Aggregated antibiotic utilization and nursing hours per patient days were similar between the 2 study periods.

CONCLUSION

Active surveillance and contact precautions for VRE colonization did not appear to prevent VRE bacteremia in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation with high prevalence of VRE characterized by predominantly sporadic molecular epidemiology.

Infect. Control Hosp. Epidemiol. 2016;37(4):398–403

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 4 , April 2016 , pp. 398 - 403
Copyright
© 2016 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

a

Deceased.

PREVIOUS PRESENTATION. This work was presented in the poster walk at the Interscience Conference of Antimicrobial Agents and Chemotherapy/International Congress of Chemotherapy (ICAAC/ICC) in San Diego, California, September 17–21, 2015 (poster # K-1249).

References

REFERENCES

1. Matar, MJ, Tarrand, J, Raad, I, et al. Colonization and infection with vancomycin-resistant Enterococcus among patients with cancer. Am J Infect Control 2006;34:534–536.CrossRefGoogle ScholarPubMed
2. DiazGranados, CA, Jernigan, JA. Impact of vancomycin resistance on mortality among patients with neutropenia and enterococcal bloodstream infection. J Infect Dis 2005;191:588–595.Google Scholar
3. Vydra, J, Shanley, RM, George, I, et al. Enterococcal bacteremia is associated with increased risk of mortality in recipients of allogeneic hematopoietic stem cell transplantation. Clin Infect Dis 2012;55:764–770.CrossRefGoogle ScholarPubMed
4. Almyroudis, NG, Lesse, AJ, Hahn, T, et al. Molecular epidemiology and risk factors for colonization by vancomycin-resistant Enterococcus in patients with hematologic malignancies. Infect Control Hosp Epidemiol 2011;32:490–496.CrossRefGoogle ScholarPubMed
5. Facklam, RR, Collins, MD. Identification of Enterococcus species isolated from human infections by a conventional test scheme. J Clin Microbiol 1989;27:731–734.Google Scholar
6. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing: 13th informational Supplement. MIC Testing Supplemental Tables. NCCLS Document M100-S13 (M7). Wayne, PA: NCCLS, 2003.Google Scholar
7. Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386.CrossRefGoogle ScholarPubMed
8. Bucaneve, G, Micozzi, A, Menichetti, F, et al. Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. N Engl J Med 2005;353:977–987.CrossRefGoogle ScholarPubMed
9. Climo, MW, Yokoe, DS, Warren, DK, et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013;368:533–542.Google Scholar
10. Raboud, J, Saskin, R, Simor, A, et al. Modeling transmission of methicillin-resistant Staphylococcus aureus among patients admitted to a hospital. Infect Control Hosp Epidemiol 2005;26:607–615.CrossRefGoogle ScholarPubMed
11. Leclercq, R, Derlot, E, Duval, J, et al. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium . N Engl J Med 1988;319:157–161.CrossRefGoogle ScholarPubMed
12. Uttley, AH, Collins, CH, Naidoo, J, et al. Vancomycin-resistant enterococci. Lancet 1988;1:57–58.Google Scholar
13. National Communicable Disease Center. Isolation Techniques for Use in Hospitals, 1st ed. Washington, DC: US Government Printing Office, 1970, PHS publication no. 2054.Google Scholar
14. Byers, KE, Anglim, AM, Anneski, CJ, et al. A hospital epidemic of vancomycin-resistant Enterococcus: risk factors and control. Infect Control Hosp Epidemiol 2001;22:140–147.CrossRefGoogle ScholarPubMed
15. Jain, R, Kralovic, SM, Evans, ME, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:1419–1430.CrossRefGoogle ScholarPubMed
16. Puzniak, LA, Leet, T, Mayfield, J, et al. To gown or not to gown: the effect on acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2002;35:18–25.Google Scholar
17. Hachem, R, Graviss, L, Hanna, H, et al. Impact of surveillance for vancomycin-resistant enterococci on controlling a bloodstream outbreak among patients with hematologic malignancy. Infect Control Hosp Epidemiol 2004;25:391–394.Google Scholar
18. Gurieva, T, Bootsma, MC, Bonten, MJ. Successful Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections revisited. Clin Infect Dis 2012;54:1618–1620.Google Scholar
19. De Angelis, G, Cataldo, MA, De Waure, C, et al. Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients: a systematic review and meta-analysis. J Antimicrob Chemother 2014;69:1185–1192.CrossRefGoogle ScholarPubMed
20. Bearman, G, Stevens, MP. Control of drug-resistant pathogens in endemic settings: contact precautions, controversies, and a proposal for a less restrictive alternative. Curr Infect Dis Rep 2012;14:620–626.CrossRefGoogle Scholar
21. Almyroudis, NG, Segal, BH. Transmission of resistant bacteria in intensive care. N Engl J Med 2011;365:762–763; author reply 764–765.Google Scholar
22. Huskins, WC, Huckabee, CM, O’Grady, NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;364:1407–1418.CrossRefGoogle ScholarPubMed
23. Harris, AD, Pineles, L, Belton, B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:1571–1580.Google ScholarPubMed
24. Karki, S, Leder, K, Cheng, AC. Patients under contact precautions have an increased risk of injuries and medication errors: a retrospective cohort study. Infect Control Hosp Epidemiol 2013;34:1118–1120.CrossRefGoogle ScholarPubMed
25. Morgan, DJ, Pineles, L, Shardell, M, et al. The effect of contact precautions on healthcare worker activity in acute care hospitals. Infect Control Hosp Epidemiol 2013;34:69–73.CrossRefGoogle ScholarPubMed
26. Masse, V, Valiquette, L, Boukhoudmi, S, et al. Impact of methicillin-resistant Staphylococcus aureus contact isolation units on medical care. PLoS One 2013;8:e57057.Google Scholar
27. Gandra, S, Barysauskas, CM, Mack, DA, et al. Impact of contact precautions on falls, pressure ulcers and transmission of MRSA and VRE in hospitalized patients. J Hosp Infect 2014;88:170–176.Google Scholar
28. Day, HR, Morgan, DJ, Himelhoch, S, et al. Association between depression and contact precautions in veterans at hospital admission. Am J Infect Control 2011;39:163–165.Google Scholar
29. Day, HR, Perencevich, EN, Harris, AD, et al. Depression, anxiety, and moods of hospitalized patients under contact precautions. Infect Control Hosp Epidemiol 2013;34:251–258.CrossRefGoogle ScholarPubMed
30. Lai, KK, Kelley, AL, Melvin, ZS, et al. Failure to eradicate vancomycin-resistant enterococci in a university hospital and the cost of barrier precautions. Infect Control Hosp Epidemiol 1998;19:647–652.Google Scholar
31. Armstrong-Evans, M, Litt, M, McArthur, MA, et al. Control of transmission of vancomycin-resistant Enterococcus faecium in a long-term-care facility. Infect Control Hosp Epidemiol 1999;20:312–317.CrossRefGoogle ScholarPubMed
32. Donskey, CJ, Helfand, MS, Pultz, NJ, et al. Effect of parenteral fluoroquinolone administration on persistence of vancomycin-resistant Enterococcus faecium in the mouse gastrointestinal tract. Antimicrob Agents Chemother 2004;48:326–328.Google Scholar