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The impact of vancomycin-resistant Enterococcus (VRE) screening policy change on the incidence of healthcare-associated VRE bacteremia

Published online by Cambridge University Press:  17 May 2021

Sun Young Cho ,
Hye Mee Kim ,
Doo Ryeon Chung ,
Jong Rim Choi ,
Myeong-A Lee ,
Hee Jae Huh ,
Nam Yong Lee ,
Kyungmin Huh ,
Cheol-In Kang  and
Kyong Ran Peck
Sun Young Cho
Affiliation:
Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Hye Mee Kim
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Republic of Korea
Doo Ryeon Chung*
Affiliation:
Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Jong Rim Choi
Affiliation:
Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea
Myeong-A Lee
Affiliation:
Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea
Hee Jae Huh
Affiliation:
Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Nam Yong Lee
Affiliation:
Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Kyungmin Huh
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Cheol-In Kang
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Kyong Ran Peck
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
*
Author for correspondence: Doo Ryeon Chung, E-mail: [email protected]
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Abstract

Objective:

To evaluate the impact of a vancomycin-resistant Enterococcus (VRE) screening policy change on the incidence of healthcare-associated (HA)-VRE bacteremia in an endemic hospital setting.

Design:

A quasi-experimental before-and-after study.

Setting:

A 1,989-bed tertiary-care referral center in Seoul, Republic of Korea.

Methods:

Since May 2010, our hospital has diminished VRE screening for admitted patients transferred from other healthcare facilities. We assessed the impact of this policy change on the incidence of HA-VRE bacteremia using segmented autoregression analysis of interrupted time series from January 2006 to December 2014 at the hospital and unit levels. In addition, we compared the molecular characteristics of VRE blood isolates collected before and after the screening policy change using multilocus sequence typing and pulsed-field gel electrophoresis.

Results:

After the VRE screening policy change, the incidence of hospital-wide HA-VRE bacteremia increased, although no significant changes of level or slope were observed. In addition, a significant slope change in the incidence of HA-VRE bacteremia (change in slope, 0.007; 95% CI, 0.001–0.013; P = .02) was observed in the hemato-oncology department. Molecular analysis revealed that various VRE sequence types appeared after the policy change and that clonally related strains became more predominant (increasing from 26.1% to 59.3%).

Conclusions:

The incidence of HA-VRE bacteremia increased significantly after VRE screening policy change, and this increase was mainly driven by high-risk patient populations. When planning VRE control programs in hospitals, different approaches that consider risk for severe VRE infection in patients may be required.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 5 , May 2022 , pp. 603 - 608
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

a

Authors of equal contribution.

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