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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.

References

Werner, G, Coque, TM, Hammerum, AM, et al. Emergence and spread of vancomycin resistance among enterococci in Europe. Euro Surveill 2008;13:19046.CrossRefGoogle ScholarPubMed
Arias, CA, Murray, BE. The rise of the Enterococcus: beyond vancomycin resistance. Nat Rev Microbiol 2012;10:266–278.CrossRefGoogle ScholarPubMed
Weiner, LM, Webb, AK, Limbago, B, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014. Infect Control Hosp Epidemiol 2016;37:1288–1301.CrossRefGoogle Scholar
DiazGranados, CA, Zimmer, SM, Klein, M, Jernigan, JA. Comparison of mortality associated with vancomycin-resistant and vancomycin-susceptible enterococcal bloodstream infections: a meta-analysis. Clin Infect Dis 2005;41:327–333.CrossRefGoogle ScholarPubMed
Song, X, Srinivasan, A, Plaut, D, Perl, TM. Effect of nosocomial vancomycin-resistant enterococcal bacteremia on mortality, length of stay, and costs. Infect Control Hosp Epidemiol 2003;24:251–256.CrossRefGoogle ScholarPubMed
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
Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:S65–S164.CrossRefGoogle ScholarPubMed
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;310:1571–80.Google ScholarPubMed
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
Morgan, DJ, Kaye, KS, Diekema, DJ. Reconsidering isolation precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. JAMA 2014;312:1395–1396.CrossRefGoogle ScholarPubMed
Lemieux, C, Gardam, M, Evans, G, et al. Longitudinal multicenter analysis of outcomes after cessation of control measures for vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 2017;38:24–30.CrossRefGoogle ScholarPubMed
Popiel, KY, Miller, MA. Evaluation of vancomycin-resistant enterococci (VRE)-associated morbidity following relaxation of VRE screening and isolation precautions in a tertiary care hospital. Infect Control Hosp Epidemiol 2014;35:818–825.CrossRefGoogle ScholarPubMed
Almyroudis, NG, Osawa, R, Samonis, G, et al. 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. Infect Control Hosp Epidemiol 2016;37:398–403.CrossRefGoogle ScholarPubMed
Martin, EM, Russell, D, Rubin, Z, et al. Elimination of routine contact precautions for endemic methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococcus: a retrospective quasi-experimental study. Infect Control Hosp Epidemiol 2016;37:1323–1330.CrossRefGoogle ScholarPubMed
Johnstone, J, Policarpio, ME, Lam, F, et al. Rates of blood cultures positive for vancomycin-resistant Enterococcus in Ontario: a quasi-experimental study. CMAJ Open 2017;5:E273–E280.CrossRefGoogle Scholar
Johnstone, J, Shing, E, Saedi, A, et al. Discontinuing contact precautions for vancomycin-resistant Enterococcus (VRE) is associated with rising VRE bloodstream infection rates in Ontario hospitals, 2009–2018: a quasi-experimental study. Clin Infect Dis 2020;71:1756–1759.CrossRefGoogle ScholarPubMed
Zaas, AK, Song, X, Tucker, P, Perl, TM. Risk factors for development of vancomycin resistant enterococcal bloodstream infection in patients with cancer who are colonized with vancomycin-resistant enterococci. Clin Infect Dis 2002;35:1139–1146.CrossRefGoogle ScholarPubMed
Alevizakos, M, Gaitanidis, A, Nasioudis, D, Tori, K, Flokas, ME, Mylonakis, E. Colonization with vancomycin-resistant enterococci and risk for bloodstream infection among patients with malignancy: a systematic review and meta-analysis. Open Forum Infect Dis 2016;4(1):ofw246.CrossRefGoogle ScholarPubMed
Chen, PY, Chuang, YC, Wang, JT, Sheng, WH, Chen, YC, Chang, SC. Predictors for vancomycin-resistant Enterococcus faecium transforming from colonization to infection: a case control study. Antimicrob Resist Infect Control 2019;8:196.CrossRefGoogle ScholarPubMed