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Outbreaks of Vancomycin-Resistant Enterococci in Hospital Settings: A Systematic Review and Calculation of the Basic Reproductive Number

Published online by Cambridge University Press:  16 December 2015

Laetitia Satilmis ,
Philippe Vanhems  and
Thomas Bénet
Laetitia Satilmis
Affiliation:
Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
Philippe Vanhems*
Affiliation:
Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France International Center for Infectiology Research, Lyon 1 University, Lyon, France
Thomas Bénet
Affiliation:
Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France International Center for Infectiology Research, Lyon 1 University, Lyon, France
*
Address correspondence to Philippe Vanhems, MD, PhD, Service d’Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d’Arsonval, 69437 Lyon CEDEX 03, France ([email protected]).
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Abstract

BACKGROUND

Vancomycin-resistant enterococci (VRE) have spread worldwide.

OBJECTIVE

To systematically review VRE outbreaks and estimate the pooled basic reproductive rate (R0) of VRE.

METHODS

Eligible studies criteria were (1) published within 10 years, (2) report outbreak details, (3) involve 1 center, (4) estimate epidemic duration, and (5) concern adults. Descriptive analysis included number of index cases, secondary cases, and screened patients; infection control measures; and definition of contact patients. R0 was estimated by the equation R0=(ln2) D/td+1, with D as the generation time and td as the doubling time.

RESULTS

Thirteen VRE outbreaks were retained from 180 articles and, among them, 10 were kept for R0 calculation. The mean (range) number of index cases was 2.3 (1–8) and the mean (range) number of secondary cases was 15 (3–56). The mean (range) number of screened patients was 174 (32–509), with pooled VRE prevalence of 5.4% (95% CI, 4.5%–6.3%). Contact precautions were reported in 12 studies (92%), wards were closed in 7 (54%), with cohorting in 6 (46%). Two major screening policies were implemented: (1) a surveillance program in the unit or hospital (7 studies [54%]) and (2) screening of selected contact patients (6 studies [46%]). The pooled R0 of VRE was 1.32 (interquartile range, 1.03–1.46).

CONCLUSION

We discerned considerable heterogeneity in screening policies during VRE outbreaks. Pooled R0 was higher than 1, confirming the epidemic nature of VRE.

Infect. Control Hosp. Epidemiol. 2016;37(3):289–394

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 3 , March 2016 , pp. 289 - 294
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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