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Cost-Effectiveness of Perirectal Surveillance Cultures for Controlling Vancomycin-Resistant Enterococcus

  • Carlene A. Muto (a1), Eve T. Giannetta (a1), Lisa J. Durbin (a1), Barbara M. Simonton (a1) and Barry M. Farr (a1)...

Several hospitals opting not to use active surveillance cultures to identify carriers of vancomycin-resistant Enterococcus (VRE) have reported that adoption of other parts of the Centers for Disease Control and Prevention guideline for controlling VRE has had little to no impact. Because use of surveillance cultures and contact isolation controlled a large outbreak at this hospital, their costs were estimated for comparison with the excess costs of VRE bacteremias occurring at a higher rate at a hospital not employing these measures.


Two university hospitals.


Inpatients deemed high risk for VRE acquisition at this hospital underwent weekly perirectal surveillance cultures. Estimated costs of cultures and resulting isolation during a 2-year period were compared with the estimated excess costs of more frequent VRE bacteremias at another hospital of similar size and complexity not using surveillance cultures to control spread throughout the hospital.


Of 54,052 patients admitted, 10,400 had perirectal swabs taken. Cultures and isolation cost an estimated $253,099. VRE culture positivity was limited to 193 (0.38%) and VRE bacteremia to 1 (0.002%) as compared with 29 bacteremias at the comparison hospital. The estimated attributable cost of VRE bacteremia at the comparison hospital of $761,320 exceeded the cost of the control program at this hospital by threefold.


The excess costs of VRE bacteremia may justify the costs of preventive measures. The costs of VRE infections at other body sites, of deaths from untreatable infections, and of dissemination of genes for vancomycin resistance also help to justify the costs of implementing an effective control program.

Corresponding author
Box 473, University of Virginia Health System, Charlottesville, VA 22908
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1. JS Garner . Guideline for isolation precautions in hospitals: the Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:5380.

3. S Slaughter , MK Hayden , C Nathan , et al. A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med 1996;125:448456.

4. J Quale , D Landman , E Atwood , et al. Experience with a hospital outbreak of vancomycin-resistant enterococci. Am J Infect Control 1996;24:372379.

5. JG Morris , DK Shay , JN Hebden , et al. Enterococci resistant to multiple antimicrobial agents, including vancomycin: establishment of endemicity in a university medical center. Ann Intern Med 1995;123:250259.

9. JS Garner , WR Jarvis , TG Emori , TC Horan , JM Hughes . CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16:128140.

10. JA Jernigan , MA Clemence , GA Stott , et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16:686696.

11. V Stosor , LR Peterson , M Postelnick , GA Noskin . Enterococcus faecium bacteremia: does vancomycin resistance make a difference? Arch Intern Med 1998;158:522527.

15. DK Shay , SA Maloney , M Montecalvo , et al. Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. J Infect Dis 1995;172:9931000.

18. PK Linden , AW Pasculle , R Manez , et al. Differences in outcomes for patients with bacteremia due to vancomycin-resistant Enterococcus faecium or vancomycin-susceptible E. faecium. Clin Infect Dis 1996;22:663670.

20. L Stroud , J Edwards , L Danzing , D Culver , R Gaynes . Risk factors for mortality associated with enterococcal bloodstream infections. Infect Control Hosp Epidemiol 1996;17:576580.

21. KA Newell , JM Millis , PM Arnow , et al. Incidence and outcome of infection by vancomycin-resistant enterococcus following orthotopic liver transplantation. Transplantation 1998;65:439442.

22. GM Lucas , N Lechtzin , DW Puryear , LL Yau , CW Flexner , RD Moore . Vancomycin-resistant and vancomycin-susceptible enterococcal bacteremia: comparison of clinical features and outcomes. Clin Infect Dis 1998;26:11271133.

23. SM Bhavnani , JA Drake , A Forrest et al. A nationwide, multicenter, case-control study comparing risk factors, treatment and outcome for vancomycin-resistant and -susceptible enterococcal bacteremia. Diagn Microbiol Infect Dis 2000;36:145158.

24. K Grumbach , D Osmond , K Vranizan , D Jaffe , AB Bindmand . Primary care physicians' experience of financial incentives in managed-care systems. N Engl J Med 1998;339:15161521.

25. SR Simon , RJ Pan , AM Sullivan , et al. Views of managed care: a survey of students, residents, faculty, and deans at schools of medical schools in the United States. N Engl J Med 1999;340:928936.

26. T Bodenheimer . The Oregon Health Plan: lessons for the nation. N Engl J Med 1997;337:651655.

27. PJ Cunningham , JM Grossman , RF St.Peter , CS Lesser . Managed care and physicians' provision of charity care. JAMA 1999;281:10871092.

28. LC Baker . Association of managed care market share and health expenditures for fee-for-service Medicare patients. JAMA 1999;281:432437.

29. AB Bindman , K Grumbach , K Vranzian , D Jaffe , D Osmond . Selection and exclusion of primary care physicians by managed care organizations. JAMA 1998;279:675679.

32. D Pittet , D Tarara , RP Wenzel . Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:15981601.

33. RW Haley , DR Schaberg , KB Crossley , SD Von Allmen , JE McGowan Jr. Extra charges and prolongation of stay attributable to nosocomial infections: a prospective inter-hospital comparison. Am J Med 1981;70:5158.

35. DM Hacek , T Suriano , GA Noskin , J Kruszynski , B Reisberg , LR Peterson . Medical and economic benefit of a comprehensive infection control program that includes routine determination of microbial clonality. Am J Clin Pathol 1999;111:647654.

36. JM Boyce , LA Mermel , MJ Zervos , et al. Controlling vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 1995;16:634637.

41. LV Karanfil , M Murphy , A Josephson , et al. A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit. Infect Control Hosp Epidemiol 1992;13:195200.

42. RK Malik , MA Montecalvo , MR Reale , et al. Epidemiology and control of vancomycin-resistant enterococci in a regional neonatal intensive care unit. Pediatr Infect Dis J 1999;18:352356.

45. BE Ostrowsky , WE Trick , AH Sohn , et al. Control of vancomycin-resistant enterococcus in healthcare facilities in a region. N Engl J Med 2001;344:14271433.

46. AH Siddiqui , AD Harris , J Hebden , PD Wilson , JG Morris , M Roghmann . The effect of active surveillance for vancomycin-resistant enterococci in high-risk units on vancomycin-resistant enterococci incidence hospital-wide. Am J Infect Control 2002;30:4043.

50. ME Rafferty , MI McCormick , LH Bopp , et al. Vancomycin-resistant enterococci in stool specimens submitted for Clostridium difficile cytotoxin assay. Infect Control Hosp Epidemiol 1997;18:342344.

52. DM Hacek , P Bednarz , GA Noskin , T Zembower , LR Peterson . Yield of vancomycin-resistant enterococci and multidrug-resistant Entero-bacteriaceae from stools submitted for Clostridium difficile testing compared to results from a focused surveillance program. J Clin Microbiol 2001;39:11521154.

53. SJ Bradley , AL Wilson , MC Allen , HA Sher , AH Goldstone , GM Scott . The control of hyperendemic glycopeptide-resistant Enterococcus spp. on a haematology unit by changing antibiotic usage. J Antimicrob Chemother 1999;43:261266.

54. J Quale , D Landman , G Saurina , E Atwood , V DoTore , K Patel . Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clin Infect Dis 1996;23:10201025.

56. CJ Donskey , TK Chowdhry , MT Hecker , et al. Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med 2000;343:19351932.

57. EN Jones , SA Marshall , MA Pfaller , et al. Nosocomial enterococcal bloodstream infections in the SCOPE Program: antimicrobial resistance, species occurrence, molecular testing results, and laboratory testing accuracy. SCOPE Hospital Study Group. Diagn Microbiol Infect Dis 1997;29:95102.

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Infection Control & Hospital Epidemiology
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