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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

  • Nikolaos G. Almyroudis (a1) (a2), Ryosuke Osawa (a1) (a2), George Samonis (a3), M. Wetzler (a1) (a2), Eunice S. Wang (a1) (a2), Philip L. McCarthy (a1) (a2) and Brahm H. Segal (a1) (a2) (a4)...

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


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


Inpatients with hematologic malignancies and recipients of hematopoietic stem cell transplantation


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.


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.


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

Corresponding author
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 (
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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).

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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;34:534536.
2. DiazGranados CA, Jernigan JA. Impact of vancomycin resistance on mortality among patients with neutropenia and enterococcal bloodstream infection. J Infect Dis 2005;191:588595.
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;55:764770.
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;32:490496.
5. Facklam RR, Collins MD. Identification of Enterococcus species isolated from human infections by a conventional test scheme. J Clin Microbiol 1989;27:731734.
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.
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;24:362386.
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;353:977987.
9. Climo MW, Yokoe DS, Warren DK, et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013;368:533542.
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;26:607615.
11. Leclercq R, Derlot E, Duval J, et al. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium . N Engl J Med 1988;319:157161.
12. Uttley AH, Collins CH, Naidoo J, et al. Vancomycin-resistant enterococci. Lancet 1988;1:5758.
13. National Communicable Disease Center. Isolation Techniques for Use in Hospitals, 1st ed. Washington, DC: US Government Printing Office, 1970, PHS publication no. 2054.
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;22:140147.
15. Jain R, Kralovic SM, Evans ME, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:14191430.
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;35:1825.
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;25:391394.
18. Gurieva T, Bootsma MC, Bonten MJ. Successful Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections revisited. Clin Infect Dis 2012;54:16181620.
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;69:11851192.
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;14:620626.
21. Almyroudis NG, Segal BH. Transmission of resistant bacteria in intensive care. N Engl J Med 2011;365:762763; author reply 764–765.
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;364:14071418.
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;310:15711580.
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;34:11181120.
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;34:6973.
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.
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;88:170176.
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;39:163165.
29. Day HR, Perencevich EN, Harris AD, et al. Depression, anxiety, and moods of hospitalized patients under contact precautions. Infect Control Hosp Epidemiol 2013;34:251258.
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;19:647652.
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;20:312317.
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;48:326328.
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