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

Published online by Cambridge University Press:  02 January 2015

Carlene A. Muto ,
Eve T. Giannetta ,
Lisa J. Durbin ,
Barbara M. Simonton  and
Barry M. Farr
Carlene A. Muto
Affiliation:
University of Virginia Health System, Charlottesville, Viriginia
Eve T. Giannetta
Affiliation:
University of Virginia Health System, Charlottesville, Viriginia
Lisa J. Durbin
Affiliation:
University of Virginia Health System, Charlottesville, Viriginia
Barbara M. Simonton
Affiliation:
University of Virginia Health System, Charlottesville, Viriginia
Barry M. Farr*
Affiliation:
University of Virginia Health System, Charlottesville, Viriginia
*
Box 473, University of Virginia Health System, Charlottesville, VA 22908
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Abstract

Background:

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.

Setting:

Two university hospitals.

Methods:

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.

Results:

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.

Conclusions:

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 8 , August 2002 , pp. 429 - 435
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

1.Garner, JS. Guideline for isolation precautions in hospitals: the Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:53–80.CrossRefGoogle ScholarPubMed
2.Anonymous. Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1995;44(RR-12):1–13.Google Scholar
3.Slaughter, S, Hayden, MK, Nathan, C, 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;125:448–456.CrossRefGoogle Scholar
4.Quale, J, Landman, D, Atwood, E, et al. Experience with a hospital outbreak of vancomycin-resistant enterococci. Am J Infect Control 1996;24:372–379.CrossRefGoogle ScholarPubMed
5.Morris, JG, Shay, DK, Hebden, JN, et al. Enterococci resistant to multiple antimicrobial agents, including vancomycin: establishment of endemicity in a university medical center. Ann Intern Med 1995;123:250–259.CrossRefGoogle Scholar
6.Byers, KE, Anglim, AM, Anneski, CJ, et al. A hospital epidemic of vancomycin-resistant Enterococcus: risk factors and control. Infect Control Hosp Epidemiol 2001;22:140–147.CrossRefGoogle ScholarPubMed
7.Centers for Disease Control and Prevention. National Nosocomial Surveillance (NNIS) System report, data summary for January 1990-May 1999, issued 1999. Am J Infect Control 2001;29:404–421.Google Scholar
8.Wenzel, RP, Osterman, CA, Hunting, KJ, Gwaltney, JM Jr. Hospital-acquired infections: I. Surveillance in a university hospital. Am J Epidemiol 1976;103:251–260.CrossRefGoogle ScholarPubMed
9.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16:128–140.CrossRefGoogle ScholarPubMed
10.Jernigan, JA, Clemence, MA, Stott, GA, et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16:686–696.CrossRefGoogle Scholar
11.Stosor, V, Peterson, LR, Postelnick, M, Noskin, GA. Enterococcus faecium bacteremia: does vancomycin resistance make a difference? Arch Intern Med 1998;158:522–527.CrossRefGoogle Scholar
12.Song, X, Perl, TM. Vancomycin-resistant enterococcal (VRE) nosocomial bloodstream infections (BSI): the attributable mortality, length of stay, and excess cost. Presented at the 37th Annual Meeting of the Infectious Diseases Society of America; November 18-21, 1999; Philadelphia, PA. Abstract.Google Scholar
13.Rosner, B. Fundamentals of Biostatistics. Boston: Duxbury Thomsom Learning; 1990:171–177.Google Scholar
14.Jernigan, JA, Hadziyannis, SC. Vancomycin-resistant Enterococcus faecium (VRE) bacteremia (B) in severely neutropenic patients. Presented at the 36th General Meeting of ICAAC; September 15-18, 1996; New Orleans, LA. Abstract J8:219.Google Scholar
15.Shay, DK, Maloney, SA, Montecalvo, M, et al. Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. J Infect Dis 1995;172:993–1000.CrossRefGoogle ScholarPubMed
16.Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin: United States, 1989-1993. MMWR 1993;42:597–599.Google Scholar
17.Edmond, MB, Jones, RN, Pfaller, MA, Wallace, SE, Wenzel, RP. Multicenter surveillance for nosocomial enterococcal bacteremia: a comparison of vancomycin-sensitive vs vancomycin-resistant cases. Infect Control Hosp Epidemiol 1996;17(suppl):18.Google Scholar
18.Linden, PK, Pasculle, AW, Manez, R, et al. Differences in outcomes for patients with bacteremia due to vancomycin-resistant Enterococcus faecium or vancomycin-susceptible E. faecium. Clin Infect Dis 1996;22:663–670.CrossRefGoogle ScholarPubMed
19.Lautenbach, E, Bilker, WB, Brennan, PJ. Enterococcal bacteremia: risk factors for vancomycin resistance and predictors of mortality. Infect Control Hosp Epidemiol 1999;20:318–323.CrossRefGoogle ScholarPubMed
20.Stroud, L, Edwards, J, Danzing, L, Culver, D, Gaynes, R. Risk factors for mortality associated with enterococcal bloodstream infections. Infect Control Hosp Epidemiol 1996;17:576–580.CrossRefGoogle ScholarPubMed
21.Newell, KA, Millis, JM, Arnow, PM, et al. Incidence and outcome of infection by vancomycin-resistant enterococcus following orthotopic liver transplantation. Transplantation 1998;65:439–442.CrossRefGoogle ScholarPubMed
22.Lucas, GM, Lechtzin, N, Puryear, DW, Yau, LL, Flexner, CW, Moore, RD. Vancomycin-resistant and vancomycin-susceptible enterococcal bacteremia: comparison of clinical features and outcomes. Clin Infect Dis 1998;26:1127–1133.CrossRefGoogle ScholarPubMed
23.Bhavnani, SM, Drake, JA, Forrest, Aet 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;36:145–158.CrossRefGoogle ScholarPubMed
24.Grumbach, K, Osmond, D, Vranizan, K, Jaffe, D, Bindmand, AB. Primary care physicians' experience of financial incentives in managed-care systems. N Engl J Med 1998;339:1516–1521.CrossRefGoogle ScholarPubMed
25.Simon, SR, Pan, RJ, Sullivan, AM, 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;340:928–936.CrossRefGoogle ScholarPubMed
26.Bodenheimer, T. The Oregon Health Plan: lessons for the nation. N Engl J Med 1997;337:651–655.CrossRefGoogle Scholar
27.Cunningham, PJ, Grossman, JM, St.Peter, RF, Lesser, CS. Managed care and physicians' provision of charity care. JAMA 1999;281:1087–1092.CrossRefGoogle ScholarPubMed
28.Baker, LC. Association of managed care market share and health expenditures for fee-for-service Medicare patients. JAMA 1999;281:432–437.CrossRefGoogle ScholarPubMed
29.Bindman, AB, Grumbach, K, Vranzian, K, Jaffe, D, Osmond, D. Selection and exclusion of primary care physicians by managed care organizations. JAMA 1998;279:675–679.CrossRefGoogle ScholarPubMed
30.Centers for Disease Control and Prevention. Vancomycin-resistant enterococci (VRE) facts: 1999. Available at www.cdc.gov/phtn/old/vrefacts.htm.Google Scholar
31.Anonymous. Public health focus: surveillance, prevention, and control of nosocomial infections. MMWR 1992;41:783–787.Google Scholar
32.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.CrossRefGoogle ScholarPubMed
33.Haley, RW, Schaberg, DR, Crossley, KB, Von Allmen, SD, McGowan, JE Jr. Extra charges and prolongation of stay attributable to nosocomial infections: a prospective inter-hospital comparison. Am J Med 1981;70:51–58.CrossRefGoogle Scholar
34.Montecalvo, MA, Jarvis, WR, Uman, J, et al. Costs and savings associated with infection control measures that reduce transmission of vancomycin-resistant enterococci in an endemic setting. Infect Control Hosp Epidemiol 2001;22:437–442.CrossRefGoogle Scholar
35.Hacek, DM, Suriano, T, Noskin, GA, Kruszynski, J, Reisberg, B, Peterson, LR. Medical and economic benefit of a comprehensive infection control program that includes routine determination of microbial clonality. Am J Clin Pathol 1999;111:647–654.CrossRefGoogle ScholarPubMed
36.Boyce, JM, Mermel, LA, Zervos, MJ, et al. Controlling vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 1995;16:634–637.CrossRefGoogle ScholarPubMed
37.Muto, CA, Karchmer, TB, Cage, EG, Durbin, LJ, Simonton, BM, Farr, BM. The utility of culturing roommates of patients with vancomycin-resistant enterococcus. Presented at the 8th Annual Meeting of the Society for Healthcare Epidemiology of America; April 5-7, 1998; Orlando, FL. Abstract 76:38.Google Scholar
38.Calfee, DP, Giannetta, E, Durbin, LJ, Farr, BM. Control of vancomycin-resistant Enterococcus colonization among inpatients at a tertiary care facility. Presented at the CDC Fourth Decennial International Conference in Conjunction with the 10th Annual Meeting of the Society for Healthcare Epidemiology of America; March 5-9, 2000; Atlanta, GA. Abstract 69:217.Google Scholar
39.Dembry, L, Uzokwe, K, Zervos, M. Control of endemic glycopeptide-resistant enterococci. Infect Control Hosp Epidemiol 1996;17:286–292.CrossRefGoogle ScholarPubMed
40.Jochimsen, EM, Fish, L, Manning, K, et al. Control of vancomycin-resistant enterococci at a community hospital: efficacy of patient and staff cohorting. Infect Control Hosp Epidemiol 1999;20:106–109.CrossRefGoogle Scholar
41.Karanfil, LV, Murphy, M, Josephson, A, et al. A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit. Infect Control Hosp Epidemiol 1992;13:195–200.CrossRefGoogle Scholar
42.Malik, RK, Montecalvo, MA, Reale, MR, et al. Epidemiology and control of vancomycin-resistant enterococci in a regional neonatal intensive care unit. Pediatr Infect Dis J 1999;18:352–356.CrossRefGoogle Scholar
43.Rubin, LG, Tucci, V, Cercenado, E, Elipoulos, G, Isenberg, HD. Vancomycin-resistant Enterococcus faecium in hospitalized children. Infect Control Hosp Epidemiol 1992;12:700–705.CrossRefGoogle Scholar
44.Rupp, ME, Marion, N, Fey, PD, et al. Outbreak of vancomycin-resistant Enterococcus faecium in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2001;22:301–303.CrossRefGoogle Scholar
45.Ostrowsky, BE, Trick, WE, Sohn, AH, et al. Control of vancomycin-resistant enterococcus in healthcare facilities in a region. N Engl J Med 2001;344:1427–1433.CrossRefGoogle Scholar
46.Siddiqui, AH, Harris, AD, Hebden, J, Wilson, PD, Morris, JG, Roghmann, M. 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;30:40–43.CrossRefGoogle ScholarPubMed
47.Reisner, BS, Shaw, S, Huber, ME, et al. Comparison of broth enrichment and direct inoculation of solid media for recovery of vancomycin-resistant enterococci from perirectal and environmental surface samples. Infect Control Hosp Epidemiol 2000;21:775–779.CrossRefGoogle Scholar
48.Muto, CA, Posey, K, Pokrywka, M, et al. The value of identifying the vancomycin-resistant enterococci (VRE) reservoir using weekly VRE surveillance culturing (VRESC): “The iceberg melts”. Presented at the 12th Annual Meeting of the Society for Healthcare Epidemiology of America; April 6-9, 2002; Salt Lake City, UT.Google Scholar
49.Weinstein, JW, Tallapragada, S, Farrel, P, Dembry, LM. Comparison of rectal and perirectal swabs for detection of colonization with vancomycin-resistant enterococci. J Clin Microbiol 1996;34:210–212.CrossRefGoogle ScholarPubMed
50.Rafferty, ME, McCormick, MI, Bopp, LH, et al. Vancomycin-resistant enterococci in stool specimens submitted for Clostridium difficile cytotoxin assay. Infect Control Hosp Epidemiol 1997;18:342–344.CrossRefGoogle ScholarPubMed
51.Leber, AL, Hindler, JF, Kato, EO, Bruckner, DA, Pegues, DA. Laboratory-based surveillance for vancomycin-resistant enterococci: utility of screening stool specimens submitted for Clostridium difficile toxin assay. Infect Control Hosp Epidemiol 2001;22:160–164.CrossRefGoogle ScholarPubMed
52.Hacek, DM, Bednarz, P, Noskin, GA, Zembower, T, Peterson, LR. 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;39:1152–1154.CrossRefGoogle Scholar
53.Bradley, SJ, Wilson, AL, Allen, MC, Sher, HA, Goldstone, AH, Scott, GM. The control of hyperendemic glycopeptide-resistant Enterococcus spp. on a haematology unit by changing antibiotic usage. J Antimicrob Chemother 1999;43:261–266.CrossRefGoogle ScholarPubMed
54.Quale, J, Landman, D, Saurina, G, Atwood, E, DoTore, V, Patel, K. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clin Infect Dis 1996;23:1020–1025.CrossRefGoogle ScholarPubMed
55.Salgado, C, Sherertz, R, Karchmer, T, et al. Public health initiative to control MRSA and VRE in Virginia and North Carolina. Presented at the 12th Annual Meeting of the Society for Healthcare Epidemiology of America; April 6-9, 2002; Salt Lake City, UT. Abstract 164:75.Google Scholar
56.Donskey, CJ, Chowdhry, TK, Hecker, MT, et al. Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med 2000;343:1935–1932.CrossRefGoogle Scholar
57.Jones, EN, Marshall, SA, Pfaller, MA, 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;29:95–102.CrossRefGoogle ScholarPubMed
58.Noble, WC, Virani, Z, Cree, RG. Co-transfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC 12201 to Staphylococcus aureus. FEMS Microbiol Lett 1992;72:195–198.CrossRefGoogle ScholarPubMed
59.Anonymous. Staphylococcus aureus resistant to vancomycin: United States, 2002. MMWR 2002;51:565–567.Google Scholar