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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

Published online by Cambridge University Press:  11 January 2016

Nikolaos G. Almyroudis ,
Ryosuke Osawa ,
George Samonis ,
M. Wetzler ,
Eunice S. Wang ,
Philip L. McCarthy Jr.  and
Brahm H. Segal
Nikolaos G. Almyroudis*
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, United States Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, United States
Ryosuke Osawa
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, United States Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, United States
George Samonis
Affiliation:
Medical School of the University of Crete, Heraklion, Greece
M. Wetzler
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, United States Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, United States
Eunice S. Wang
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, United States Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, United States
Philip L. McCarthy Jr.
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, United States Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, United States
Brahm H. Segal
Affiliation:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, United States Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, United States Department of Immunology, Roswell Park Cancer Institute, Buffalo, New York, United States.
*
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 (Nick.Almyroudis@RoswellPark.org).
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Abstract

OBJECTIVE

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

SETTING

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

PARTICIPANTS

Inpatients with hematologic malignancies and recipients of hematopoietic stem cell transplantation

METHODS

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.

RESULTS

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.

CONCLUSION

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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 4 , April 2016 , pp. 398 - 403
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

a

Deceased.

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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