geoscience.net logo
+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Point prevalence and clinical culture positivity of vancomycin resistant enterococci are poor estimates of infection control intervention impact


, : Point prevalence and clinical culture positivity of vancomycin resistant enterococci are poor estimates of infection control intervention impact. Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 42: 316

Background: Active surveillance culturing (AS) and subsequent patient isolation are aimed at containing VRE. Controversy over the benefits of AS is partly due to the fact that the observational units are hospital wards and not individual patients, so clinical trials are logistically difficult and expensive. Existing studies often evaluate the benefits of infection control interventions using PP or CCP. We demonstrate that it is necessary to measure incident colonization. Methods: We created a stochastic (probabilistic) model to simulate the transmission of VRE in a 10-bed ICU. Parameter estimates were obtained from screening data in a teaching hospital including 20% of patients colonized on admission and 4 day ICU stay. We simulated VRE transmission and AS for 1 year comparing two strategies: (1) 60% compliance with obtaining AS perirectal cultures for VRE on admission and subsequent isolation of positives and (2) identical AS and isolate strategy with 100% compliance. Sensitivity analyses were performed to determine the robustness of findings under varying conditions. Results: The model predicts that improving AS cultures from 60% to 100% would prevent 43 cases of new incident VRE colonization in 1 year. Studies that measure new incident cases of VRE would find a benefit 96% of the time, but studies that measure PP or CCP would find a benefit only 45.5% of the time using the same model and same data. PP or CCP often failed to detect a benefit due to stochastic fluctuations in prevalence and high prevalence of VRE in patients entering the ICU. Conclusion: Studies to assess the benefits of AS for VRE should measure new incident cases. Relying on PP or CCP to assess the benefits of infection control interventions may underestimate the magnitude of their benefit and may be responsible for a persistent bias against the broader institution of AS. The benefits of AS and other infection control interventions are probably underestimated.

US$29.90


Other references

Frühwald, F.; Neuhold, A.; Seidl, G.; Pavelka, R.; Mailath, G.; Zrunek, M., 1986: Realtime sonography in the diagnosis and follow-up of malignant tongue tumors. II. Detection and staging. 92 sonographic examinations performed in 62 patients were evaluated to determine the possible application of sonography in the diagnosis and follow-up of malignant tumours of the tongue. Squamous cell carcinomas were by far dominant and proved to...

Predoiu, I.; Visarion, N., 1980: Effect of the eradication policy on brucellosis in swine in Romania. In Romania, only an eradication policy based on the complete elimination of infected herds was found to be fully effective. Elimination of herds was based on clinical and serological diagnosis (agglutination and complement fixation tests). Replace...

Trout, G.M.; Nelson, J.A., 1971: Memorials. John Albert Nelson 1890-1971. Journal of Dairy Science 54(11): 1723-1724

Vessey, D.A.; Zakim, D., 1974: Stimulation of microsomal udp glucuronyl transferase ec 2.4.1.17 by glucuronic acid derivatives. Biochemical Journal 139(1): 243-249

Staneva-Stoycheva, D.; Bogoslovova, T., 1976: Changes in some metabolic effects of isoprenaline and glucagon in normotensive and spontaneously hypertensive rats. Some of the characteristic metabolic effects of isoprenaline (Iso) and glucagon (G) were investigated in normotensive (NT) and spontaneously hypertensive (SH) rats in order to elucidate the possible adrenergic reactivity and the 2nd messenger tran...

Chock, S.P.; Schmauder-Chock, E.A., 1992: The secretory granule and the mechanism of stimulus-secretion coupling. Current Topics in Cellular Regulation 32: 183-208

Bender W.R., 1968: Inst carotid arteriography in the diagnosis and management of neopl tumors of the carotid body human. American Journal Of Roentgenology Radium Therapy & Nuclear Medicine: 893-898

Warnock S.J., 1990: Tomato evolution and its implications for tomato culture. Hortscience 25(2): 139-140

Foulaadvand, M.Ebrahim.; Kolomeisky, A.B.; Teymouri, H., 2009: Asymmetric exclusion processes with disorder: effect of correlations. Multiparticle dynamics in one-dimensional asymmetric exclusion processes with disorder is investigated theoretically by computational and analytical methods. It is argued that the general phase diagram consists of three nonequilibrium phases that...

Scheidbach, H.; Ptok, H.; Schubert, D.; Kose, D.; Hügel, O.; Gastinger, I.; Köckerling, F.; Lippert, H., 2007: Palliative stoma creation: comparison of laparoscopic vs conventional procedures. The creation of a stoma is an established therapeutic concept for the palliation of non-resectable rectal carcinomas and advanced tumours infiltrating the pelvis. In two prospective country-wide multicentre studies, each conducted over a similar p...