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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.


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