1180 Identification of VRE bacteremia
Monitoring for VRE bloodstream infection (BSI) was conducted through passive microbiologic surveillance; VRE BSIs were tracked for 2 months after the conclusion of surveillance efforts. Microbiologically confirmed VRE BSIs were defined as having ≥1 positive Enterococcus blood culture with resistance to van- comycin, as reported by institutional susceptibility results. VRE infections from other sources were tracked based on at least 1 positive culture as well as chart review to confirm signs and/or symptoms of infection. Genotypic analyses were conducted on an ad hoc basis based on availability of blood samples for compar- ison to stool sample isolates.
Results
Overall, 96 patients received care in the liver transplant unit during the study period, and 91 patients were evaluated for VRE colonization (Fig. 1). Although 43 patients were colonized at some point during the study with VRE, 48 patients were never colonized. Table 1 presents the characteristics of these 2 patient groups. At the beginning of the study, 23 patients were present in the SICU. For these patients, the point prevalence of VRE
Rebecca Y. Linfield et al
colonization was 14 of 23 (60.9%), with 23 of 23 (100%) of patients contributing data. In addition, 73 patients were admitted during the study period. Admission screening (either perirectal swabbing or stool sam- pling) was performed for 68 of these 73 patients (93.2%), and 22 (30.1%) tested positive for VRE colonization on admission. All patients who had an admission screening without weekly sur- veillance were discharged before the scheduled weekly surveillance day. A total of 28 noncolonized patients underwent weekly sur-
veillance. Weekly surveillance (either perirectal or stool) was performed for 28 of 28 (100%). Incidental colonization occurred in 7 of 28 patients (25.0%). The incidence rate of VRE coloni- zation was 27.0 per 1,000 SICU days.
Compliance with stool samples and perirectal swabs
Overall, there were 226 collection opportunities. Both stool samples and perirectal swabs were collected in 102 (45.1%) of those opportunities. Perirectal swabs only were collected in 99 opportunities (43.8%), and stool samples only were collected in 25 opportunities (11.1%). Compliance with collection of a perirectal swab occurred 201 of 226 times (88.9%) compared to 127 of 226 (56.1%) for stool collection (P≤0.001). For admission screening, compliance with perirectal swabbing occurred in 85 of 91
Fig. 1. Admission and incident VRE colonization. The diagram shows pre-existing point prevalence of VRE colonization in the unit, VRE colonization on admission, and incident VRE colonization. Note. VRE, vancomycin-resistant enterococci.
Table 1. Patient Characteristics on Initial Surveillance Characteristic Male
Mean age, y
Mean Charlson score Mean MELD score Antibiotic therapy Vasopressor Lactulose
Immunomodulatory therapy Surgeries in the prior 30 days
VRE Colonized Patients (N=43), No. (%)a 18 (41.9) 58.2 5.9
20.3c
36 (83.7) 24 (55.8) 14 (32.6) 26 (60.5) 20 (46.5)
Note. VRE, vancomycin-resistant enterococci; MELD, model for end-stage liver disease. aUnless otherwise noted. bBold values indicate statistical significance. cMELD score was calculated based on available laboratory data.
Patients Never Colonized With VRE (N=48), No. (%)a 30 (62.5) 56.1 5.1
15.5c
36 (75.0) 10 (41.7) 12 (12.0) 14 (29.2) 27 (56.3)
P Valueb .049 .479 .102 .079 .307 .178 .426 .003 .353
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