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needed, but colonization data could influence early empiric therapy for VRE, which can improve outcomes.10,11 Currently, patients in the unit are placed on empiric therapy for VRE per physician preference. Our study has several limitations. First, the study took place in
an SICU with a high VRE burden. It is unknown whether weekly VRE colonization surveillance would be as effective in identifying incident colonization in hospital units with lower VRE burdens. Second, our surveillancemethodology was based on routine culture methods. Modern PCR platforms may influence sensitivity of stool or perirectal swabs. However, we did not pursue PCR testing because a high-cost platform would not be practical for surveil- lance. Moreover, we did not measure the VRE concentration in stool samples, which many have impacted stool sensitivity com- pared to perirectal swabs.12 In addition, genotypic analysis of all isolates would help determine whether VRE was transmitted within the unit or whether VRE “emerged” over the course of hospitali- zation. If VRE transmission is the primary driver of spread, uni- versal chlorhexidine bathing, improved hand hygiene, and universal contact precautions should be recommended.16,23 If the primary problem is the “emergence” of existing VRE, greater attention to antimicrobial usage would be warranted. In conclusion, we suggest using perirectal swabs for VRE surveillance instead of stool samples because perirectal swabs are more sensitive and more convenient in detecting VRE. Moreover, we recommend at least weekly surveillance of VRE instead of admission-only screening in high-burden units. Further work in VRE surveillance may have implications for both patient care and infection prevention.
Acknowledgments.
Financial support. The overall study was supported by the UCLA Division of Infectious Diseases and the Perkins Foundation.
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
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