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Laboratory-Based Surveillance for Vancomycin-Resistant Enterococci: Utility of Screening Stool Specimens Submitted for Clostridium difficile Toxin Assay

Published online by Cambridge University Press:  02 January 2015

Amy L. Leber ,
Janet F. Hindler ,
Ellen O. Kato ,
David A. Bruckner  and
David A. Pegues
Amy L. Leber
Affiliation:
Department of Pathology and Laboratory Medicine, University of California-Los Angeles, Los Angeles, California
Janet F. Hindler
Affiliation:
Department of Pathology and Laboratory Medicine, University of California-Los Angeles, Los Angeles, California
Ellen O. Kato
Affiliation:
Department of Pathology and Laboratory Medicine, University of California-Los Angeles, Los Angeles, California
David A. Bruckner
Affiliation:
Department of Pathology and Laboratory Medicine, University of California-Los Angeles, Los Angeles, California
David A. Pegues*
Affiliation:
Department Internal Medicine, University of California-Los Angeles, Los Angeles, California
*
Department of Internal Medicine, Division of Infectious Diseases, UCLA School of Medicine, 10833 LeConteAve, Los Angeles, CA 90095-1688
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Abstract

Objective:

To study vancomycin-resistant enterococci (VRE) gastrointestinal colonization prevalence in high-risk hospitalized patients and to assess the cost and utility of this laboratory-based surveillance.

Setting:

Large university teaching hospital.

Design:

Quarterly prevalence culture survey of 50 stool specimens submitted for Clostridium difficile toxin A assay from October 1996 through June 1999 (n=526). Screening culture survey of all C difficile-positive stool specimens from July 1998 through June 1999 (n=140).

Patients:

Specimens for analysis were collected from patients who were admitted to the hospital and who had C difficile toxin A testing ordered. Patient samples were excluded from analysis if they were obtained from patients not hospitalized at UCLA Medical Center, if the C difficile toxin assay result was indeterminate, or if the patient was known to have previous VRE colonization or infection.

Results:

During quarterly surveillance, VRE was detected in 19.8%, C difficile toxin A in 9.5%, and both VRE and C difficile toxin A in 3.2% of stool specimens submitted for C difficile toxin assay. Patients whose stool specimens were positive for C difficile toxin A were significantly more likely than those whose specimens were negative to have VRE detected (odds ratio, 2.3; 95% confidence interval, 1.2-4.5). Based on these findings, in July 1998, we began routine screening of all C difficile-positive stool specimens for VRE. From July 1998 through June 1999, 58 (41.4%) of 140 patients with C difficile-positive specimens had VRE newly detected in the stool. The combined cost of the two laboratory-based surveillance strategies was approximately $62 per VRE-positive patient identified and $5,800 per year.

Conclusion:

Quarterly surveillance of stool submitted for C difficile assay combined with screening all C difficile-positive stools is a cost-effective and efficient strategy for detecting VRE stool colonization among high-risk hospitalized patients. Such a laboratory-based surveillance should be included as part of a comprehensive program to limit nosocomial VRE transmission.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 3 , March 2001 , pp. 160 - 164
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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