Infectious Disease

No increases in hospital-acquired VRE bloodstream infections seen after screening ceased

October 18, 2022

2 min read

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The authors report no relevant financial disclosures.

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In Alberta, Canada, the rate of hospital-acquired vancomycin-resistant enterococci bloodstream infections remained consistent regardless of patient risk, even in units that changed or discontinued screening protocols, according to a study.

“Based on recommendations from the Canadian Consensus Development Conference on Surveillance and Screening for Antimicrobial Resistant Organisms, new vancomycin-resistant enterococci (VRE) screening protocols were implemented for all acute-care facilities in Alberta, which eliminated routine admission screening and focused on high- risk patient care units,” Ted R. Pfister, MSc, health technology assessment analyst at Alberta Health Services, told Healio. “It’s possible that after routine VRE screening and isolation was discontinued, more patients would be identified with a bloodstream infection with VRE.”

Hospital_Hall

The rate of hospital-acquired vancomycin-resistant enterococci bloodstream infections remained consistent regardless of patient risk after discontinuation of screening protocols. Source: Adobe Stock.

According to Pfister, previous studies evaluating the effectiveness of screening and contact isolation practice on VRE infection produced mixed results, leading to varied infection control practices.

“The purpose of this study was to determine whether discontinuing routine screening for VRE in Alberta acute care facilities had an impact on the rate of hospital-acquired (HA) VRE bloodstream infections (VRE-BSI),” he said.

To do so, Pfister and colleagues assessed all patients who were admitted to the Alberta Health Services or Covenant Health acute-care facilities between Jan. 1, 2013, and March 31, 2020, who had HA VRE-BSI. These patients were separated into three cohorts — group 1, which was composed of low-risk patients with no VRE screening; group 2, which was composed of high-risk patients with no VRE screening; and group 3, which was composed of high-risk patients with VRE screening continued. According to the study, the researchers used an intervention time-series Poisson regression to determine the change in VRE incidence between the preintervention and postintervention periods.

Overall, the researchers determined there was no statistically significant difference in the slope change or rate of rise in VRE-BSI before and after the intervention, demonstrating consistent rates regardless of screening or patient risk.

In group one, 129 HA VRE BSIs were identified. According to the study, before the start of the intervention when routine screening still occurred, 49 HA VRE-BSIs were identified with a rate of 0.08 per 10,000 patient days, whereas 80 HA VRE-BSIs were identified in the postintervention period, with an identical one rate of 0.08 per 10,000 patient days (P = .99).

Among group 2, 46 HA VRE-BSIs were identified throughout the study period, with 32 cases in the preintervention period (1.07 per 10,000 patient days) and 14 cases in the postintervention period (1.16 per 10,000 patient days; P = .98).

In group 3, 27 HA VRE-BSIs were identified, with 12 cases in the preintervention period (1.63 per 10,000 patient days) and 15 cases in the postintervention period (1.28 per 10,000 patient days; P = .95).

The overall incidence rate ratios (IRRs) across the three groups were 1.015 (95% CI, 0.982-1.049), 1.025 (95% CI, 0.967-1.086), and 0.989 (95% CI, 0.924-1.059) for groups 1, 2 and 3, respectively.

“The study provides further evidence and confidence to existing policy changes in Alberta that have eliminated routine screening and isolation for VRE patients,” Pfister said. “In the Alberta context and during the time period that was studied, eliminating screening and isolation for VRE in hospitalized patient populations did not result in an increase in bloodstream infections caused by VRE.”

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