Discontinuation of Systematic Surveillance and Contact Precautions for Vancomycin-ResistantEnterococcus(VRE) and Its Impact on the Incidence of VREfaeciumBacteremia in Patients with Hematologic Malignancies

Abstract

OBJECTIVETo study the effect of discontinuation of systematic surveillance for vancomycin-resistantEnterococcus(VRE) and contact isolation of colonized patients on the incidence of VRE bacteremiaSETTINGA hematology-oncology unit with high prevalence of VRE colonization characterized by predominantly sporadic molecular epidemiologyPARTICIPANTSInpatients with hematologic malignancies and recipients of hematopoietic stem cell transplantationMETHODSThe incidence of VRE bacteremia was measured prospectively during 2 different 3-year time periods; the first during active VRE surveillance and contact precautions and the second after discontinuation of these policies. We assessed the collateral impact of this policy change on the incidence of bacteremia due to methicillin-resistantStaphylococcus aureus(MRSA) andClostridium difficileinfection even though we maintained contact precautions for these organisms. Incidence of infectious events was measured as number of events per 1,000 patients days per month. Time series analysis was used to evaluate trends.RESULTSThe incidence of VRE bacteremia remained stable after discontinuation of VRE surveillance and contact precautions. The incidence of MRSA bacteremia andClostridium difficileinfection for which we continued contact precautions also remained stable. Aggregated antibiotic utilization and nursing hours per patient days were similar between the 2 study periods.CONCLUSIONActive surveillance and contact precautions for VRE colonization did not appear to prevent VRE bacteremia in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation with high prevalence of VRE characterized by predominantly sporadic molecular epidemiology.Infect. Control Hosp. Epidemiol.2016;37(4):398–403