Utility of a focused vancomycin-resistant enterococci screening protocol to identify colonization in hospitalized children

• Published in: American journal of infection control 2012-11, Vol.40 (9), p.891-892
• Main Authors: Weddle, Gina, DNP, RN, CPNP, Jackson, Mary Anne, MD, Selvarangan, Rangaraj, PhD
• Format: Article
• Language: English
• Subjects: Bacteriological Techniques - economics; Bacteriological Techniques - methods; Biological and medical sciences; Carrier State - diagnosis; Carrier State - epidemiology; Carrier State - microbiology; Child; Child, Hospitalized; Child, Preschool; Children & youth; Chronic Disease - epidemiology; Costs and Cost Analysis; Disease control; Drug resistance; Enterococcus - drug effects; Enterococcus - isolation & purification; Epidemiology. Vaccinations; Female; General aspects; Gram-positive bacteria; Gram-Positive Bacterial Infections - diagnosis; Gram-Positive Bacterial Infections - epidemiology; Gram-Positive Bacterial Infections - microbiology; Humans; Infant; Infant, Newborn; Infection Control; Infectious Disease; Infectious diseases; Male; Mass Screening - methods; Medical sciences; Medical screening; Nosocomial infections; Pediatric; Pediatrics; Prevalence; Risk Factors; Surveillance; Vancomycin Resistance; VRE
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2011.12.005

Screening for vancomycin-resistant enterococci (VRE) is controversial, and disagreement exists on policy implementation. This study investigated the likelihood of a positive test using 1, 2, or 3 rectal screenings for VRE colonization. In this descriptive study of positive VRE screening cultures, a total of 1211 VRE screens identified 41 positive results. The mean age of these positive patients was 5.7 years. Thirty-nine of the 41 had a chronic illness, and only 2 were healthy. Diagnoses included pulmonary disease in 11 patients and chronic gastrointestinal abnormality in 7. Six patients had been born preterm, and 12 had been treated in a neonatal intensive care unit within the previous 6 months. Thirty-six of the 41 positive results were identified on the first screen. The likelihood of subsequently having a positive screen after a negative screen was 0.43% (95% confidence interval, 0.15%-1.02%). The cost of cultures plus isolation was $50,000 for the study period. Our data show that the likelihood of detecting a positive VRE culture after an initial negative was low, particularly in otherwise healthy children.