Abstract
Vancomycin-resistant Enterococcus (VRE) infections have been associated with increased mortality and poor outcomes. VRE screening has been used to identify colonized patients to prevent transmission; however, little is known about the utility of screening results to guide antibiotic therapy. A retrospective review was performed at a tertiary-care center between June 1, 2015, and May 31, 2018. All patients who underwent VRE polymerase chain reaction assay (PCR) screening and had a bacterial culture from 7 days before to 90 days after the screening test were included. In total, 1,374 patients who had a VRE screening test met inclusion criteria. Sensitivity, specificity, and positive and negative predictive values of VRE screening for VRE infection were calculated. The appropriateness of the antibiotic therapy for each patient based on screening results was also assessed. We detected no difference in the appropriateness of antibiotic therapy between patients with a positive screen and those with a negative screen (59.3% vs 61.0%; P = .8657). The VRE PCR demonstrated 54% sensitivity, 89% specificity, a positive predictive value (PPV) of 13% and a negative predictive value (NPV) of 98%. The high NPV and specificity indicate that patients with a negative VRE screening results may not require empiric antibiotic coverage for VRE. Although VRE screening may have utility to detect colonization in high-risk patients, a positive VRE screen is of limited value in determining the need for an antibiotic with VRE culture-directed coverage.
Highlights
Patients 18 years or older who underwent screening for vancomycin-resistant Enterococcus (VRE) by polymerase chain reaction assay (PCR) and had a bacterial culture from 7 days before to 90 days after the screen were included
In the subset of patients who were identified as true positives, the average number of days from VRE screening test to positive culture was 14.7; only the first screening result was included in the analysis and this number may not reflect time to positive culture
Antimicrobial Stewardship & Healthcare Epidemiology in high-risk medical units.18A prospective, observational study in ICU patients concluded that twice-weekly VRE screening can effectively identify colonized patients and reduce transmission.[19]
Summary
Patients 18 years or older who underwent screening for VRE by polymerase chain reaction assay (PCR) and had a bacterial culture from 7 days before to 90 days after the screen were included. The first screening result was included for patients who had multiple VRE screening tests. All bacterial cultures for patients undergoing screening were reviewed for the specified period, and patients were classified as having a VRE infection if any culture showed at least 1 Enterococcus isolate with vancomycin resistance and an identifiable source of infection. Patients with VRE from urine cultures were evaluated for asymptomatic bacteriuria or colonization and were excluded from the analysi
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