Abstract
BackgroundEvidence supporting the effectiveness of single-room contact precautions (SCP) in preventing in-hospital acquisition of vancomycin-resistant enterococci (haVRE) is limited.AimWe assessed the impact of SCP on haVRE and their transmission.MethodsWe conducted a prospective, multicentre cohort study in German haematological/oncological departments during 2016. Two sites performed SCP for VRE patients and two did not (NCP). We defined a 5% haVRE-risk difference as non-inferiority margin, screened patients for VRE, and characterised isolates by whole genome sequencing and core genome MLST (cgMLST). Potential confounders were assessed by competing risk regression analysis.ResultsWe included 1,397 patients at NCP and 1,531 patients at SCP sites. Not performing SCP was associated with a significantly higher proportion of haVRE; 12.2% (170/1,397) patients at NCP and 7.4% (113/1,531) patients at SCP sites (relative risk (RR) 1.74; 95% confidence interval (CI): 1.35–2.23). The difference (4.8%) was below the non-inferiority margin. Competing risk regression analysis indicated a stronger impact of antimicrobial exposure (subdistribution hazard ratio (SHR) 7.46; 95% CI: 4.59–12.12) and underlying disease (SHR for acute leukaemia 2.34; 95% CI: 1.46–3.75) on haVRE than NCP (SHR 1.60; 95% CI: 1.14–2.25). Based on cgMLST and patient movement data, we observed 131 patient-to-patient VRE transmissions at NCP and 85 at SCP sites (RR 1.76; 95% CI: 1.33–2.34).ConclusionsWe show a positive impact of SCP on haVRE in a high-risk population, although the observed difference was below the pre-specified non-inferiority margin. Importantly, other factors including antimicrobial exposure seem to be more influential.
Highlights
The prevalence of colonisation and infection by vancomycin-resistant enterococci (VRE) is increasing globally [1,2]
Considering the unclear effectiveness and the potential harm associated with single-room contact precautions (SCP), we aimed to assess the impact of SCP on in-hospital acquisition and transmission of VRE in haematological/oncological patients including molecular genetic analyses
During 2016, we assessed 1,434 patients corresponding to 2,486 hospitalisations on participating haematological and oncological wards at NCP sites and 1,645 patients corresponding to 3,191 hospitalisations at SCP sites
Summary
The prevalence of colonisation and infection by vancomycin-resistant enterococci (VRE) is increasing globally [1,2]. In order to reduce in-hospital acquisition and transmission of VRE, single-room contact precautions (SCP) including staff and visitors wearing gloves and gowns are recommended by some national infection prevention and control committees [4,5,6]. A meta-analysis including eight studies on discontinuation of contact precautions, but not necessarily including single-room accommodation, showed no effect on VRE infection rates [9]. Evidence supporting the effectiveness of single-room contact precautions (SCP) in preventing in-hospital acquisition of vancomycin-resistant enterococci (haVRE) is limited.
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