title: Reporting of vancomycin-resistant enterococci in Connecticut: implementation and validation of a state-based surveillance system.
abstract: OBJECTIVE
  To assess state-based surveillance for isolation from a sterile site of vancomycin-resistant enterococci (VRE) in Connecticut.
  
  
  METHODS
  Clinical laboratory reporting (passive surveillance) of VRE isolates to the Connecticut Department of Public Health (CDPH) was followed by state-initiated validation, laboratory proficiency testing, and review of hospital demographic characteristics.
  
  
  METHODS
  All 45 clinical laboratories and all 37 (36 for 1995 and 1996) acute-care hospitals in Connecticut were included in the study.
  
  
  METHODS
  The outcome measures included determination of the statewide incidence of VRE and the accuracy of passive reporting, determination of clinical laboratory proficiency in detecting VRE, and analysis of hospital characteristics that might be associated with an increased incidence of VRE.
  
  
  RESULTS
  During 1994 through 1996, 29 (78%) of 37 hospital-affiliated clinical laboratories and 1 (11%) of 9 commercial or other laboratories in Connecticut reported to the CDPH the isolation of VRE from sterile sites; 158 isolates were reported for these 3 years. Based on verification, we discovered that these laboratories actually detected 58 VRE isolates in 1994, 104 in 1995, and 104 in 1996 (total, 266). The age-standardized incidence rate of VRE was 14.1 cases per million population in 1994 and 26.8 cases per million population for both 1995 and 1996. Laboratory proficiency testing revealed that high-level vancomycin resistance was identified accurately and that low- and moderate-level resistance was not detected. The incidence of VRE isolates was three times greater in hospitals with over 300 beds compared with categories of hospitals with fewer beds. Increases in the number of VRE isolates were at least twice as likely in hospitals located in areas with a higher population density, or with a residency program or trauma center in the hospital.
  
  
  CONCLUSIONS
  Passive reporting of VRE isolates from sterile sites markedly underestimated the actual number of iso lates, as determined in a statewide reporting system. Statewide passive surveillance systems for routine or emerging pathogens must be validated and laboratory proficiency ensured if results are to be accurate and substantial underreporting is to be corrected.
authors.affiliation: Epidemiology Program, Connecticut Department of Public Health, Hartford 06134-0308, USA.
authors.forename: Z F
authors.initials: ZF
authors.lastname: Dembek
authors.forename: S E
authors.initials: SE
authors.lastname: Kellerman
authors.forename: L
authors.initials: L
authors.lastname: Ganley
authors.forename: C M
authors.initials: CM
authors.lastname: Capacchione
authors.forename: F C
authors.initials: FC
authors.lastname: Tenover
authors.forename: M L
authors.initials: ML
authors.lastname: Cartter
authors.forename: H J
authors.initials: HJ
authors.lastname: Van Kruiningen
authors.forename: W R
authors.initials: WR
authors.lastname: Jarvis
authors.forename: J L
authors.initials: JL
authors.lastname: Hadler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015373:Bacterial Typing Techniques / Q000592:standards / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003237:Connecticut / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D018563:Disease Notification / Q000592:standards* / Q000706:statistics & numerical data; D016983:Enterococcus / Q000145:classification / Q000302:isolation & purification*; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D006276:Health Facility Size / Q000706:statistics & numerical data; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008826:Microbial Sensitivity Tests / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D011156:Population Density; D011159:Population Surveillance / Q000379:methods; D015203:Reproducibility of Results; D013223:Statistics as Topic; D020713:Vancomycin Resistance