Cost-effectiveness of perirectal surveillance cultures for controlling vancomycin-resistant Enterococcus.
BACKGROUND
Several hospitals opting not to use active surveillance cultures to identify carriers of vancomycin-resistant Enterococcus (VRE) have reported that adoption of other parts of the Centers for Disease Control and Prevention guideline for controlling VRE has had little to no impact. Because use of surveillance cultures and contact isolation controlled a large outbreak at this hospital, their costs were estimated for comparison with the excess costs of VRE bacteremias occurring at a higher rate at a hospital not employing these measures.


METHODS
Two university hospitals.


METHODS
Inpatients deemed high risk for VRE acquisition at this hospital underwent weekly perirectal surveillance cultures. Estimated costs of cultures and resulting isolation during a 2-year period were compared with the estimated excess costs of more frequent VRE bacteremias at another hospital of similar size and complexity not using surveillance cultures to control spread throughout the hospital.


RESULTS
Of 54,052 patients admitted, 10,400 had perirectal swabs taken. Cultures and isolation cost an estimated $253,099. VRE culture positivity was limited to 193 (0.38%) and VRE bacteremia to 1 (0.002%) as compared with 29 bacteremias at the comparison hospital. The estimated attributable cost of VRE bacteremia at the comparison hospital of $761,320 exceeded the cost of the control program at this hospital by threefold.


CONCLUSIONS
The excess costs of VRE bacteremia may justify the costs of preventive measures. The costs of VRE infections at other body sites, of deaths from untreatable infections, and of dissemination of genes for vancomycin resistance also help to justify the costs of implementing an effective control program.
University of Virginia Health System, Charlottesville 22908, USA.
Carlene A
CA
Muto
Eve T
ET
Giannetta
Lisa J
LJ
Durbin
Barbara M
BM
Simonton
Barry M
BM
Farr
D018929:Cell Culture Techniques; D015169:Colony Count, Microbial; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D016983:Enterococcus; D016908:Gram-Positive Bacterial Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000191:economics; D011159:Population Surveillance / Q000379:methods*; D020713:Vancomycin Resistance; D014768:Virginia / Q000453:epidemiology