Impact of surveillance for vancomycin-resistant enterococci on controlling a bloodstream outbreak among patients with hematologic malignancy.
OBJECTIVE
To determine the impact of stool surveillance cultures of critically ill patients on controlling vancomycin-resistant enterococci (VRE) outbreak bacteremia.


METHODS
Stool surveillance cultures were performed on patients who had hematologic malignancy or were critically ill at the time of hospital admission to identify those colonized with VRE. Hence, contact isolation was initiated.


METHODS
A tertiary-care cancer center with a high prevalence of VRE.


METHODS
All patients with hematologic malignancy who were admitted to the hospital as well as all of those admitted to the intensive care unit were eligible.


RESULTS
Active stool surveillance cultures performed between 1997 and 2001 decreased the incidence density of VRE bacteremias eightfold while vancomycin use remained constant. In fiscal year (FY) 1997 and FY 1998, there were five and three VRE outbreak bacteremias, respectively. The outbreak clones were responsible for infection in 69% of those patients with VRE bacteremia. However, the stool surveillance program resulted in the complete control of VRE bacteremia by FY 1999 until the end of the study.


CONCLUSIONS
Despite the steady use of vancomycin, the active surveillance program among high-risk patients with hematologic malignancy and those who were critically ill resulted in the complete control of VRE outbreak bacteremia at our institution.
Hachem
Ray
R
Department of Infectious Diseases, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
Graviss
Linda
L
Hanna
Hend
H
Arbuckle
Rebecca
R
Dvorak
Tanya
T
Hackett
Brenda
B
Gonzalez
Virginia
V
Perego
Cheryl
C
Tarrand
Jeffrey
J
Raad
Issam
I
D016470:Bacteremia / Q000150:complications* / Q000382:microbiology; D002173:Cancer Care Facilities; D004196:Disease Outbreaks; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification*; D019337:Hematologic Neoplasms / Q000097:blood / Q000150:complications* / Q000382:microbiology; D006801:Humans; D013781:Texas / Q000453:epidemiology; D020713:Vancomycin Resistance