title: Three surveillance strategies for vancomycin-resistant enterococci in hospitalized patients: detection of colonization efficiency and a cost-effectiveness model.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness and detection sensitivity associated with three active surveillance strategies for the identification of patients harboring vancomycin-resistant enterococci (VRE) to determine which is the most medically and economically useful.
  
  
  METHODS
  Culture for VRE from 200 consecutive stool specimens submitted for Clostridium difficile culture. Following this, risk factors were assessed for patients whose culture yielded VRE, and a cost-effectiveness evaluation was performed using a decision analytic model with a probabilistic analysis.
  
  
  METHODS
  A 688-bed, tertiary-care facility in Chicago, Illinois, with approximately 39,000 annual admissions, 7,000 newborn deliveries, 56,000 emergency department visits, and 115,000 home care and 265,000 outpatient visits.
  
  
  METHODS
  All stool specimens submitted to the clinical microbiology laboratory for C. difficile culture from hospital inpatients.
  
  
  RESULTS
  From 200 stool samples submitted for C. difficile testing, we identified 5 patients with VRE in non-high-risk areas not screened as part of our routine patient surveillance. Medical record review revealed that all 5 had been hospitalized within the prior 2 years. Three of 5 had a history of renal impairment. The strategy that would involve screening the greatest number of patients (all those with a history of hospital admission in the prior 2 years) resulted in highest screening cost per patient admitted (dollars 2.48), lower per patient admission costs (dollars 480), and the best survival rates.
  
  
  CONCLUSIONS
  An expanded VRE surveillance program that encompassed all patients hospitalized within the prior 2 years was a cost-effective screening strategy compared with a more traditional one focused on high-risk units.
authors.affiliation: Midwest Center for Health Services and Policy Research, Hines VA Hospital, Hines, IL 60141, USA. todd.lee@med.va.gov
authors.forename: Todd A
authors.initials: TA
authors.lastname: Lee
authors.forename: Donna M
authors.initials: DM
authors.lastname: Hacek
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Stroupe
authors.forename: Susan M
authors.initials: SM
authors.lastname: Collins
authors.forename: Lance R
authors.initials: LR
authors.lastname: Peterson
mesh_terms: D002353:Carrier State / Q000175:diagnosis* / Q000382:microbiology; D016360:Clostridioides difficile / Q000302:isolation & purification; D003362:Cost-Benefit Analysis; D016983:Enterococcus / Q000302:isolation & purification*; D005243:Feces / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis*; D006760:Hospitalization; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods; D018803:Models, Economic; D018571:Sentinel Surveillance; D020713:Vancomycin Resistance