title: To swab or not to swab? A prospective analysis of 341 SICU VRE screens.
abstract: BACKGROUND
  Vancomycin-resistant Enterococcus (VRE) screening is routine practice in many intensive care units despite the question of its clinical significance. The value of VRE screening at predicting subsequent VRE or other hospital-acquired infection (HAI) is unknown. The purpose of this investigation was to examine the rate of subsequent VRE HAI in patients undergoing VRE screening.
  
  
  METHODS
  This study was conducted in a 24-bed surgical intensive care unit (SICU) at a Level I trauma center. Patients admitted to the SICU between February and August 2011 who had rectal swab for VRE screening within 72 hours were followed prospectively for the development of VRE and other HAIs. Demographics, clinical characteristics, and infection rates were compared between VRE-positive and VRE-negative patients. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of VRE screening for predicting subsequent VRE HAI were calculated.
  
  
  RESULTS
  A total of 341 patients had VRE screening within 72 hours of SICU admission, with 32 VRE-positive (9%) and 309 VRE-negative (91%) patients. VRE-positive patients had a higher incidence of any HAI (78% vs. 35%, p < 0.001). Eight VRE-positive patients (25%) developed VRE HAI compared with only 3 VRE-negative patients (1%) (p < 0.001). VRE screening had a 73% sensitivity, 93% specificity, 25% PPV, and 99% NPV for determining subsequent VRE HAI.
  
  
  CONCLUSIONS
  VRE colonization was present in 9% of SICU patients at admission. Negative VRE screen result had a high specificity and NPV for the development of subsequent VRE HAI. Empiric treatment of VRE infection may be unnecessary in VRE-negative patients.
  
  
  METHODS
  Prognostic/epidemiologic study, level III. Therapeutic study, level IV.
authors.forename: Douglas Z
authors.initials: DZ
authors.lastname: Liou
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ley
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Aasin
authors.initials: A
authors.lastname: Tareen
authors.forename: Tamara
authors.initials: T
authors.lastname: Casas
authors.forename: Debora
authors.initials: D
authors.lastname: Lee
authors.forename: Marko
authors.initials: M
authors.lastname: Bukur
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D003422:Critical Care / Q000379:methods; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification* / Q000472:pathogenicity; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012007:Rectum / Q000382:microbiology*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014193:Trauma Centers; D020713:Vancomycin Resistance