title: Is it worth screening for vancomycin-resistant Enterococcus faecium colonization?: Financial burden of screening in a developing country.
abstract: BACKGROUND
  The screening of critically ill patients at high risk of vancomycin resistant enterococci (VRE) colonization, to detect and isolate colonized patients, is recommended to prevent and control the transmission of VRE. Screening asymptomatic carriers brings financial burden for institutions. In this study, we performed risk analysis for VRE colonization and determined the financial burden of screening in a middle-income country, Turkey.
  
  
  METHODS
  We retrospectively analyzed the VRE surveillance data from a pediatric hospital between 2010 and 2014. A case-control study was conducted to identify the risk factors of colonization. Total cost of VRE screening and additional costs for a VRE colonized patient (including active surveillance cultures and contact isolation) were calculated.
  
  
  RESULTS
  During the 4-year period, 6,372 patients were screened for perirectal VRE colonization. The rate of culture-positive specimens among all patients screened was 239 (3.75%). The rate of VRE infection was 0.04% (n = 3) among all patients screened. Length of hospital stay, malignancy, and being transferred from another institution were independently associated risk factors for colonization. Annual estimated costs for the laboratory were projected as $19,074 (76,295/4) for all patients screened. Cost of contact isolation for each patient colonized in a ward and an intensive care unit was $270 and $718, respectively.
  
  
  CONCLUSIONS
  In developing countries, institutions should identify their own high-risk patients; screening priorities should be based on prevalence of infection and hospital financial resources.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey. Electronic address: draysegululu@yahoo.co.uk.
authors.forename: Aysegul
authors.initials: A
authors.lastname: Ulu-Kilic
authors.affiliation: Infection Control Committee, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Esra
authors.initials: E
authors.lastname: Özhan
authors.affiliation: Infection Control Committee, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Altun
authors.affiliation: Department of Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Duygu
authors.initials: D
authors.lastname: Perçin
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Tamer
authors.initials: T
authors.lastname: Güneş
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Alp
mesh_terms: D000293:Adolescent; D002353:Carrier State / Q000175:diagnosis* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D016638:Critical Illness; D003906:Developing Countries; D016984:Enterococcus faecium / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D012189:Retrospective Studies; D014421:Turkey; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification*
keywords: Enterococcus faecium; Vancomycin-resistance; colonization; pediatrics