Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis.
BACKGROUND Information about the health and economic impact of infections caused by vancomycin-resistant enterococci (VRE) can inform investments in infection prevention and development of novel therapeutics. OBJECTIVE To systematically review the incidence of VRE infection in the United States and the clinical and economic outcomes. METHODS We searched various databases for US studies published from January 1, 2000, through June 8, 2015, that evaluated incidence, mortality, length of stay, discharge to a long-term care facility, readmission, recurrence, or costs attributable to VRE infections. We included multicenter studies that evaluated incidence and single-center and multicenter studies that evaluated outcomes. We kept studies that did not have a denominator or uninfected controls only if they assessed postinfection length of stay, costs, or recurrence. We performed meta-analysis to pool the mortality data. RESULTS Five studies provided incidence data and 13 studies evaluated outcomes or costs. The incidence of VRE infections increased in Atlanta and Detroit but did not increase in national samples. Compared with uninfected controls, VRE infection was associated with increased mortality (pooled odds ratio, 2.55), longer length of stay (3-4.6 days longer or 1.4 times longer), increased risk of discharge to a long-term care facility (2.8- to 6.5-fold) or readmission (2.9-fold), and higher costs ($9,949 higher or 1.6-fold more). CONCLUSIONS VRE infection is associated with large attributable burdens, including excess mortality, prolonged in-hospital stay, and increased treatment costs. Multicenter studies that use suitable controls and adjust for time at risk or confounders are needed to estimate the burden of VRE infections. Infect Control Hosp Epidemiol. 2017;38:203-215.
1University of Iowa Carver College of Medicine,Iowa City,Iowa.
Hsiu-Yin
HY
Chiang
1University of Iowa Carver College of Medicine,Iowa City,Iowa.
Eli N
EN
Perencevich
1University of Iowa Carver College of Medicine,Iowa City,Iowa.
Rajeshwari
R
Nair
3Department of Clinical Epidemiology,University of Utah,Salt Lake City,Utah.
Richard E
RE
Nelson
3Department of Clinical Epidemiology,University of Utah,Salt Lake City,Utah.
Matthew
M
Samore
3Department of Clinical Epidemiology,University of Utah,Salt Lake City,Utah.
Karim
K
Khader
4University of Iowa College of Public Health,Iowa City,Iowa.
Margaret L
ML
Chorazy
1University of Iowa Carver College of Medicine,Iowa City,Iowa.
Loreen A
LA
Herwaldt
5Ruth Lilly Medical Library,Indiana University School of Medicine,Indianapolis,Indiana.
Amy
A
Blevins
1University of Iowa Carver College of Medicine,Iowa City,Iowa.
Melissa A
MA
Ward
1University of Iowa Carver College of Medicine,Iowa City,Iowa.
Marin L
ML
Schweizer
D003428:Cross Infection / Q000453:epidemiology*; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology*; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data*; D014481:United States; D020713:Vancomycin Resistance; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification*