Longitudinal Multicenter Analysis of Outcomes After Cessation of Control Measures for Vancomycin-Resistant Enterococci.
OBJECTIVE To assess clinically relevant outcomes after complete cessation of control measures for vancomycin-resistant enterococci (VRE). DESIGN Quasi-experimental ecological study over 3.5 years. METHODS All VRE screening and isolation practices at 4 large academic hospitals in Ontario, Canada, were stopped on July 1, 2012. In total, 618 anonymized abstracted charts of patients with VRE-positive clinical isolates identified between July 1, 2010, and December 31, 2013, were reviewed to determine whether the case was a true VRE infection, a VRE colonization or contaminant, or a true VRE bacteremia. All deaths within 30 days of the last VRE infection were also reviewed to determine whether the death was fully or partially attributable to VRE. All-cause mortality was evaluated over the study period. Generalized estimating equation methods were used to cluster outcome rates within hospitals, and negative binomial models were created for each outcome. RESULTS The incidence rate ratio (IRR) for VRE infections was 0.59 and the associated P value was .34. For VRE bacteremias, the IRR was 0.54 and P=.38; for all-cause mortality the IRR was 0.70 and P=.66; and for VRE attributable death, the IRR was 0.35 and P=.49. VRE control measures were not significantly associated with any of the outcomes. Rates of all outcomes appeared to increase during the 18-month period after cessation of VRE control measures, but none reached statistical significance. CONCLUSION Clinically significant VRE outcomes remain rare. Cessation of all control measures for VRE had no significant attributable adverse clinical impact. Infect Control Hosp Epidemiol 2016;1-7.
1University Health Network,Department of Infection Prevention and Control,Toronto,Canada.
Camille
C
Lemieux
1University Health Network,Department of Infection Prevention and Control,Toronto,Canada.
Michael
M
Gardam
4Queen's University,Departments of Medicine,Biomedical and Molecular Sciences, and Pathology and Molecular Medicine,Kingston,Canada.
Gerald
G
Evans
5Schulich School of Medicine and Dentistry,Department of Pathology and Laboratory Medicine,Western University,London,Canada.
Michael
M
John
6University of Ottawa,Department of Medicine,Ottawa,Canada.
Kathryn N
KN
Suh
8University of Ottawa,Department of Medicine/School of Epidemiology, Public Health and Preventive Medicine,Ottawa,Canada Ottawa Hospital Research Institute,Ottawa,Canada.
Carl
C
vanWalraven
1University Health Network,Department of Infection Prevention and Control,Toronto,Canada.
Elisa
E
Vicencio
1University Health Network,Department of Infection Prevention and Control,Toronto,Canada.
Cameron
C
Coulby
6University of Ottawa,Department of Medicine,Ottawa,Canada.
Virginia
V
Roth
1University Health Network,Department of Infection Prevention and Control,Toronto,Canada.
Susy
S
Hota
D000368:Aged; D016470:Bacteremia / Q000401:mortality*; D003428:Cross Infection / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000401:mortality*; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D020713:Vancomycin Resistance; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification*