Clinical impact of Vancomycin Resistant Enterococci colonization in non‐liver solid organ transplantation and its implications for infection control strategies: A single centre 10 year retrospective study

AbstractObjective:To determine the costs and savings of a 15-component infection control program that reduced transmission of vancomycin-resistant enterococci (VRE) in an endemic setting.Design:Evaluation of costs and savings, using historical control data.Setting:Adult oncology unit of a 650-bed hospital.Participants:Patients with leukemia, lymphoma, and solid tumors, excluding bone marrow transplant recipients.Methods:Costs and savings with estimated ranges were calculated. Excess length of stay (LOS) associated with VRE bloodstream infection (BSI) was determined by matching VRE BSI patients with VRE-negative patients by oncology diagnosis. Differences in LOS between the matched groups were evaluated using a mixed-effect analysis of variance linear-regression model.Results:The cost of enhanced infection control strategies for 1 year was $116,515. VRE BSI was associated with an increased LOS of 13.7 days. The savings associated with fewer VRE BSI ($123,081), fewer patients with VRE colonization ($2,755), and reductions in antimicrobial use ($179,997) totaled $305,833. Estimated ranges of costs and savings for enhanced infection control strategies were $97,939 to $148,883 for costs and $271,531 to $421,461 for savings.Conclusion:The net savings due to enhanced infection control strategies for 1 year was $189,318. Estimates suggest that these strategies would be cost-beneficial for hospital units where the number of patients with VRE BSI is at least see to nine patients per year or if the savings from fewer VRE BSI patients in combination with decreased antimicrobial use equalled $100,000 to $150,000 per year.

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Linezolid- and Vancomycin-resistant Enterococcus faecium in Solid Organ Transplant Recipients: Infection Control and Antimicrobial Stewardship Using Whole Genome Sequencing

Clinical Infectious Diseases ◽

10.1093/cid/ciy903 ◽

2018 ◽

Vol 69 (2) ◽

pp. 259-265 ◽

Cited By ~ 7

Author(s):

Lilian Abbo ◽

Bhavarth S Shukla ◽

Amber Giles ◽

Laura Aragon ◽

Adriana Jimenez ◽

...

Keyword(s):

Infection Control ◽

Organ Transplant ◽

Solid Organ ◽

Vancomycin Resistant Enterococcus ◽

Transplant Recipients ◽

Laboratory Methods ◽

Staff Members ◽

Vancomycin Resistant Enterococci ◽

Solid Organ Transplant Recipients ◽

Vancomycin Resistant

AbstractBackgroundVancomycin-resistant enterococci are an important cause of healthcare-associated infections and are inherently resistant to many commonly used antibiotics. Linezolid is the only drug currently approved by the US Food and Drug Administration to treat vancomycin-resistant enterococci; however, resistance to this antibiotic appears to be increasing. Although outbreaks of linezolid- and vancomycin-resistant Enterococcus faecium (LR-VRE) in solid organ transplant recipients remain uncommon, they represent a major challenge for infection control and hospital epidemiology.MethodsWe describe a cluster of 4 LR-VRE infections among a group of liver and multivisceral transplant recipients in a single intensive care unit. Failure of treatment with linezolid in 2 cases led to a review of standard clinical laboratory methods for susceptibility determination. Testing by alternative methods including whole genome sequencing (WGS) and a comprehensive outbreak investigation including sampling of staff members and surfaces was performed.ResultsReview of laboratory testing methods revealed a limitation in the VITEK 2 system with regard to reporting resistance to linezolid. Linezolid resistance in all cases was confirmed by E-test method. The use of WGS identified a resistant subpopulation with the G2376C mutation in the 23S ribosomal RNA. Sampling of staff members’ dominant hands as well as sampling of surfaces in the unit identified no contaminated sources for transmission.ConclusionsThis cluster of LR-VRE in transplant recipients highlights the possible shortcomings of standard microbiology laboratory methods and underscores the importance of WGS to identify resistance mechanisms that can inform patient care, as well as infection control and antibiotic stewardship measures.

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