NEW YORK (Reuters Health) - A “clinical prediction rule” developed by investigators at Harvard Medical School can be used to identify patients at high risk of harboring vancomycin-resistant enterococci (VRE). By using this rule to target VRE-screening measures and contact isolation precautions, say the authors of a study in which it is described, hospitals may reduce the influx of VRE into their institutions.
VRE is associated with high morbidity and mortality rates and excess health care costs, lead investigator Dr. Evelina Tacconelli and her Boston-based research team note in their report in the October 1 issue of Clinical Infectious Diseases.
And the incidence of VRE is rising. For example, at Beth Israel Deaconess Medical Center, the isolation of VRE from clinical culture samples rose from 0.56 per 1000 patient admissions in 1998 to 1.52 per 1000 in 2001, illustrating the “troubling trend” in increasing incidence and emphasizing the need for limiting its spread.
Dr. Tacconelli’s group conducted a case-control study at Beth Israel, with cases defined as those patients from whom VRE was isolated from a clinical culture sample within 48 hours of hospital admission. For each of the 116 cases, one control subject was selected from adult patients from whom enterococci were not isolated.
The investigators identified six risk factors associated with VRE recovery: recovery of methicillin-resistant staphylococcus aureus during the previous year, long-term hemodialysis, transfer from a long-term care facility or hospital, exposure to two or more antibiotics within the previous 30 days, hospitalization within the last year, and age 60 years or older.
They then validated the prediction rule using data from Brigham and Women’s Hospital, where 45 cases and 135 controls were identified. Each risk factor was assigned a value of 2 to 4 points.
When 10 points was used as the cutoff for predicting VRE-positivity, the sensitivity of the prediction rule was 44% and the specificity was 98%, the report indicates.
The authors therefore recommend that VRE screening, using rectal swab samples, be restricted to patients with a point score of 10 or higher at hospital admission. VRE infection-control precautions would immediately be applied until screening rectal cultures results are available.
“The benefit of early detection is obvious,” they maintain, “because the time period in which VRE dissemination could occur would be greatly isolated.”
Source: Clin Infect Dis 2004;39:964-970. [ Google search on this article ]
MeSH Headings: Biological Phenomena : Biological Phenomena, Cell Phenomena, and Immunity : Biological Sciences : Biology : Drug Resistance, Microbial : Genetics : Genetics, Microbial : Microbiologic Phenomena : Penicillin Resistance : Pharmacogenetics : Methicillin Resistance : beta-Lactam Resistance : Vancomycin Resistance : Biological Sciences
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