Impact of a vancomycin-resistant Enterococcus (VRE) screening result on appropriateness of antibiotic therapy
Abstract Objective: Vancomycin-resistant Enterococcus (VRE) infections have been associated with increased mortality and poor outcomes. VRE screening has been used to identify colonized patients to prevent transmission; however, little is known about the utility of screening results to guide antib...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2021-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X21002151/type/journal_article |
| _version_ | 1811157239309795328 |
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| author | Jenna L. Reynolds Raelene E. Trudeau Maria Teresa Seville Lynn Chan |
| author_facet | Jenna L. Reynolds Raelene E. Trudeau Maria Teresa Seville Lynn Chan |
| author_sort | Jenna L. Reynolds |
| collection | DOAJ |
| description |
Abstract
Objective:
Vancomycin-resistant Enterococcus (VRE) infections have been associated with increased mortality and poor outcomes. VRE screening has been used to identify colonized patients to prevent transmission; however, little is known about the utility of screening results to guide antibiotic therapy.
Design and setting:
A retrospective review was performed at a tertiary-care center between June 1, 2015, and May 31, 2018.
Patients:
All patients who underwent VRE polymerase chain reaction assay (PCR) screening and had a bacterial culture from 7 days before to 90 days after the screening test were included. In total, 1,374 patients who had a VRE screening test met inclusion criteria.
Methods:
Sensitivity, specificity, and positive and negative predictive values of VRE screening for VRE infection were calculated. The appropriateness of the antibiotic therapy for each patient based on screening results was also assessed.
Results:
We detected no difference in the appropriateness of antibiotic therapy between patients with a positive screen and those with a negative screen (59.3% vs 61.0%; P = .8657). The VRE PCR demonstrated 54% sensitivity, 89% specificity, a positive predictive value (PPV) of 13% and a negative predictive value (NPV) of 98%.
Conclusions:
The high NPV and specificity indicate that patients with a negative VRE screening results may not require empiric antibiotic coverage for VRE. Although VRE screening may have utility to detect colonization in high-risk patients, a positive VRE screen is of limited value in determining the need for an antibiotic with VRE culture-directed coverage.
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| first_indexed | 2024-04-10T05:03:50Z |
| format | Article |
| id | doaj.art-87147458a3404718a2de3b7ad5e61148 |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-04-10T05:03:50Z |
| publishDate | 2021-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-87147458a3404718a2de3b7ad5e611482023-03-09T12:27:47ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2021-01-01110.1017/ash.2021.215Impact of a vancomycin-resistant Enterococcus (VRE) screening result on appropriateness of antibiotic therapyJenna L. Reynolds0https://orcid.org/0000-0003-1591-3681Raelene E. Trudeau1Maria Teresa Seville2Lynn Chan3Department of Pharmacy, Mayo Clinic Hospital, Phoenix, ArizonaDepartment of Pharmacy, University of Texas Southwestern Medical Center, Dallas, TexasDivision of Infectious Diseases, Mayo Clinic Hospital, Phoenix, ArizonaDepartment of Pharmacy, Mayo Clinic Hospital, Phoenix, Arizona Abstract Objective: Vancomycin-resistant Enterococcus (VRE) infections have been associated with increased mortality and poor outcomes. VRE screening has been used to identify colonized patients to prevent transmission; however, little is known about the utility of screening results to guide antibiotic therapy. Design and setting: A retrospective review was performed at a tertiary-care center between June 1, 2015, and May 31, 2018. Patients: All patients who underwent VRE polymerase chain reaction assay (PCR) screening and had a bacterial culture from 7 days before to 90 days after the screening test were included. In total, 1,374 patients who had a VRE screening test met inclusion criteria. Methods: Sensitivity, specificity, and positive and negative predictive values of VRE screening for VRE infection were calculated. The appropriateness of the antibiotic therapy for each patient based on screening results was also assessed. Results: We detected no difference in the appropriateness of antibiotic therapy between patients with a positive screen and those with a negative screen (59.3% vs 61.0%; P = .8657). The VRE PCR demonstrated 54% sensitivity, 89% specificity, a positive predictive value (PPV) of 13% and a negative predictive value (NPV) of 98%. Conclusions: The high NPV and specificity indicate that patients with a negative VRE screening results may not require empiric antibiotic coverage for VRE. Although VRE screening may have utility to detect colonization in high-risk patients, a positive VRE screen is of limited value in determining the need for an antibiotic with VRE culture-directed coverage. https://www.cambridge.org/core/product/identifier/S2732494X21002151/type/journal_article |
| spellingShingle | Jenna L. Reynolds Raelene E. Trudeau Maria Teresa Seville Lynn Chan Impact of a vancomycin-resistant Enterococcus (VRE) screening result on appropriateness of antibiotic therapy Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Impact of a vancomycin-resistant Enterococcus (VRE) screening result on appropriateness of antibiotic therapy |
| title_full | Impact of a vancomycin-resistant Enterococcus (VRE) screening result on appropriateness of antibiotic therapy |
| title_fullStr | Impact of a vancomycin-resistant Enterococcus (VRE) screening result on appropriateness of antibiotic therapy |
| title_full_unstemmed | Impact of a vancomycin-resistant Enterococcus (VRE) screening result on appropriateness of antibiotic therapy |
| title_short | Impact of a vancomycin-resistant Enterococcus (VRE) screening result on appropriateness of antibiotic therapy |
| title_sort | impact of a vancomycin resistant enterococcus vre screening result on appropriateness of antibiotic therapy |
| url | https://www.cambridge.org/core/product/identifier/S2732494X21002151/type/journal_article |
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