The Epidemiology of Infection With Vancomycin-Resistant Enterococci
Condition: Infection
MeSH terms: Infections; Communicable Diseases
Study type: Observational

Summary: 
      Current projects study veteran patients with chronic ulcers and MRSA colonization and
      infection, patients with imipenem-resistant P. aeruginosa colonization and infection, the
      relationships between staffing pattern, severity of illness and nosocomial infections in
      intensive care units and infection control practices for veteran patients with suspected
      tuberculosis.
    

Detailed description: 
      Nosocomial infections are often caused by antimicrobial-resistant pathogens such as
      vancomycin resistant enterococci (VRE) and are a major cause increased morbidity, mortality
      and cost in hospitalized patients. Nosocomial bloodstream infections (BSI) add 7 to 21 days
      to the length of stay and cost institutions $3,061 to $40,000. The average cost of treating
      patients with VRE BSI has been estimated as 30% more than vancomycin sensitive enterococcal
      BSI. In addition, the attributable mortality of VRE BSI has been estimated as 37%. Preventing
      VRE infection and VRE transmission is clearly important and understanding the risk factors
      for each is a necessary first step. The goal of this three year study is to identify
      potentially effective interventions for the prevention of VRE infection and colonization
      Before testing interventions, we need to identify risk factors for VRE infection which will
      allow us to (1) identify potentially effective interventions and (2) focus on patients at
      highest risk for VRE infection. We will study the effect of antibiotic use, particularly
      vancomycin, and impaired host defenses on VRE infection in a large cohort study of VRE
      colonized patients. The goal is to develop a statistical model, which will allow us to
      identify alterable risk factors, which could reduce the risk of VRE infection. Many
      case-control studies have been performed to study VRE colonization and infection; however,
      most of these studies were small with insufficient sample sizes for multivariate modeling.
      Vancomycin-resistant enterococci (VRE) can be transmitted from patient to patient. We propose
      to model the ecological relationship between the rate of VRE transmission and the
      pre-existing prevalence of VRE in an ICU to determine whether the relationship is linear or
      exponential. The objective is to determine at what point the rate of transmission increases
      significantly that specific interventions should occur (e.g. reverse isolation of all
      patients, close unit to new admissions). Controlling health care costs is an important part
      of health care today and is particularly important in the capitated reimbursement system that
      VHA is adopting. Potential interventions to prevent VRE infections and VRE transmission must
      be cost-effective to the healthcare system to justify their adoption. The current study will
      quantify the operational costs associated with VRE colonization and infection in hospitalized
      patients compared to their non-colonized counterparts. Patients from the intensive care units
      with and without VRE colonization will be covaried for severity of illness and stratified by
      Major Diagnostic Category (by primary ICD-9 code) and marginal health care costs compared.
      This estimate can then be used to examine the potential cost-effectiveness of identified
      interventions, and to justify the system-wide costs of implementing these interventions.
    

Time perspective: Prospective
Keywords: Infection