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Abstract

Background

Evidence supporting the effectiveness of single-room contact precautions (SCP) in preventing in-hospital acquisition of vancomycin-resistant enterococci (haVRE) is limited.

Aim

We assessed the impact of SCP on haVRE and their transmission.

Methods

We conducted a prospective, multicentre cohort study in German haematological/oncological departments during 2016. Two sites performed SCP for VRE patients and two did not (NCP). We defined a 5% haVRE-risk difference as non-inferiority margin, screened patients for VRE, and characterised isolates by whole genome sequencing and core genome MLST (cgMLST). Potential confounders were assessed by competing risk regression analysis.

Results

We included 1,397 patients at NCP and 1,531 patients at SCP sites. Not performing SCP was associated with a significantly higher proportion of haVRE; 12.2% (170/1,397) patients at NCP and 7.4% (113/1,531) patients at SCP sites (relative risk (RR) 1.74; 95% confidence interval (CI): 1.35–2.23). The difference (4.8%) was below the non-inferiority margin. Competing risk regression analysis indicated a stronger impact of antimicrobial exposure (subdistribution hazard ratio (SHR) 7.46; 95% CI: 4.59–12.12) and underlying disease (SHR for acute leukaemia 2.34; 95% CI: 1.46–3.75) on haVRE than NCP (SHR 1.60; 95% CI: 1.14–2.25). Based on cgMLST and patient movement data, we observed 131 patient-to-patient VRE transmissions at NCP and 85 at SCP sites (RR 1.76; 95% CI: 1.33–2.34).

Conclusions

We show a positive impact of SCP on haVRE in a high-risk population, although the observed difference was below the pre-specified non-inferiority margin. Importantly, other factors including antimicrobial exposure seem to be more influential.

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2022-01-13
2024-04-18
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2022.27.2.2001876
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Impact of single-room contact precautions on acquisition and transmission of vancomycin-resistant enterococci on haematological and oncological wards, multicentre cohort-study, Germany, January−December 2016
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Lena+M.+Biehl&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Biehl Lena M.</a>, <a href="/search?value1=Paul+G.+Higgins&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Higgins Paul G.</a>, <a href="/search?value1=Jannik+Stemler&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Stemler Jannik</a>, <a href="/search?value1=Meyke+Gilles&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gilles Meyke</a>, <a href="/search?value1=Silke+Peter&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Peter Silke</a>, <a href="/search?value1=Daniela+D%C3%B6rfel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dörfel Daniela</a>, <a href="/search?value1=Wichard+Vogel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vogel Wichard</a>, <a href="/search?value1=Winfried+V.+Kern&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kern Winfried V.</a>, <a href="/search?value1=Hanna+G%C3%B6lz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gölz Hanna</a>, <a href="/search?value1=Hartmut+Bertz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bertz Hartmut</a>, <a href="/search?value1=Holger+Rohde&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rohde Holger</a>, <a href="/search?value1=Eva-Maria+Klupp&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Klupp Eva-Maria</a>, <a href="/search?value1=Philippe+Schafhausen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schafhausen Philippe</a>, <a href="/search?value1=Jon+Salmanton-Garc%C3%ADa&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Salmanton-García Jon</a>, <a href="/search?value1=Melanie+Stecher&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Stecher Melanie</a>, <a href="/search?value1=Julia+Wille&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wille Julia</a>, <a href="/search?value1=Blasius+Liss&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Liss Blasius</a>, <a href="/search?value1=Kyriaki+Xanthopoulou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Xanthopoulou Kyriaki</a>, <a href="/search?value1=Janine+Zweigner&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zweigner Janine</a>, <a href="/search?value1=Harald+Seifert&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Seifert Harald</a>, <a href="/search?value1=Maria+J.G.T.+Vehreschild&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vehreschild Maria J.G.T.</a></span>. Impact of single-room contact precautions on acquisition and transmission of vancomycin-resistant enterococci on haematological and oncological wards, multicentre cohort-study, Germany, January−December 2016. <a href="/content/ecdc">Euro Surveill.</a> 2022;27(2):pii=2001876. <a href="https://doi.org/10.2807/1560-7917.ES.2022.27.2.2001876" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2022.27.2.2001876</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 28 Oct 2020;&nbsp;&nbsp; <span class="generated">Accepted</span>: 18 Aug 2021 </span> </p>
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