Three surveillance strategies for vancomycin-resistant enterococci in hospitalized patients: detection of colonization efficiency and a cost-effectiveness model

Infect Control Hosp Epidemiol. 2005 Jan;26(1):39-46. doi: 10.1086/502485.


Objective: To evaluate the cost-effectiveness and detection sensitivity associated with three active surveillance strategies for the identification of patients harboring vancomycin-resistant enterococci (VRE) to determine which is the most medically and economically useful.

Design: Culture for VRE from 200 consecutive stool specimens submitted for Clostridium difficile culture. Following this, risk factors were assessed for patients whose culture yielded VRE, and a cost-effectiveness evaluation was performed using a decision analytic model with a probabilistic analysis.

Setting: A 688-bed, tertiary-care facility in Chicago, Illinois, with approximately 39,000 annual admissions, 7,000 newborn deliveries, 56,000 emergency department visits, and 115,000 home care and 265,000 outpatient visits.

Subjects: All stool specimens submitted to the clinical microbiology laboratory for C. difficile culture from hospital inpatients.

Results: From 200 stool samples submitted for C. difficile testing, we identified 5 patients with VRE in non-high-risk areas not screened as part of our routine patient surveillance. Medical record review revealed that all 5 had been hospitalized within the prior 2 years. Three of 5 had a history of renal impairment. The strategy that would involve screening the greatest number of patients (all those with a history of hospital admission in the prior 2 years) resulted in highest screening cost per patient admitted (dollars 2.48), lower per patient admission costs (dollars 480), and the best survival rates.

Conclusion: An expanded VRE surveillance program that encompassed all patients hospitalized within the prior 2 years was a cost-effective screening strategy compared with a more traditional one focused on high-risk units.

MeSH terms

  • Carrier State / diagnosis*
  • Carrier State / microbiology
  • Clostridioides difficile / isolation & purification
  • Cost-Benefit Analysis
  • Enterococcus / isolation & purification*
  • Feces / microbiology
  • Gram-Positive Bacterial Infections / diagnosis*
  • Hospitalization
  • Humans
  • Infection Control / economics
  • Infection Control / methods
  • Models, Economic
  • Sentinel Surveillance*
  • Vancomycin Resistance*