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Table 2 Study results – reductions in vancomycin use and changes in VRE

From: Does vancomycin prescribing intervention affect vancomycin-resistant enterococcus infection and colonization in hospitals? A systematic review

Reference

Vancomycin use % reduction

VRE acquisition absolute change

VRE acquisition percentage change

Significant change in VRE acquisition?

RR of VRE after intervention(s)

(95% CI)

Rubin et al [26], 1992

66%

-.157 proportion of patients colonized (prevalence)

-82.5%

p = 0.023 (FET)

0.17 (0.04, 0.72)

Morris et al [20], 1995

66%

-0% mean rate of stool colonization (prevalence)

0%

NS

0.96 (0.59, 1.57)

Quale et al [27], 1996a

44%

-32% point prevalence of fecal colonization

-2.1 new patients with positive cultures per month (incidence)

-68% (prevalence)

-39% (incidence)

p < 0.001 (prevalence)

p = 0.03 (incidence)

0.32 (0.22, 0.46) (prevalence)

* (incidence)

Anglim et al [28], 1997

47%

-0.52 cases/day (incidence)

-52.2%

Chi-square test for trend, 16.6; p = 0.002

0.48 (0.31, 0.75)

Morgan et al [29], 1997

9%

-0% of all enterococcal isolates resistant to vancomycin (incidence)

0%

NS

1 (*)

Adachi et al [30], 1997

54%

"No further increase" (incidence)

~0%

NS

1.75 (*)

Lai et al [31], 1998b

25%

+2.46 cases/month (incidence)

+33.5%

*

1.33 (*)

Montecalvo et al [42], 1999

28%

-10.4 pts/1,000 pt-days (colonization)

-1.65 pts/1,000 pt-days (BSI) (incidence)

-50% (colonization)

-79% (BSI)

p < 0.001 (colonization)

p = 0.04 (BSI)

0.5 (0.33, 0.75) (colonization)

0.22 (0.05, 0.92) (BSI)

Shaikh et al [33], 2002

50% (g/1,000 pt-days)

53% ($/1,000 pt-days)

-0.21 cases/1,000 pt-days (total incidence)

-0.157/1,000 pt-days (BSI) (incidence)

-48% (total incidence)

-46% (BSI)

p = 0.008 (total infections)

p = 0.027 (BSI)

0.52* (total incidence)

0.54* (BSI)

Fridkin et al [34], 2002c

35–37% median difference

-7.5% mean difference in prevalence

Unable to calculate with provided data

"Statistical significance" *

*

Lautenbach et al. [35], 2001d

Period 3 vs. 1: 26.3%

Period 2 vs. 1: 8.1%

Period 3 vs. 2: 19.8%

% of enterococcal isolates resistant to vancomycin (prevalence):

Period 3 vs. 1: +9.5%

Period 2 vs. 1: +7.6%

Period 3 vs. 2: +1.9%

Period 3 vs. 1: +54.6%

Period 2 vs. 1: +43.7%

Period 3 vs. 2: +7.6%

p < 0.001 (detected with χ2 test for trend)

Period 3 vs. 1: 1.55 (1.37, 1.74)

Period 2 vs. 1: 1.44 (1.27, 1.62)

Period 3 vs. 2: 1.076 (0.968, 1.195)

Guglielmo et al. [36] 2005 (hospital-wide study)

86.7% inappropriate use

+7.94 infections/month (incidence)

475%

*

5.77 (*)

Guglielmo et al. [36] (ICU-specific study)

33.4% inappropriate use

-1.17 infections/month

-4.1 infections/1,000 pt days (incidence)

-48% (infections/month), -65.1% (infections/1,000 pt days)

p = 0.0003 (infections/1,000pt-days)

0.517 (infections/month), 0.35 (0.22, 0.57) (infections/1,000 pt days)

  1. Abbreviations: FET = Fisher's exact test, NS = not significant, BSI = blood stream infection
  2. *Insufficient data reported to perform calculation
  3. aQuale: only prevalence data used to calculate significance, RR (CI); insufficient data to calculate for incidence
  4. bLai: data on VRE incidence are from five months prior to intervention and final five months of follow up
  5. cFridkin: includes only data from ICUs implementing unit-specific change
  6. dLautenbach: table includes data from initial three of four study periods; following are data from the fourth period compared with the first: increase in vancomycin use of 15.5%, VRE absolute change +6% of enterococcal isolates resistant to vancomycin, VRE acquisition % change +66.7%, significant increase with p < 0.001, RR = 1.70 (1.53, 1.89)
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BMC Infectious Diseases

ISSN: 1471-2334

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