Vancomycin-Resistant Enterococci (VRE) Infections : surveillance results 2014–2015

In 2014–2015, the incidence rate of healthcare-associated VRE infection (cat. 1a + 1b) was 0.18/10,000 patient days (Table 2).  

In the health region of Montreal, teaching healthcare facilities have a threefold higher healthcare-associated incidence VRE infection rate than non teaching facilities (Table 2).

Table 2 – Incidence Rate and Percentile Distribution of Healthcare-Associated VRE Infection (Cat. 1a + 1b) by Type of Healthcare Facility, Québec, 2014–2015 (Incidence Rate per 10,000 Patient Days [95% CI])

[I.C. 95%] : 95% confidence interval.
^¥ Significant statistical difference (p < 0.05) between non-teaching and teaching healthcare facilities form the health region of Montreal.

The incidence rate of healthcare-associated VRE infections in 2014-2015 was stable as compared to 2013-2014 (Table 3).

Table 3 – Change in Incidence Rate of Healthcare-Associated VRE Infection (Cat. 1a + 1b) by Type of Healthcare Facility, Québec, 2011–2012 to 2014–2015 (Incidence Rate per 10,000 Patient Days [95% CI])

NB: Facilities that have been analyzed are those participating in surveillance in 2014-2015 and at least 11 periods of each 2011-2012 to 2013-2014 years.

In total, 103 cases of VRE infection were reported: 91 (88.3%) were identified in patients who acquired VRE infection during a current hospital stay (84 patients), a previous hospital stay (3 patients) or in ambulatory care of the reporting facility (4 patients) (cat. 1a, 1b and 1c.). A total of 12 cases were associated to another facility, community or unknown (cat. 2, 3 and 4) (table 4). Among the 103 VRE infections, 63 infections were from known colonized cases. A total of 53 cases were of category 1a, 1 case of category 1b, 3 cases of category 1c, 5 cases of category 3 and 1 case of category 4.

Table 4 – Cases of VRE Infection by Presumed Source of Acquisition, Québec, 2014–2015 (N, %)

In 2014-2015, among 103 infections, 23 primary bloodstream infections (BSI) and 13 secondary bloodstream infections have been reported (Table 5).

Table 5 – Number of Cases of VRE Infection from All Sources by Type of Infection and Number of Complications (Secondary BSIs), Québec, 2014–2015 (N = 103)

BSI : bloodstream infection
CRBSI : catheter-related bloodstream infection
MBI : mucosal barrier injury
Non-CRBSI : non- catheter-related primary bloodstream infection
HD: hemodialysis

A total of 18 deaths within 30 days were observed, yielding a case fatality of 17.5% (Table 6). Since 2011-2012, the case fatality decreased from 19% to 17.5% (non significant).

Table 6 – Number of Deaths and 30-days case fatality Related to VRE Infection, Québec, 2011-2012 to 2014-2015

In 2014-2015, the acquisition rate of healthcare-associated VRE colonization (cat. 1a + 1b) was 10.99 / 10,000 patient days. In the health region of Montreal, the acquisition rate of healthcare-associated VRE colonization in teaching facilities was almost identical to the one in non-teaching facilities (Table 7).

Table 7 – Change in the Number of Cases and Acquisition rate of Healthcare-associated VRE colonization (Cat. 1a + 1b) by type of Healthcare facility, Québec, 2011-2012 à 2014-2015 (Acquisition rate of Healthcare-Associated VRE colonization per 10,000  patient days)

Table 8 shows the number of non teaching facilities that identified the type of screening used at admission (57 out of 63) and during hospitalization (57 out of 63). The majority of teaching facilities identified the type of screening used at admission (24 out of 26) and during hospitalization (24 out of 26). Only two facilities (one teaching and one non-teaching) did not identify the total type of screening.

Table 8 – Number of Healthcare Facilities that Identified the type of Screening Procedure Used at Admission and During Hospitalization by Type of Facility, Québec, 2014-2015

^* The number of facilities that reported the type of screening procedures used at admission and during hospitalization is not additive.
HR: Health region.

Tables 9 and 10 feature the total number of screening tests performed at admission and during hospitalization, as well as the mean number of VRE screening tests.

Table 9 – Total Number of Screening Tests Performed at Admission and During Hospitalization by Type of Healthcare Facility, Québec, 2014-2015

Table 10 – Mean Number of VRE Screening Score by Type of Healthcare Facility, Québec, 2014-2015 (Mean VRE Screening Tests per Admission)

^*The mean numbers of VRE screening score at admission and during hospitalization are not additive.

The incidence rate of HA-VRE infection and the percentile rankings by type of facility are shown in Figure 1 and 2. Figures 3 and 4 feature the rate of acquisition and percentile ranking of HA-VRE colonization by type of facility.

Figure 1 – Incidence Rate and Percentile Ranking of Healthcare-Associated VRE infection (Cat. 1a + 1b) for Healthcare Facilities from the health region of Montreal, Québec, 2014-2015 (Incidence Rate per 10,000 Patient Days)

NB : Facilities 6, 12, 13, 38, 48, 76, 80, 83, 116 and 118 did not report any cases of infection in 2014-2015.

Figure 2 – Incidence Rate and Percentile Ranking of Healthcare-Associated VRE infection (Cat. 1a + 1b) for Healthcare Facilities outside Heath Regions of Montreal, Québec, 2014-2015 (Incidence Rate per 10,000 Patient Days)

NB : Facilities 2, 10, 11, 14, 15, 16, 18, 20, 23, 24, 27, 28, 30, 31, 32, 33, 37, 39, 40, 41, 44, 47, 49, 51, 52, 53, 56, 59, 61, 63, 64, 65, 67, 70, 71, 72, 74, 75, 77, 81, 82, 84, 85, 86, 88, 89, 91, 95, 96, 97, 99, 103, 107, 109, 111, 112, 113 and 130 did not report any cases of infection in 2014-2015.

Figure 3 – Acquisition Rate of Healthcare-Associated VRE Colonization (Cat.1a + 1b) in Healthcare Facilities from the health region of Montreal, Québec, 2014-2015 (Acquisition Rate of Healthcare-Associated VRE colonization per 10,000 patient days)

NB : Facilities 6 and 12 did not report any cases of infection in 2014-2015.

Figure 4 – Acquisition Rate of Healthcare-Associated VRE Colonization (Cat.1a + 1b) in Healthcare Facilities outside Heath Regions of Montreal, Québec, 2014-2015 (Acquisition Rate of Healthcare-Associated VRE colonization per 10,000 patient days)

NB : Facilities 23, 49, 53, 61, 64, 67, 71, 72, 75, 85, 86, 88, 89, 91, 97, 107, 109 and 112 did not report any cases of infection in 2014‑2015.

At the local level, in 2014-2015, the incidence rate of HA-VRE infection ranged from 0 to 2.00 * 10,000 patient days, whereas the acquisition rate of HA-VRE colonization ranged from 0 to 63.05 / 10,000 patient days. A total of 20 facilities (22.5%) did not report any HA-VRE infection or colonization in 2014-2015. A detailed summary of the surveillance data for HA-VRE infection by healthcare facility can be found in Table 11.

Table 11 – Incidence Rate of Healthcare-Associated VRE Infection (cat. 1a + 1b), Acquisition Rate of Healthcare-Associated VRE Colonization and Mean VRE Screening Tests by Admission and by Facility, Québec, 2014-2015 (Incidence Rate per 10,000 patient days [95% CI]; Acquisition Rate of Colonization per 10,000 patient days)

^*   Number of screening test divided by number of admissions.

Comité de surveillance provinciale des infections nosocomiales (SPIN)

Editorial committee 

Christophe Garenc, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

Muleka Ngenda-Muadi, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

Mélissa Trudeau, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

Patrice Vigeant, CISSS de la Montérégie-Ouest - Hôpital du Suroît