In 2015–2016, the incidence rate of healthcare-associated VRE infection (cat. 1a and 1b) was 0.16 per 10,000 patient days for healthcare facilities participating to the last year (Table 2) and was 0.16 per 10,000 patient days for healthcare facilities participating to the last five years (Table 3).  

In the health region of Montreal (06 HR), teaching healthcare facilities have a twofold higher healthcare-associated VRE infection incidence rate than non-teaching facilities (Table 2).

Table 2 – Incidence Rate and Percentile Distribution of Healthcare-Associated VRE Infection (Cat. 1a and 1b) by Type of Facility and Regional Categories, Québec, 2015–2016 (Incidence Rate per 10,000 Patient Days [95% CI])

HR: Health region.
[I.C. 95%]: 95% confidence interval.

Table 3 – Change in Incidence Rate of Healthcare-Associated VRE Infection (Cat. 1a and 1b) by Type of Facility and Regional Category, Québec, 2011–2012 to 2015–2016 (Incidence Rate per 10,000 Patient Days [95% CI])

HR: Health region
* Data are those from facilities that participated in surveillance for at least 11 periods for each year between 2011-2012 and 2015-2016.

In total, 89 cases of VRE infection were reported: 82 (92.1%) were identified in patients who acquired VRE infection during a current hospital stay (72 patients), a previous hospital stay (6 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). A total of 7 cases were associated to another facility, community and unknown (cat. 2, 3 and 4) (Table 4). Among the 89 VRE infections, 48 infections were from known colonized cases.

Table 4 – Cases of VRE Infection by Presumed Origin of Acquisition, Québec, 2015–2016 (N, %)

In 2015-2016, among 89 infections, 15 primary bloodstream infections (BSI) and 13 secondary bloodstream infections have been reported (Table 5). The number of BSI observed in 2015-2016 is decreasing as compared to 2014-2015 (N = 23).

Table 5 – Number of Cases of VRE Infection from All Origins by Type of Infection and Number of Complications (Secondary BSIs), Québec, 2015–2016 (N = 89)

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 16 deaths within 30 days were observed in 2015-2016, yielding a case fatality of 18.0% (Table 6). Since 2011-2012, the case fatality is stable from 18.0% to 19.2%.

Table 6 – Number of Deaths and 30-days Case Fatality Related to VRE Infections, Québec, 2011-2012 to
2015-2016

In 2015-2016, the acquisition rate of healthcare-associated VRE colonization (cat. 1a and 1b) was 9.76 per 10,000 patient days in healthcare facilities participating at the least year of surveillance (Table 11) and was 9.60 per 10,000 patient days in those participating at the least five year of surveillance (Table 7). In the health region of Montreal (06 HR) and others, the acquisition rate of healthcare-associated VRE colonization in non-teaching facilities was higher to the one in teaching facilities (Table 7). This trend is similar to 2014-2015.

Table 7 – Change in the Number of Cases and Acquisition Rate of Healthcare-associated VRE Colonization (Cat. 1a and 1b) by Type of Facility and Regional Category, Québec, 2011-2012 to 2015-2016 (Acquisition rate of Healthcare-Associated VRE colonization per 10,000 patient days)

* HR: Health region * Number of healthcare facilities participating in each of the five years of surveillance.
¥ Significant statistical difference (p ˂ 0.05) between acquisition rate of HA-VRE colonization of 2014-2015 and 2015-2016.

Table 8 shows the number of non-teaching facilities that specified the type of screening used at admission (55 out of 63) and during hospitalization (53 out of 63). The majority of teaching facilities specified the type of screening used at admission (23 out of 26) and during hospitalization (23 out of 26). Only two teaching facilities from the health region of Montreal and one from other health region did not identify the total type of screening.

Table 8 – Number of Healthcare Facilities that specified the type of Screening Procedure Used at Admission and During Hospitalization by Type of Facility and Regional Category, Québec, 2015-2016

* 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 Facility and Regional Category, Québec, 2015-2016

HR: Health region.

Table 10 – Mean Number of VRE Screening Score by Type of Healthcare Facility and Regional Categories, Québec, 2015-2016 (Mean VRE Screening Tests per Admission)

 * The mean numbers of VRE screening score at admission and during hospitalization are not additive.
HR: Health region.

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 and 1b) for Healthcare Facilities from the health region of Montreal, Québec, 2015-2016 (Incidence Rate per 10,000 patient days)

NB: Facilities 6, 12, 13, 34, 38, 48, 76, 80, 83 and 118 did not report any cases of infection in 2015-2016.

Figure 2 – Incidence Rate and Percentile Ranking of Healthcare-Associated VRE Infection (Cat. 1a and 1b) for Healthcare Facilities outside Heath Region of Montreal, Québec, 2015-2016 (Incidence Rate per 10,000 patient days)

NB: Facilities 2, 7, 10, 11, 15, 16, 18, 20, 23, 24, 27, 28, 30, 31, 32, 33, 37, 39, 41, 42, 44, 45, 47, 49, 51, 52, 53, 56, 58, 59, 61, 64, 65, 67, 70, 71, 72, 74, 75, 77, 81, 82, 84, 85, 86, 88, 89, 91, 95, 96, 97, 99, 100, 103, 107, 109, 111, 112, 113 and 130 did not report any cases of infection in 2015-2016.

Figure 3 – Acquisition Rate of Healthcare-Associated VRE Colonization (Cat.1a and 1b) in Healthcare Facilities from the Health Region of Montreal, Québec, 2015-2016 (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 2015-2016.

Figure 4 – Acquisition Rate of Healthcare-Associated VRE Colonization (Cat.1a and 1b) in Healthcare Facilities outside Heath Region of Montreal, Québec, 2015-2016 (Acquisition Rate of Healthcare-Associated VRE Colonization per 10,000 patient days)

NB: Facilities 16, 20, 32, 49, 59, 61, 64, 67, 70, 71, 72, 74, 75, 84, 86, 88, 89, 91, 97, 100, 107, 109 and 112 did not report any cases of infection in 2015 2016.

At the local level, in 2015-2016, the incidence rate of HA-VRE infection ranged from 0 to 1.18 per 10,000 patient days, whereas the acquisition rate of HA-VRE colonization ranged from 0 to 60.23 per 10,000 patient days. A total of 25 facilities (28.1%) did not report any HA-VRE infection or colonization in 2015-2016. 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 and 1b), Acquisition Rate of Healthcare-Associated VRE Colonization and Mean VRE Screening Tests by Admission and by Facility, Québec, 2015-2016 (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 admisions.

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

Danielle Moisan, Centre hospitalier régional du Grand-Portage

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

Isabelle Rocher, 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

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