Controlling the spread of vancomycin-resistant enterococci. Is active screening worthwhile?

Vancomycin-resistant enterococci (VRE) are significant causes of healthcare-acquired infections. Active screening, i.e. the use of rectal swabs or faeces to detect carriage in at-risk patients, has been described as contributing to prevention by identifying previously unrecognized cases. The aim of this review was to determine the impact of screening for VRE on prevention and control, its cost-effectiveness and recent approaches to laboratory detection. A review of published studies in English from 2000 was undertaken. Whereas various guidelines were accessed and reviewed, the emphasis was on original reports and studies. It was determined that the patient groups who may need screening are those admitted to critical care units, haematology/oncology and transplant wards, patients on chronic dialysis and patients admitted to acute hospitals from long-stay units. Active screening is associated with reduced VRE colonization and infection and cost savings in some studies, even if these fall short of randomized trials. Selective media increase sensitivity and reduce the time to detection but the role of molecular methods remains to be determined. In conclusion, active screening contributes to VRE prevention probably by heightening awareness of control measures, including isolation. However, further studies are required to: better define high-risk groups that warrant screening; quantify the clinical and economic benefit; and determine the optimal laboratory methods in a range of different patient populations.