497. Scoring System for the Prediction of Vancomycin-Resistant enterococci Pre-colonization at Admission to Intensive Care Unit
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: The endemic state of vancomycin-resistant enterococci (VRE) in the intensive care unit (ICU) is achieved by both influx of VRE from newly admitted patients who are colonized already and cross-transmission between inpatients. To detect an influx of VRE, active surveillance culture program has been operated. However, it takes about 3-5 days to detect VRE, and it leads to a delayed identification of VRE-colonized patients with early transmission to others.
Methods: This study was conducted with patients who admitted to ICU in Korea University Guro hospital from January 2008 to February 2009. Active surveillance culture was done within 48 hours in all patients who admitted to ICU. Patients who transferred from general ward were excluded. Risk factors for VRE pre-colonization were found out and we designed a scoring system which predicts the possibility of VRE pre-colonization at admission to ICU.
Results: During the study period, VRE surveillance culture was done in 1,217 patients. VRE was isolated in 29 (2.4%) patients and 17 patients admitted directly to ICU from community or other hospital. High Charlson score (OR 1.714, 95% CI 1.234-2.380) and use of cephalosporin within 3 months (OR 6.889, 95% CI 1.461-32.48) were significant risk factors for pre-colonization of VRE. The equation of scoring was as follows: -3.841 + 0.539 x Charlson score + 1.930 x cephalosporin use within recent 3 months. Given the cut off value as -1.9554, sensitivity of this scoring system was 94.1% and specificity was 72.5%.
Conclusions: Pre-emptive isolation of high risk patients of VRE pre-colonization based on the scoring system would control influx and spread of VRE in ICU.
Hee Jin Cheong, MD1, Won Suk Choi, MD2, Jung Yeon Heo, MD1, Yu Mi Jo, MD, Woo Joo Kim, MD4, Ji Yun Noh, MD1, Joon Young Song, MD1 and  J. Noh, None..
J. Heo, None..
Y. Jo, None..
W. Choi, None..
J. Song, None..
H. Cheong, None..
W. Kim, None., (1)Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea, (2)Internal Medicine, Korea University College of Medicine, Seoul, South Korea, (3)Korea University, Seoul, South Korea