Friday, 6 September 2013

Changing ‘superbug’ control policies

allenandsurendra125Patients are usually kept in isolation from other patients in hospitals if they harbour multi-drug resistant bacteria, commonly known as ‘superbugs’. Vancomycin-resistant enterococcus (VRE) is one such superbug that has been relatively common in Australian hospitals. It had been unclear how long people may carry VRE once they acquire it in their bowel. Therefore, many hospitals had a policy of regarding previously colonized patients as being potentially infectious whenever they were admitted to hospital, even if the VRE had been detected many years before.

A recent study published in the Journal of Clinical Microbiology showed that this policy of ‘Once VRE, always VRE’ may not be necessary. It found that carriage of VRE appears to be rare after 4 years from initial detection and that the majority of patients clear VRE in the first 1-2 years after detection. This implies that a life-long isolation policy is not justified; particularly since isolation has shown to have adverse impacts on patient care and safety. Patients who reported recent antibiotic use had a higher risk of continued carriage of VRE, and this, together with other emerging evidence suggests that antibiotics may play a more important role than cross transmission in maintaining VRE in hospitals.

This study has resulted in a change to VRE control policies at The Alfred Hospital and was funded by Alfred Health. This work is part of Surendra Karki’s doctoral studies supervised by Associate Professor Allen Cheng and Associate Professor Karin Leder. This was a joint project between the Infectious Disease Epidemiology Unit at the SPHPM, the Microbiology Laboratory at The Alfred Hospital and the Austin Hospital.

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