Impact of a vancomycin-resistant Enterococcus (VRE) screening result on appropriateness of antibiotic therapy

Objective: Vancomycin-resistant Enterococcus (VRE) infections have been associated with increased mortality and poor outcomes. VRE screening has been used to identify colonized patients to prevent transmission; however, little is known about the utility of screening results to guide antibiotic therapy. Design and setting: A retrospective review was performed at a tertiary-care center between June 1, 2015, and May 31, 2018. Patients: All patients who underwent VRE polymerase chain reaction assay (PCR) screening and had a bacterial culture from 7 days before to 90 days after the screening test were included. In total, 1,374 patients who had a VRE screening test met inclusion criteria. Methods: Sensitivity, specificity, and positive and negative predictive values of VRE screening for VRE infection were calculated. The appropriateness of the antibiotic therapy for each patient based on screening results was also assessed. Results: We detected no difference in the appropriateness of antibiotic therapy between patients with a positive screen and those with a negative screen (59.3% vs 61.0%; P = .8657). The VRE PCR demonstrated 54% sensitivity, 89% specificity, a positive predictive value (PPV) of 13% and a negative predictive value (NPV) of 98%. Conclusions: The high NPV and specificity indicate that patients with a negative VRE screening results may not require empiric antibiotic coverage for VRE. Although VRE screening may have utility to detect colonization in high-risk patients, a positive VRE screen is of limited value in determining the need for an antibiotic with VRE culture-directed coverage.