Evaluation of Vancomycin-Resistant Enterococci (VRE)–Associated Morbidity Following Relaxation of VRE Screening and Isolation Precautions in a Tertiary Care Hospital
Bibliographic record
Abstract
OBJECTIVE: To determine whether relaxing vancomycin-resistant enterococci (VRE) precautions results in an increase in the incidence of invasive VRE infections over time. DESIGN: Retrospective analysis of a microbiology database before and after relaxation of VRE screening and isolation precautions. SETTING: Urban tertiary care teaching hospital in Montreal, Canada. PARTICIPANTS: All hospitalized and emergency room patients over a 13-year period from January 1, 2000, to March 31, 2013. METHODS: We assessed the results of all microbiology cultures for the presence of VRE as well as the results of all polymerase chain reaction assays for vanA and vanB during the study period. Applying criteria for 4 clinical situations (bacteremia, definite infection, possible infection, and colonization with VRE), we analyzed the effects of relaxed VRE screening and isolation precautions on the incidence of each of these outcomes over the time preceding and following this change. RESULTS: When VRE screening and isolation precautions were relaxed, a marked rise in VRE colonization was observed, with a lesser but definite rise in the 3 other outcomes. Despite this initial rise in all measures, all incidences other than colonization plateaued during the 34 months of follow-up. CONCLUSIONS: Relaxation of VRE screening and isolation precautions was associated with an immediate increase in colonization and infection incidence. Despite increasing colonization, infection outcomes remained infrequent and stable, suggesting a finite number of susceptible hosts at risk. Relaxation of VRE protocols may not lead to increasing infection incidence in a hospital setting, advocating that cost effectiveness exercises, with targeted screening and isolation precautions, are crucial.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".