Vancomycin Resistant Enterococcus(VRE) Surveillance in Canada: The Beginning of a New Era.

Marianna Ofner, John Conly, Amar Kureishi, Shirley Paton*, Lindsay Nicolle, Wendy Johnson, Lyn Johnston and CHEC members.

Canadian Nosocomial Infection Surveillance Program(CNISP), Health Canada, The Toronto Hospital, Calgary Foothills Hospital, Winnipeg Health Sciences Centre, Halifax Queen Elizabeth II and the Canadian Hospital Epidemiology Committee members(CHEC)

With the recognition of a new era of nosocomial antibiotic resistant organisms in Canadian health care facilities, 2 studies were conducted to determine the extent and current control measures of VRE within CHEC member institutions (n=21). CHEC member institutions are located geographically across Canada, include both paediatric and adult institutions, and are largely tertiary care teaching hospital. Fifty-seven percent (12/21) of the sites reported performing various methods of surveillance for VRE within their institutions. A total of 2690 specimens were tested for VRE. Four sites identified a total of 34 VRE isolates(with MIC levels ranging from 8-128), 31 patients were colonized and 3 infected. Nine institutions (43%) reported restricted use of vancomycin, including 3 with only oral vancomycin restrictions. The average amount of vancomycin dispensed by the hospital pharmacies per patient /year from 1991 to 1994 showed significant increases over time(r=0.94). Sixty-seven percent(67%) of the hospitals have some method of flagging charts of known VRE patients. Forty-three percent(43%) of the CHEC members have not performed active surveillance for VRE and those who have performed surveillance have done so with significant variations in methods and patient groups. To date, only one of the CHEC member sites has reported an outbreak of VRE, which occurred on a renal ward in a tertiary care teaching institution. In order to determine the prevalence of VRE colonization and/ or infection within high risk groups a National sentinel health care institution VRE point prevalence surveillance project will be implemented in January 1996. Standardized epidemiological and laboratory information will be collected.