Guest post from Prof Dale Fisher (bio below). Please help Dale out by completing this survey. I found it interesting (and more importantly, quick)…
With the emergence of VRE through the 1990’s the infection control community became very concerned that a repeat of MRSA could take place, with this MDRO rapidly becoming endemic internationally. Countries that had been aggressive in MRSA prevention efforts had succeeded, so if VRE was to be the “new MRSA” there was justification for a strong proactive stance. Furthermore the identification of the plasmid mediated capacity to create VRSA further supported those campaigning for aggressive infection prevention.
Furthermore, at that time antibiotic options for treatment of infection were very limited. VRE emergence also has a prolonged survival time in the inanimate hospital environment and is associated with a large reservoir of “asymptomatic carriers”.
Now, after more than 20 years experience, we know it is not as prevalent as MRSA in most countries and it is treatable. The threat of VRSA has not materialized.
On the other hand, the aggressive measures are likely to have worked with active surveillance, isolation, enhanced environmental cleaning etc.
There is a growing school of thought that easing off infection prevention strategies is justified especially in an era of competing demands, notably that of Gram-negative resistance championed by carbapenemase producing Enterobacteriaciae (CPE). However, if we do ease the efforts on VRE, and if the prevalence does increase significantly then there is no “putting the cat back in the bag”.
For this and many other reasons, the approach to VRE prevention is anything but standardized.
Please follow this link https://www.surveymonkey.com/r/HP6ZC7X
This survey will take less than 3 mins and help us better understand the diversity of approaches that are undertaken.
Prof Dale Fisher is an Australian-trained ID physician. He is head of infectious diseases at National University Hospital in Singapore and chair of the National Infection Prevention and Control Committee.