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Should we continue to isolate patients with vancomycin-resistant enterococci in hospitals?

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The routine use of contact precautions for patients with vancomycin-resistant enterococci cannot be justified once colonisation with this multidrug-resistant bacterium becomes endemic

Infections with vancomycin-resistant enterococci (VRE), which have become more common in Australian hospitals since the late 1990s, are associated with poor patient outcomes. Patients with gastrointestinal colonisation of VRE are at greater risk of infection, and patients infected with VRE are at higher risk of all-cause mortality.1

During outbreaks, VRE is assumed to spread between patients mainly via the hands of health care workers or in the hospital environment. Widely recommended strategies for minimising the risk of VRE transmission include screening to identify colonised patients, and subsequent contact precautions to minimise cross-transmission. Many hospitals use contact precautions for patients colonised or infected with VRE on current and each subsequent hospital admission, assuming VRE colonisation is lifelong. These recommendations for contact precautions are based on observational studies conducted primarily during outbreaks, inductive reasoning based on the known transmission potential, and expert opinion. However, dissent has been expressed against the routine use of contact precautions, particularly in hospitals where VRE is endemic.2

VRE is endemic…