1. RESULTS INTRODUCTION METHODS CONCLUSION  Since the early 90’s Enterococcus faecium resistant to Glycopeptides (GRE) have emerged in several French hospitals.  Consequences: - a increase in hospital mortality - an increase of the length of stay - extra cost 1  French guidelines: -Cohorting of colonized and contact patients with dedicated staff -Screening of contact patients -Strict hygiene precautions 2  These measures result in considerable disruption of patient managemanent.  The objectives of this study were to: assess value and the length of analysis of screening methods set up the most efficient screening strategy for GRE control in hospitalization units.  The ChromID VRE ® appeared as the best technique in term of quality and speed of analysis.  Variability of the analysis (sensitivity and specificity) according to the quantity of stool inoculated on to the medium  The dark coloration of strains on BEV make it difficult to read.  The sensibility, specificity and likelihood ratio allowed are not linked to the prevalence of colonization in the population studied.  During an outbreak: inclusion of the ChromID VRE ® will be useful in providing a quick view of the situation  The enrichment did not increase the sensitivity of BEV, in contrast to others studies 3.  The speeds of analysis obtained were the times of microbiological analysis. Delays due to transportation and confirmation(?) need to be included.  These techniques will be compared with molecular methods based on simplex and multiplex PCR.  O bservational study in intensive care units and hematology units of 4 London Hospitals in 2009.  Passive collection of stool samples sent for pathogen analysis  Comparison of 3 culture techniques: o Bile esculin agar containing 8mg/liter vancomycin (BEV) medium, o BEV after enrichment (ENR) o chromogen medium ChromID VRE ® (CID; bioMérieux).  Data collection: microbiological data (using vitek 2 and E-test) and lead times according to each technique.  Positive results: Enterococcus faecium resistant to vancomycin and teicoplanin as defined by the French Society for Microbiology.  Data analysis: sensitivity, specificity, predictive values, likelihood ratio and the Youden index.  Gold standard (GS) based on the comparison of results with the estimation of a capture recapture study  137 stool samples from 131 patients were included: 50.4% from ICU and 35% from Hematology.  37 GRE among 68 strains were isolated on BEV.  37 GRE among 54 strains were isolated on ENR.  40 GRE among 91 strains were isolated on CID.  Population of colonized patients estimated to 42 with the capture recapture method.  The CID after 48h of incubation was chosen as Gold standard based on this estimation and on the experience of the French reference lab  Sensibilities varied from 87.5% with the ENR to 95% with the CID after 24h. LR+/LR-rates varied from 326.4 to +∞. (Table 1)  The Youden index varied from 0.93 for the ENR to 0.97 for the CID after 24h.  The median lead time to isolate a strain of GRE varied from 20 [20-23] to 44 [44-47] hours (Figure 1)  Results were available after 34 [34-58] hours with the CID vs 70 [68-91] hours with the ENR. Fifth Decennial International Conference on Healthcare-Associated Infections, 19-22 th of March 2010, Atlanta 1.Salgado CD, Farr BM. Outcomes associated with vancomycin-resistant enterococci: a meta-analysis. Infect Control Hosp Epidemiol 2003 Sep;24(9):690-8.clonal multi- institutional outbreak of Clostridium difficile associated diarrhea with high morbidity and mortality. N Eng J Med 2005 8;353(23):2442-9. 2.CTINILS. Avis du comité technique des infections nosocomiales et des infections liées auxsoins relatif à la maîtrise de la diffusion des entérocoques résistants aux glycopeptides http://nosobasechu- lyonfr/recommandations/Ministere/AvisERV_061005pdf 2005.c. 3. Palladino S, Kay ID, Flexman JP, et al. Rapid detection of vanA and vanB genes directly from clinical specimens and enrichment broths by real-time multiplex PCR assay. J Clin Microbiol 2003 Jun;41(6):2483-6. Screening Strategies of Patients Colonized or Infected with Glycopeptide Resistant Enterococci. G. Birgand a, M Simonet b, F. Wallet b, SP Barrett c, BS Azadian c, R. Leclercq d, R.J. Courcol b, B. Grandbastien a a Infection Control Unit, Lille Teaching Hospital, France, b Department of microbiology, Lille Teaching Hospital, France, c Department of microbiology, Chelsea & Westminster Hospital, London, United Kingdom, d Reference laboratory for antibiotics resistances, Caen Teaching Hospital, France Background. - Since the early 90’s, several French hospitals have been affected by the emergence of Enterococcus faecium resistant to Glycopeptides (GRE). French guidelines for the control of GRE are based on a “search and destroy” policy. Implementation of these strict measures during the hospitalization of colonized patients has the potential to be very disruptive. Objectives. - This study assessed qualities of microbiological screening methods in term of intrinsic value and length of analysis in order to set up the most efficient strategy for GRE control. Methods. - This observational study was based on the comparison of 3 culture techniques: a Bile esculin agar containing 8mg/liter vancomycin (BEV) medium, the BEV after enrichment (ENR) and the chromogen medium ChromID VRE ® (CID; bioMérieux). These methods were assessed on stool samples from inpatients hospitalized in intensive care units (ICU) and hematology departments of 3 hospitals in London. Data collected included qualitative and quantitative microbiological data and the delay according to each technique. Data analysis was performed with epidemiological tools in reference to a Gold standard (GS). Results. - During this study, 137 stool samples from 131 patients were included. 50.4% came from ICU and 35% from Hematology. 37 GRE among 68 strains were isolated on BEV. 37 GRE among 54 strains were isolated on ENR. Finally, 40 GRE among 91 strains were isolated on CID. A “capture recapture” method allowed us to estimate the overall number of colonized patients in the population studied to about 4. The sensitivities of the different methods obtained in comparison with CID after 48h, which was taken as the GS varied from 87.5% with the ENR to 95% with the CID after 24h. Likelihood ratio positive/Likelihood ratio negative rates varied from 326.4 to +∞. The Youden index varied from 0.93 for the ENR to 0.97 for the CID after 24h. The median lead time to isolate a strain of GRE varied from 20 [20-23] to 44 [44- 47] hours. Results were available after 34 [34-58] hours with the CID vs 70 [68-91] hours with the ENR. Conclusion. - The CID appeared as the best technique in term of quality and speed of analysis. During an outbreak of GRE carriage, the inclusion of the CID as a preliminary screen may provide a rapid overview of the situation. During this study, enrichment did not increase the sensitivity of BEV. These techniques will be compared with molecular methods based on simplex and multiplex PCR. ABSTRACT Table 1: Analysis of the intrinsic values of the microbiological technics used to screen GRE colonized patients Figure 1: lengths of the different steps during the analysis for each screening method ChromID VRE ® Enterococcosel ®