In 2013–2014, the incidence rate of healthcare-associated VRE infection (cat. 1a + 1b) was 0.19/10,000 patient days (Table 2).  

The incidence rate of healthcare-associated VRE infection in teaching healthcare facilities was significantly (eight times) higher than that in non-teaching facilities (Table 2).

Table 2 – Incidence Rate and Percentile Distribution of Healthcare-Associated VRE Infection (Cat. 1a + 1b) by Type of Healthcare Facility, Québec, 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI])

[I.C. 95%] : 95% confidence interval.
^¥ Significant statistical difference (p < 0.05) between non-teaching and teaching healthcare facilities.

The incidence rate of healthcare-associated VRE infections in 2013-2014 was significantly 2.8 times higher in teaching facilities in 2012-2013 as well as the one at provincial level that was 2.4 times higher in 2013-2014 than in 2012-2013 (Table 3). The incidence rate of healthcare-associated VRE infections in non-teaching facilities was stable.

Table 3 – Change in Incidence Rate of Healthcare-Associated VRE Infection (Cat. 1a + 1b) by Type of Healthcare Facility, Québec, 2011–2012 to 2013–2014 (Incidence Rate per 10,000 Patient Days [95% CI])

^¥ Significant statistical difference (p < 0.05) between healthcare-associated incidence rate in 2012-2013 and 2013-2014.

In total, 107 cases of VRE infection were reported: 92 (86.0%) were identified in patients who acquired VRE infection during a current hospital stay (89 patients), a previous hospital stay (3 patients) or in ambulatory care of the reporting facility (5 patients) (cat. 1a, 1b and 1c.). A total of 10 cases were associated to another facility, community or unknown (cat. 2, 3 and 4) (table 4). Among the 107 VRE infections, 25 infections were from known colonized cases. A total of 19 cases were of category 1a, 1 case of category 1b, 4 cases of category 3 and 1 case of category 4.

Table 4 – Cases of VRE Infection by Presumed Source of Acquisition, Québec, 2013–2014 (N, %)

In 2013-2014, among 107 infections, 20 primary bloodstream infections (BSI) have been reported (Table 5).

Table 5 – Number of Cases of VRE Infection from All Sources by Type of Infection and Number of Complications (Secondary BSIs), Québec, 2013–2014 (N = 107)

A total of 23 deaths were observed, yielding a 30-days case fatality of 21.5% (Table 6).

Table 6 – Number of Deaths and 30-days case fatality Related to VRE Infection, Québec, 2011-2012 à 2013-2014

In 2013-2014, the acquisition rate of healthcare-associated VRE colonization (cat. 1a + 1b) was 9.77 / 10,000 patient days. This incidence rate in teaching facilities was almost 1.44 times higher than in non-teaching facilities (Table 7).

Table 7 – Change in the Number of Cases and Acquisition rate of Healthcare-associated VRE colonization (Cat. 1a + 1b) by type of Healthcare facility, Québec, 2011-2012 à 2013-2014 (Acquisition rate of Healthcare-Associated VRE colonization per 10,000  patient days)

Table 8 shows the number of teaching facilities that identified the type of screening used at admission (25 out of 26) and during hospitalization (24 out of 26). Almost all teaching facilities (25 at admission and 24 during hospitalization out of 26) identified their screening procedure, while almost 9% of non-teaching facilities didn’t do so (59 at admission and 56 during hospitalization out of 63).

Table 8 – Number of Healthcare Facilities that Identified the type of Screening Procedure Used at Admission and During Hospitalization by Type of Facility, Québec, 2013-2014

* The number of facilities that reported the type of screening procedures used at admission and during hospitalization is not additive.

Tables 9 and 10 feature the total number of screening tests performed at admission and during hospitalization, as well as the mean number of VRE screening tests.

Table 9 – Total Number of Screening Tests Performed at Admission and During Hospitalization by Type of Healthcare Facility, Québec, 2013-2014

Table 10 – Mean Number of VRE Screening Score by Type of Healthcare Facility, Québec, 2013-2014 (Mean VRE Screening Tests per Admission)

* The mean numbers of VRE screening score at admission and during hospitalization are not additive. 

The incidence rate of HA-VRE infection and the percentile rankings by type of facility are shown in figure 1 and 2. Figures 3 and 4 feature the rate of acquisition and percentile ranking of HA-VRE colonization by type of facility.

Figure 1 – Incidence Rate and Percentile Ranking of Healthcare-Associated VRE infection (Cat. 1a + 1b) for Non-Teaching Healthcare Facilities, Québec, 2013-2014 (Incidence Rate per 10,000 Patient Days)

NB: Facilities 9, 10, 11, 14, 16, 19, 23, 32, 37, 38, 39, 40, 41, 42, 44, 45, 46, 47, 49, 51, 52, 53, 56, 58, 59, 61, 63, 64, 67, 70, 71, 72, 74, 75, 76, 77, 80, 81, 82, 83, 84, 85, 86, 88, 89, 91, 95, 96, 97, 99, 103, 107, 109, 111, 112, 113 and 130 did not report any cases of infection in 2013-2014.

Figure 2 – Incidence Rate and Percentile Ranking of Healthcare-Associated VRE infection (Cat. 1a + 1b) for Teaching Healthcare Facilities, Québec, 2013-2014 (Incidence Rate per 10,000 Patient Days)

NB: Facilities 2, 6, 7, 12, 13, 18, 20, 24, 27, 28, 30, 31, 33, 48, 116 and 118 did not report any cases of infection in 2013-2014.

Figure 3 – Acquisition Rate of Healthcare-Associated VRE Colonization (Cat.1a + 1b) in Non-Teaching Healthcare Facilities, Québec, 2013-2014 (Acquisition Rate of Healthcare-Associated VRE colonization per 10,000 patient days)

NB: Facilities 32, 47, 49, 53, 59, 64, 72, 74, 75, 77, 85, 86, 88, 89, 97, 99, 107, 109 and 112 did not report any cases of infection in 2013-2014.

Figure 4 – Acquisition Rate of Healthcare-Associated VRE Colonization (Cat.1a + 1b) in Teaching Healthcare Facilities, Québec, 2013-2014 (Acquisition Rate of Healthcare-Associated VRE colonization per 10,000 patient days)

NB: Facilities 6, 12, 30 and 118 did not report any cases of infection in 2013-2014.

At the local level, in 2013-2014, the incidence rate of HA-VRE infection ranged from 0 to 1.54 * 10,000 patient days, whereas the acquisition rate of HA-VRE colonization ranged from 0 to 62.32 / 10,000 patient days. A total of 23 facilities (25.8%) did not report any HA-VRE infection or colonization in 2013-2014. A detailed summary of the surveillance data for HA-VRE infection by healthcare facility can be found in Table 11.

Table 11 – Incidence Rate of Healthcare-Associated VRE Infection (cat. 1a + 1b), Acquisition Rate of Healthcare-Associated VRE Colonization and Mean VRE Screening Tests by Admission and by Facility, Québec, 2013-2014 (Incidence Rate per 10,000 patient days [95% CI]; Acquisition Rate of Colonization per 10,000 patient days)

* Number of screening test divided by number of admissions.

Comité de surveillance provinciale des infections nosocomiales (SPIN)

Editorial committee 

Christophe Garenc, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

Isabelle Rocher, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

Mélissa Trudeau, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec

Patrice Vigeant, Centre de santé et de services sociaux du Suroît