Guidance
➤ Outside an outbreak setting and if facility endemic rates of VRE infection
are low, the hospital may consider the alternative approach of using
CP for patients with active VRE infection for the duration of the index
admission and discontinuing CP on hospital discharge.
• In adopting this approach, hospitals should monitor VRE infection rates, maximize
and consider monitoring use of standard precautions, and minimize patient cohorting
to avoid intrafacility transmission.
• If institutional VRE infection rates increase, the hospital should transition to a
screening culture–based approach for discontinuation of CP.
Multidrug-Resistant Enterobacteriaceae (MDR-E)
➤ If a hospital uses CP for patients infected or colonized with MDR-E
(ESBL-E and/or CRE), SHEA recommends establishing a policy for
discontinuation of CP for MDR-E that includes the following:
• Maintaining CP for ESBL-E and CRE for the duration of the index hospital stay
when infection or colonization with these bacteria is first detected.
• Considering discontinuation of CP on a case-by-case basis, taking into account the
following criteria:
▶ at least 6 months have elapsed since the last positive culture
▶ presence of a clinical infection and ongoing antibiotic use, where discontinuation
of CP should be discouraged in the setting of suspected or known infection with
ESBL-E or CRE, and concurrent broad spectrum antibiotic use that may select for
these organisms, and
▶ procurement of an adequate number of screening samples, with at least 2
consecutive negative rectal swab samples obtained at least 1 week apart to consider
an individual negative for ESBL-E or CRE colonization.
➤ SHEA recommends that for extensively drug-resistant
Enterobacteriaceae, such as carbapenemase-producing CRE, or
Enterobacteriaceae with very limited treatment options (susceptible
to ≤2 antibiotic classes used to treat that organism), hospitals should
maintain CP indefinitely.
