Dynamic Screening Strategies for the Control of a Prolonged Vancomycin-Resistant Enterococci Outbreak: A Decade-Long Study in a Japanese Tertiary Hospital

In low-prevalence settings, the epidemiological yield of screening strategies for controlling vancomycin-resistant enterococci (VRE) outbreaks has not been fully established.We retrospectively analysed a prolonged VRE outbreak at a 536-bed tertiary-care hospital in Japan from 2010 to 2021 to evaluate sequential screening strategies across epidemic phases and to identify risk factors for VRE acquisition.Hospital-wide, admission-based, antimicrobial exposure-based, passive, and haemodialysis-targeted screening strategies were implemented over time.Screening yields were compared longitudinally, and a retrospective case-control study was performed using data from the initial hospital-wide screening phase.Molecular epidemiology was assessed by pulsed-field gel electrophoresis (PFGE).In total, 169 VRE-positive patients were identified, including seven infections and 162 asymptomatic carriers.Hospital-wide screening in the early epidemic phase showed the highest positivity rate (0.91%), whereas targeted strategies consistently yielded lower rates (0.09-0.34%).Haemodialysis, specific oral care practices, and prior exposure to https://doi.org/10.1017/S0950268826101344