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Surveillance of glycopeptide-resistant enterococci (GRE)

  • Document type:
    Publication
  • Author:
    Department of Health
  • Published date:
    26 August 2005
  • Primary audience:
    Professionals
  • Publication format:
    Electronic only
  • Gateway reference:
    2005
  • Copyright holder:
    Crown

Surveillance of glycopeptide-resistant enterococci (GRE) has been included in the mandatory healthcare associated infection surveillance system for acute Trusts in England since September 2003. This scheme is operated by the Health Protection Agency on behalf of the Department of Health. Data are collected quarterly from each of the 173 acute NHS Trusts in England by Health Protection Agency (HPA) Local and Regional Services Division (LARS) and transferred to the HPA's Centre for Infections (CfI) for national analysis.

Acute NHS Trusts in England are required to report all clinically significant GRE bacteraemia detected in their Trust. 

Positive blood cultures from the same patient within 14 days of the initial culture are considered to be part of the original episode and should not be reported.  Positive blood cultures more than 14 days apart should be reported as these are considered to be a new episode. 

Enterococci from blood cultures should be tested for susceptibility to vancomycin.  Teicoplanin is not an acceptable alternative to vancomycin for these purposes.

This report describes the data collected during the first year of the mandatory surveillance scheme (October 2003 - September 2004). 

GRE bacteraemia surveillance system - results

These tables give data on numbers of clinically significant GRE bacteraemia in NHS acute Trusts: Mandatory surveillance, October 2003 - September 2004.

National data

  • The total number of reports of clinically significant GRE bacteraemia in England in October 2003 - September 2004 was 620.
  • Two Trusts did not submit any data, primarily due to IT problems.
  • Ninety-six Trusts reported at least one case of GRE bacteraemia during the year but only fourteen Trusts reported more than ten cases of GRE bacteraemia. 
  • Seventy-five Trusts reported no cases of GRE bacteraemia. 

N.B. All data are provisional.

Interpretation of the data

These data are complex and need to be interpreted with care, taking the following into account:

  • The GRE bacteraemia cases reported by an acute Trust were not necessarily acquired in that Trust. There is much patient transfer between hospitals, such that a patient requiring specialist care may be transferred to a Trust with a specialist unit for their particular condition. When their care is complete, they may then return to the originating hospital. In this way Trusts may import GRE from other hospitals or from the community.
  • Trusts differ in size, different Trusts will have a variable case mix and treat different numbers of patients in a year; it is not valid to compare numbers of GRE bacteraemia between Trusts without measurement of the case mix.
  • Not all acute Trusts are the same. Some have specialist units which receive referrals from other acute Trusts, while others include units which in other places form part of other types of Trusts, such as community or mental health Trusts.  This means that it is not valid to compare one Trust with another.
  • These differences in the make-up of different Trusts also have an effect on their GRE bacteraemia numbers. A Trust that has a large number of specialist units is quite likely to experience a higher number than a Trust with few specialist units, where patients are less likely to experience GRE bacteraemia. Thus, although a Trust may have a high number of GRE bacteraemia, this does not necessarily reflect an infection control problem in the Trust. Rather, the numbers should form the basis for further investigation.

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