Randomised and quasi-randomised controlled trials were eligible if they reported the prevalence or incidence of VRE colonisation or infection, following any intervention that successfully reduced vancomycin use, compared with rates in control groups not exposed to the intervention. Studies had to be conducted in a U.S. hospital setting and focus on population-level associations.
The participants in the included studies were adults or children, mostly in general in-patient wards or intensive care units, who had been exposed to either endemic VRE of several years’ duration (where stated) and/or an outbreak. The type, timing and sequence of the interventions differed. All studies included restriction of vancomycin (and in some cases other antimicrobials), and some also included infection control measures. The controls were patients in the same ward or hospital, prior to the implementation of the intervention. Vancomycin use was generally measured by the amount of vancomycin prescribed or inappropriately prescribed, and VRE outcomes were reported as the rates of colonisation and/or infection. The studies used various methods of sampling and outcome ascertainment and reported prevalence and incidence in differing ways, including both point prevalence and rates over time. The duration of follow-up ranged from 4 months to 8 years.
The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.