Vancomycin-Resistant Enterococci Infection
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Vancomycin-Resistant Enterococci Infection

(VRE; Multiply-Resistant Enterococci)

Definition

Enterococci are bacteria that commonly live in the intestines. The bacteria can also be found in the mouth and the female genital tract. In some cases, enterococci cause infections. When this happens, your doctor might prescribe the antibiotic vancomycin . Sometimes the bacteria are resistant to vancomycin. When the bacteria are resistant, the infection is not cured.

The Intestines

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Vancomycin-resistant enterococci (VRE) infection is common in hospitals and long-term care facilities. It is particularly dangerous to those who are critically ill. If you think you have this condition, tell your doctor right away.

Causes

A number of species cause VRE infection, but the most common are:

  • Enterococcus faecium
  • Enterococcus faecalis

Risk Factors

These factors increase your chance of developing VRE. Tell your doctor if you have any of these risk factors:

  • Having enterococci growing (colonizing) in your body (most commonly in the intestines)
  • Being in contact with an infected person or in contact with contaminated surfaces (eg, tables, door knobs)
  • Being previously treated with vancomycin or another antibiotic for a long time
  • Being hospitalized (eg, intensive care unit, cancer ward, transplant ward) or being in a long-term care facility
  • Having a weakened immune system
  • Having certain conditions (eg, neutropenia , mucositis)
  • Being treated with corticosteroids, parenteral feeding, or chemotherapy
  • Having surgery (eg, chest or abdominal surgery)
  • Having a urinary catheter
  • Undergoing dialysis

Symptoms

Symptoms depend on where the infection is found. For example, if VRE causes a urinary tract infection , you may have:

  • Fever and chills
  • A frequent need to urinate
  • Pain in the abdomen

VRE can cause the following:

  • Urinary tract infection (most common)
  • Intra-abdominal and pelvic infection (also common)
  • Surgical wound infection
  • Bacteremia—bacteria in the blood
  • Endocarditis —infection of the inner surface of the heart muscles and valves
  • Neonatal sepsis —bacteria in the blood, occurring in infants
  • Meningitis —infection of the membranes that surround the brain and spinal cord

Each infection has its own symptoms. Your doctor will discuss these symptoms with you.

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. A lab test is done to diagnose VRE and to rule out other conditions.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Antibiotics

VRE can be treated with other types of antibiotics. Tests can be done to find out which ones will work. The type that is chosen is based on the kind of infection that you have and how severe it is. Common antibiotics used to treat VRE include:

  • Linezolid (Zyvox) —most common
  • Quinupristin-dalfopristin (Synercid)
  • Daptomycin (Cubicin)
  • Tigecycline (Tygacil)
  • Nitrofurantoin (Macrobid)

Catheter Removal

If the infection is in your bladder and you have a catheter, your doctor will remove the catheter.

If enterococci have colonized but you don’t have symptoms, then treatment is usually not needed.

Prevention

To help reduce your chance of getting VRE, take the following steps:

  • Use proper hand-washing techniques since this is the best way to prevent VRE. Hand washing is especially important:
    • After using the bathroom
    • Before preparing food
    • After being in contact with someone who has VRE
  • Clean and disinfect areas of your home that may be contaminated with VRE, such as the bathroom and kitchen.
  • Wear gloves if you are caring for someone with VRE. If you have contact with bodily fluids, wear a gown over your clothing. Also, clean the person’s room and linens.
  • If you are prescribed vancomycin, talk to your doctor. Taking this antibiotic is a risk factor for the bacteria to colonize in your body and for you to get VRE.
  • If you have VRE, tell your doctor. Hospitals take special precautions when they know a patient is infected.

In some hospitals, screening tests are done for patients at high-risk for VRE, like those in the intensive care unit.

RESOURCES:

Centers for Disease Control and Prevention
http://www.cdc.gov/

National Institutes of Health
http://www.nih.gov/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index_e.html/

Public Health Agency of Canada
http://www.phac-aspc.gc.ca/

References:

Antimicrobial (drug) resistance: vancomycin-resistant enterococci (VRE). National Institute of Allergy and Infectious Diseases website. Available at: http://www3.niaid.nih.gov/topics/antimicrobialResistance/Examples/vre/prevention.htm . Accessed August 11, 2008.

Huycke MM, Sahm DF, Gilmore MS. Multiple-drug resistant enterococci: the nature of the problem and an agenda for the future. Emerg Infect Diseases . 1998 April-June;4(2).

Information for the public about VRE. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/dhqp/ar_VRE_publicFAQ.html. . Updated April 2008. Accessed August 11, 2008.

Multidrug-resistant organisms in non-hospital healthcare settings. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/dhqp/ar_multidrugFAQ.html. Published December 2000. Accessed August 11, 2008.

Task Force of Antimicrobial Resistance (TFAR). Guidelines for the prevention and control of vancomycin resistant enterococci (VRE) in long-term care facilities. South Dakota Department of Health website. Available at: http://doh.sd.gov/PDF/VRE.pdf . Accessed August 11, 2008.

Vancomycin-resistant enterococci (VRE) infection. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated June 2008. Accessed August 11, 2008.



Last reviewed August 2008 by David L. Horn, MD, FACP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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