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Vancomycin-Resistant Enterococci Infection

Definition

Enterococci are bacteria that commonly live in:

  • Intestines
  • Mouth
  • Female genital tract

In some cases, it can cause an infection. When this happens, the antibiotic vancomycin may be given to cure the infection.

However, some types of the bacteria are resistant to vancomycin. When the bacteria are resistant, the infection is not cured. This is called vancomycin-resistant enterococci (VRE) infection. It is more common in hospitals and long-term care facilities. It can be very dangerous to those who are critically ill.

The Intestines
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Causes

VRE is caused by specific bacteria.

Risk Factors

Factors that increase your chance of VRE include:

  • Vancomycin-Resistant Enterococci growing in your body, usually in the intestines
  • Contact with an infected person or being in contact with contaminated surfaces
  • Previous treatment with vancomycin or another antibiotic for a long time
  • Hospitalization, or being in a long-term care facility
  • A weakened immune system from medication or illness
  • Certain medical conditions, such as neutropenia or mucositis
  • Treatment with corticosteroids, parenteral feeding, or chemotherapy
  • Previous surgery, especially a transplant
  • Use of a urinary catheter
  • Dialysis
  • Any severe illness

Symptoms

Symptoms depend on where the infection is found. VRE can cause the following:

  • Urinary tract infection
  • Intra-abdominal and pelvic infection
  • Surgical wound infection
  • Sepsis—an infection or its toxin spreading through the bloodstream
  • Endocarditis—an infection of the inner surface of the heart muscles and valves
  • Neonatal sepsis—a blood infection occurring in infants
  • Meningitis—an infection of the membranes that surround the brain and spinal cord

Each infection has its own symptoms.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. A lab test is done to find which bacteria is causing the infection and see what antibiotics can kill the bacteria.

Treatment

Talk with your doctor about the best treatment plan for you. Options include:

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 will also be based on the kind of infection and how severe it is.

Catheter Removal

If the infection is in your bladder and you have a urinary catheter in place, you may have the catheter removed as soon as it is possible. This decreases the risk of further infection.

Prevention

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

  • Use proper hand-washing techniques . 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. This included the bathroom and kitchen.
  • Wear gloves if you are caring for someone with VRE. If you will 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.

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

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

References

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).

Vancomycin-resistant enterococci (VRE) infection. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 10, 2014. Accessed June 19, 2014.

Vancomycin-resistant enterococci (VRE). National Institute of Allergy and Infectious Diseases website. Available at: http://www.niaid.nih.gov/topics/antimicrobialResistance/Examples/vre/Pages/default.aspx. Updated March 8, 2012. Accessed June 19, 2014.

Vancomycin-resistant enterococci (VRE) in healthcare settings. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/HAI/organisms/vre/vre.html. Updated May 10, 2011. Accessed June 19, 2014.