Vancomycin-resistant enterococci infection
Vancomycin-resistant enterococci (VRE) infection is caused by certain strains of enterococci bacteria that have developed resistance to the antibiotic vancomycin, which is typically used to treat infections caused by these bacteria. Enterococci are commonly found in the intestines, mouth, and female genital tract, and while they can be harmless, they may lead to serious infections, particularly in hospital settings and among critically ill patients. The most common species responsible for VRE are Enterococcus faecium and E. faecalis.
Risk factors for developing a VRE infection include previous use of vancomycin or other antibiotics, undergoing hospitalization or long-term care, and having a weakened immune system. Symptoms can vary depending on the site of the infection and may include fever, chills, and abdominal pain, particularly in cases of urinary tract infections. Diagnosis typically involves a medical history review, physical examination, and laboratory tests.
Treatment options for VRE infections may include alternative antibiotics such as linezolid or daptomycin, depending on the severity of the infection. Prevention strategies focus on stringent hand hygiene, proper cleaning and disinfection of contaminated areas, and protective measures for caregivers. Hospitals often implement special precautions and screening protocols to manage VRE cases effectively.
Vancomycin-resistant enterococci infection
- ANATOMY OR SYSTEM AFFECTED: All
- ALSO KNOWN AS: Multiply-resistant enterococci
Definition
Enterococci are bacteria that commonly live in the intestines, mouth, and female genital tract. In some cases, the bacteria can cause an infection. When this happens, the antibiotic vancomycin may be given to cure the infection.
However, some types of bacteria are resistant to vancomycin. When the bacteria are resistant, the infection is not cured, leading to vancomycin-resistant enterococci (VRE) infection. The infection is common in hospitals and long-term care facilities, and it is dangerous to those who are critically ill.
Causes
A number of species cause VRE infection, but the most common are Enterococcus faecium and E. faecalis.
Risk Factors
The factors that increase the chance of developing VRE include enterococci growing (colonizing) in the body, most commonly in the intestines; contact with an infected person or contact with contaminated surfaces (such as tables and door knobs); earlier treatment with vancomycin or another antibiotic; hospitalization (such as in an intensive care unit, cancer ward, or transplant ward) or long-term institutionalization; a weakened immune system; having neutropenia or mucositis; treatment with corticosteroids, parenteral feeding, or chemotherapy; surgery (such as chest or abdominal surgery); urinary catheterization; and dialysis. According to information published by the Centers for Disease Control in January 2024, VRE caused an estimated 54,500 infections and 5,400 deaths in the United States in 2017.
Symptoms
Symptoms depend on where the infection is found. For example, if VRE causes a urinary tract infection (most common), the patient may have a fever and chills, a frequent need to urinate, and pain in the abdomen. VRE also can cause intra-abdominal and pelvic infection (also common), surgical wound infection, bacteremia (bacterial infection of the blood), endocarditis (infection of the inner surface of the heart muscles and valves), neonatal sepsis (caused by a bacterial infection of an infant’s blood), and meningitis (infection of the membranes that surround the brain and spinal cord). Each infection has its own symptoms, which the doctor will discuss with the patient.
Screening and Diagnosis
A doctor will ask about symptoms and medical history and will perform a physical exam. A laboratory test is done to diagnose VRE and to rule out other conditions.
Treatment and Therapy
VRE can be treated with other types of antibiotics, and tests can determine which ones will work for each patient. The type that is chosen is based on the kind of infection and how severe it is. Common antibiotics used to treat VRE include linezolid (Zyvox), which is most common; quinupristin-dalfopristin (Synercid); daptomycin (Cubicin); tigecycline (Tygacil); and nitrofurantoin (Macrobid). If the infection is in the bladder, the doctor may order the placement of a catheter to drain urine from the bladder.
Prevention and Outcomes
The best way to reduce the chance of getting VRE is to use proper handwashing techniques. Handwashing is especially important after using a restroom, before preparing food, and after being in contact with someone who has VRE. Also, areas of the home (including bathrooms and kitchen) that may be contaminated with VRE should be cleaned and disinfected.
One should wear gloves if caring for someone with VRE. If a caregiver expects contact with the bodily fluids of the infected person, the caregiver should wear a gown over his or her clothing. Also, the ill person’s room and linens should be cleaned.
If the patient is prescribed vancomycin, he or she should consult the doctor because this antibiotic increases the chance that the bacteria will colonize the patient’s body and start an infection. Hospitals normally take special precautions when they know a patient is infected with VRE. In some hospitals, screening tests are done for patients at high risk for VRE.
Bibliography
Conte, John E. Manual of Antibiotics and Infectious Diseases: Treatment and Prevention. 9th ed. Philadelphia: Lippincott Williams & Wilkins, 2002.
Huycke, M. M., D. F. Sahm, and M. S. Gilmore. “Multiple-Drug Resistant Enterococci: The Nature of the Problem and an Agenda for the Future.” Emerging Infectious Diseases 4, no. 2 (April-June, 1998).
"Vancomycin-Resistant Enterococci (VRE) Basics." Centers for Disease Control, 22 Jan. 2024, www.cdc.gov/vre/about/index.html. Accessed 4 Feb. 2025.
Walsh, Christopher. Antibiotics: Actions, Origins, Resistance. Washington, D.C.: ASM Press, 2003.