Summary about Disease
Vancomycin-Resistant Enterococcus (VRE) is a type of bacteria (enterococci) that has developed resistance to the antibiotic vancomycin. Enterococci are normally present in the human intestines and in the environment. VRE infections can be difficult to treat because vancomycin is often used as a last-resort antibiotic for other infections. VRE infections are most common in hospitals and other healthcare settings.
Symptoms
Many people who are colonized with VRE (meaning they have the bacteria in their bodies but are not sick) have no symptoms. If VRE causes an infection, symptoms depend on the location of the infection, which can include:
Urinary tract infection (UTI): Burning during urination, frequent urination, cloudy urine, back pain.
Wound infection: Redness, swelling, pain, pus or drainage.
Bloodstream infection (bacteremia): Fever, chills, low blood pressure.
Pneumonia: Cough, chest pain, shortness of breath.
Causes
VRE develops when enterococci bacteria acquire genes that make them resistant to vancomycin. This resistance can develop through:
Overuse of antibiotics: Broad-spectrum antibiotics can kill off susceptible bacteria, allowing resistant bacteria like VRE to thrive.
Spread in healthcare settings: VRE can spread through direct contact with contaminated surfaces, equipment, or healthcare workers' hands.
Colonization: Some people carry VRE in their intestines without showing symptoms. These individuals can then spread the bacteria to others.
Medicine Used
Treatment for VRE infections depends on the severity and location of the infection, as well as the specific strain of VRE involved. Antibiotics other than vancomycin are used, including:
Daptomycin
Linezolid
Tigecycline
Quinupristin/dalfopristin (for E. faecium only) Antibiotic susceptibility testing is crucial to determine which antibiotics will be effective against the particular VRE strain.
Is Communicable
Yes, VRE is communicable. It can spread from person to person, primarily through direct contact with contaminated surfaces or objects, or through contact with an infected person's bodily fluids (e.g., feces, urine, wound drainage). Healthcare settings are common locations for VRE transmission.
Precautions
Preventing the spread of VRE relies on strict infection control measures, including:
Hand hygiene: Frequent and thorough hand washing with soap and water or using alcohol-based hand sanitizer.
Contact precautions: Healthcare workers should wear gloves and gowns when entering a patient's room known to be colonized or infected with VRE.
Environmental cleaning: Regular cleaning and disinfection of surfaces and equipment, especially frequently touched surfaces.
Patient isolation: Isolating patients known to be colonized or infected with VRE to prevent spread to other patients.
Judicious antibiotic use: Prescribing antibiotics only when necessary and using narrow-spectrum antibiotics when possible.
Screening: Screening high-risk patients (e.g., those with a history of antibiotic use or prolonged hospital stays) for VRE colonization.
How long does an outbreak last?
The duration of a VRE outbreak can vary significantly depending on the setting (e.g., hospital unit, long-term care facility), the effectiveness of infection control measures, and the number of individuals affected. An outbreak can last from a few weeks to several months, or even longer if control measures are not implemented effectively.
How is it diagnosed?
VRE is diagnosed through laboratory testing of samples such as:
Stool: Most common method for detecting VRE colonization.
Urine: If a urinary tract infection is suspected.
Wound drainage: If a wound infection is suspected.
Blood: If a bloodstream infection is suspected. The samples are cultured in a laboratory to identify the presence of Enterococcus bacteria and to determine whether they are resistant to vancomycin. Molecular tests (e.g., PCR) can also be used to detect the genes responsible for vancomycin resistance.
Timeline of Symptoms
The timeline of symptoms depends on the type and location of the infection. Some possible timelines:
Colonization: No symptoms. Can persist for weeks, months, or even years.
UTI: Symptoms may develop within a few days of infection.
Wound infection: Symptoms may develop within a few days to a week after injury or surgery.
Bacteremia: Symptoms can develop rapidly (within hours) and can be life-threatening.
Important Considerations
VRE colonization does not always lead to infection. Many people can carry VRE without becoming ill.
Patients with weakened immune systems, those who have undergone surgery, or those with indwelling medical devices are at higher risk of developing VRE infections.
The spread of VRE is a significant concern in healthcare settings due to its resistance to multiple antibiotics, making treatment challenging.
Antibiotic stewardship programs are essential to reduce the overuse and misuse of antibiotics, which contributes to the development of antibiotic resistance.
Communication between healthcare providers, patients, and their families is crucial to ensure adherence to infection control measures and appropriate antibiotic use.