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Best practice for the management of patients colonised or infected with VRE in the acute and non-acute care settings.
Enterococci (Enterococcus species) are bacteria normally found in the gastrointestinal tract of animals and humans, and in the female genital tract. Although usually harmless, these bacteria can be significant pathogens in immune-compromised patients, capable of causing endocarditis, urinary tract, bloodstream, wound and intra-abdominal infections.
Vancomycin-resistant enterococci are specific strains of enterococci that have developed resistance to vancomycin, an antibiotic that is commonly used to treat serious infections caused by enterococci. The emergence of enterococci with acquired resistance to vancomycin usually occurs within the context of heavy usage of certain antibiotics in the hospital setting, for example in renal, liver, haematology, oncology, organ transplant and intensive care units.
VRE are spread in a similar manner to other multi-drug resistant organisms through:
VRE are capable of prolonged survival on hands, gloves and environmental surfaces, but can be readily removed by hand hygiene and thorough cleaning of bathrooms and frequently touched surfaces, such as door handles, stethoscopes, over-bed tables, call bells, and bedside monitors. Colonised or infected patients who have diarrhoea, faecal incontinence, a colostomy or ileostomy, or whose hygiene practices may be compromised by cognitive or functional impairment, are more likely to contaminate their surrounding environment.
The prevention of infection with VRE involves the simultaneous application of a number of strategies:
Hospitals should have a strategy for management of VRE carriage and infection with practices adapted to suit the clinical setting. For example, management of patients identified with VRE in intensive care units may be different to management of a patient attending an outpatient department where the risk of transmission and infection are much lower.