Vancomycin-resistant enterococci (VRE)
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.
Mode of transmission
VRE are spread in a similar manner to other multi-resistant organisms through:
- inadequately decontaminated hands of staff
- indirectly via the environment (contaminated surfaces and equipment).
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:
- identification of carriage (screening of high risk patient groups) and appropriate inpatient placement, for example single room, according to risk profile
- diligent hand hygiene practices, including alcohol-based hand rubs at point of care
- application of personal protective equipment when performing patient care activities
- appropriate cleaning and disinfection of patient surroundings and medical equipment
- antimicrobial stewardship which ensures that antibiotics are prescribed appropriately.
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.