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Vancomycin-Resistant Enterococci (VRE)

Overview

What is vancomycin-resistant enterococci (VRE)?

Vancomycin-resistant enterococci (VRE) are a type of bacteria called enterococci that have developed resistance to many antibiotics, especially vancomycin. Enterococci bacteria live in our intestines and on our skin, usually without causing problems.

Enterococci bacteria become a problem when they cause infection. These infections can occur anywhere in the body. Some common sites include the intestines, the urinary tract, and wounds. For some people, especially those who are weak or ill, these infections can become serious.

Vancomycin-resistant enterococci infections are treated with antibiotics, which are the types of medicines normally used to kill bacteria. VRE infections are more difficult to treat than other infections with enterococci, because fewer antibiotics are effective against the bacteria.

What causes a VRE infection?

VRE, like many bacteria, can be spread from one person to another through casual contact or through contaminated objects. Most often, VRE is spread from the hands of a doctor to a patient in a hospital or other health care setting. VRE is not usually spread through the air like the common cold or flu virus unless you have VRE pneumonia and are coughing, which is rare.

If you are healthy, your chances of getting VRE are very low. Even if you have been exposed to VRE, or have VRE in your body, you are not likely to get an infection. VRE infections typically only occur among people who have weakened immune systems, such as people with long-term illnesses or people who have had major surgery or other medical procedures and have been treated with multiple antibiotics.

Experts do not know exactly why some people become infected with VRE and others do not. But they do know that VRE infections are more likely to develop when antibiotics such as vancomycin are used often. Given enough time, bacteria can change so that these antibiotics no longer work well. This is why VRE and other antibiotic-resistant bacteria are sometimes called "super bugs."

What are the symptoms?

The symptoms of a VRE infection depend on where the infection is. If VRE is causing a wound infection, that area of your skin may be red or tender. If you have a urinary tract infection, you may have back pain, a burning sensation when you urinate, or a need to urinate more often than usual. Some people with VRE infections have diarrhea, feel weak and sick, or have fever and chills.

How is VRE diagnosed?

If your doctor suspects that you are infected with VRE, he or she will send a sample of your infected wound, blood, urine, or stool to a lab. The lab will grow the bacteria and then test to see which kinds of antibiotics kill the bacteria. This test may take several days.

How are infections treated?

If you get a serious infection with VRE, you may be isolated in a private hospital room to reduce the chances of spreading the bacteria to others. When your doctors and nurses are caring for you, they may use extra precautions such as wearing gloves and gowns.

VRE infections may be difficult to cure because the bacteria do not respond to many antibiotics. If you have an infection, your doctor will order antibiotics that may be given by mouth or into a vein through an IV (intravenously). Sometimes more than one antibiotic is prescribed to help stop the infection. Part of your treatment may include sending samples of your blood, urine, or stool to a lab to see if you still have VRE in your body.

Some people get rid of VRE on their own as their bodies get stronger. This can take a few months or even longer. Other times, an infection will go away and then come back. Sometimes the infection will go away but the bacteria will remain without causing infection. This is called colonization.

How can you prevent VRE?

As more antibiotic-resistant bacteria develop and more cases of VRE are documented, hospitals and other health care facilities are taking extra care to practice infection control, which includes frequent hand-washing and isolation of patients infected with VRE.

Even though most healthy people are not at risk for becoming infected or colonized with VRE, you can take steps to prevent getting VRE.

  • Practice good hygiene.
    • Keep your hands clean by washing them thoroughly with soap and clean, running water or using an alcohol-based hand sanitizer. Hand-washing is the best way to avoid infection of any kind.
    • Keep cuts and scrapes clean and covered with a bandage and avoid contact with other people's wounds or bandages.
    • Do not share personal items such as towels or razors.
    • Keep your environment clean by wiping all frequently touched surfaces (such as countertops, doorknobs, and light switches) with a disinfectant, especially if someone in the house has VRE.
  • Be smart about using antibiotics. Know that antibiotics can help treat bacterial infections but they cannot cure viral infections. Always ask your doctor if antibiotics are the best treatment. And avoid pressuring your doctor into prescribing antibiotics when he or she thinks they won't help you get better.
  • Always take all your antibiotic medicine as prescribed by your doctor. If you use only part of the medicine, it may not cure your infection. Also, it may cause antibiotic-resistant bacteria to develop.
  • Do not save any antibiotics, and do not use antibiotics that were prescribed for someone else or for a different problem.
  • If you are in the hospital, remind doctors and nurses to wash their hands before they touch you.

References

Other Works Consulted

  • Centers for Disease Control and Prevention (2011). Vancomycin-resistant enterococci (VRE) in healthcare settings. Available online: http://www.cdc.gov/HAI/organisms/vre/vre.html.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Theresa O'Young, PharmD - Clinical Pharmacy
Last Revised March 14, 2011

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