Vancomycin-resistant enterococci overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Enterococci are bacteria that are normally present in the human intestines and in the female genital tract and are often found in the environment. These bacteria can sometimes cause infections. Vancomycin is an antibiotic that is often used to treat infections caused by enterococci. In some instances, enterococci have become resistant to this drug and thus are called vancomycin-resistant enterococci (VRE). Most VRE infections occur in hospitals.
Historical Perspective
Vancomycin-resistant enterococci (VRE), first reported in Europe in 1988, are emerging as a global threat to public health. The incidence of VRE infection and colonization among hospitalized patients has increased rapidly in the last 7 years. From 1989, the year VRE was first identified in the United States, through 1993, the proportion of enterococcal isolates resistant to vancomycin reported to the National Nosocomial Infections Surveillance System increased 20-fold.
Risk Factors
Prior treatment with antibiotics is common in nearly all patients colonized or infected with MDR enterococci. Clindamycin, cephalosporin,aztreonam,ciprofloxacin, aminoglycoside, and metronidazole use is equally or more often associated with colonization or infection with MDR enterococci than vancomycin use. Other risk factors include prolonged hospitalization, high severity of illness score, intraabdominal surgery, renal insufficiency, enteral tube feedings, and exposure to specific hospital units, nurses, or contaminated objects and surfaces within patient-care areas.
Treatment
Medical Therapy
Most VRE infections can be treated with antibiotics other than vancomycin. The treatment of VRE is determined by laboratory testing to determine which antibiotics are effective. For persons who get VRE infections and have urinary catheters, removal of the catheter when it is no longer needed can help getting rid of the infection. People who are colonized (bacteria are present, but have no symptoms of an infection) with VRE do not usually need treatment.