VRE infection is caused by vancomycin resistant enterococcus, a type of antibiotic resistant bacteria that can be found in hospitals, and -- more rarely -- the community. Enterococcus bacteria, such as Enterococcus faecalis, normally inhabit the human bowel. However, they can cause infection if spread to other parts of the body, such as the bloodstream. Vancomycin is a drug that is often used to treat infections like these caused by enterococci. However, VRE poses a challenge because it is resistant to this strong antibiotic.
VRE Statistics and Risk Factors
VRE actually refers to several different species of antibiotic resistant Enterococcus bacteria that share similar characteristics and background.
- It was first identified in 1986.
- Although there are many species of Enterococcus that demonstrate some level of antibiotic resistance, the CDC reports that E. faecium and E. faecalis are the most commonly isolated.
- The CDC states that 1 in 8 infections in hospitals are caused by Enterococcus bacteria, and 30% of these are VRE.
People who are susceptible for VRE infection are those with weakened immune systems, who are receiving antibiotic treatment (or who have previously received treatment for a long period of time), or who are already colonized with the bacteria. Most at risk are those hospitalized for surgery, in ICUs, or for long periods of time. Also, invasive lines or procedures -- e.g., surgery, Foley catheters, and IVs -- are a risk factor for VRE and other infections because they can introduce bacteria into areas of the body that are usually free of microbes.
VRE Causes Urinary Tract Infections, Surgical Site Infections, and Bloodstream Infections
VRE can cause different problems depending on where in the body the bacteria is present. According to the CDC, VRE can colonize the intestines or urinary tract without causing disease. However, if the bacteria flourishes in the urinary tract it can cause an infection there called a urinary tract infection (UTI). In addition, if the enterococcus spreads to other parts of the body, it can cause an infection there, too. In addition to UTIs, VRE is known for causing bloodstream infections and wound infections (including surgical site infections, or SSIs).
VRE Signs and Symptoms
Signs and symptoms of VRE infection vary depending on where the infection is. Generally, antibiotic resistant infections present the sames symptoms as normal infections; the problem occurs when attempting to treat them. If you are experiencing signs or symptoms like urinary frequency and burning, slow-healing wounds (especially if red, tender, and/or having pus), or unexplainable fevers, seek medical attention.
Treatment of VRE
Most often, VRE is treated with antibiotics other than vancomycin. Because some strains of VRE are resistant to other antibiotics, too, a sample of infected material (urine, wound drainage, etc.) is first taken and tested in the laboratory for susceptibility to different kinds of antibiotics. This is called a "sensitivity test." It is often performed at the same time that the bacterial culture is taken so that two samples do not need to be taken. These two tests are often called a C&S (culture and sensitivity) by healthcare workers. It enables physicians to prescribe effective antibiotics.
If the infection is associated with an invasive line, such as a Foley catheter or a PICC line, the line is often taken out to remove the source of infection.
Hand Hygiene is Key to Preventing Hospital Acquired Infections
As with all nosocomial infections (also known as hospital acquired infections or healthcare associated infections), consistent hand washing by healthcare workers, visitors, and patients is the single most important act of prevention.
Hands should be washed:
- with soap and water
- before and after gloves are donned
- thoroughly for 20 seconds
The CDC states that alcohol-based hand sanitizers that have at least 60% alcohol are just as effective as washing with soap and water unless the hands are visibly soiled. Also, alcohol-based sanitizers are not effective for certain bacteria that form resilient spores, like C. diff.
Other Ways to Prevent VRE Infection
In addition to hand hygiene, maintaining cleanliness at bacterial points of entry is also vital.
- It is very important for women to always wipe front to back after urinating. This decreases the chance that bacteria will be introduced into the urethra.
- Decrease the amount of invasive lines. Remove Foley catheters, PICC lines, and IVs as soon as safely possible. Until then, keep the insertion sites as clean as possible. Perineal hygiene is especially important for people with Foley catheters.
- Keep wounds and incisions clean.
References
Information for the Public About VRE
Vancomycin-resistant Enterococci (VRE) and the Clinical Laboratory
CDC.gov, "Put Your Hands Together" (accessed January 12, 2010)
Young-Bem Se, M.D., Hyoung-Joon Chun, M.D., et al. (2009). Incidence and risk factors of infection caused by vancomycin-resistant enterococcus colonization in neurosurgical intensive care unit patients. Journal of Korean Neurosurgical Society,46 (2), 123-129.
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Christie Bailey - Christie is an RN, BSN with a passion for holistic health. Currently, she is pursuing her masters degree to become a holistic nurse ...
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