Vancomycin-Resistant Enterococcus Infection

Contact Precautions

Vancomycin-resistant Enterococcus (VRE) infection is a mutation of a common bacterium normally found in the GI tract. The infection is spread easily by direct person-to-person contact. Facilities in more than 40 states have reported VRE infections. In intensive care units (ICUs), 30% of Enterococcus infections have been found to be resistant to vancomycin. In non-ICU settings, resistance to vancomycin has been noted in 25% of Enterococcus infections.

Those most at risk for VRE infection include the following:

Immunosuppressed patients, such as transplant recipients, or those with severe underlying disease
Patients with a history of taking vancomycin, third-generation cephalosporins, antibiotics targeted at anaerobic bacteria (such as Clostridium difficile), or multiple courses of antibiotics
Patients with indwelling urinary or central venous catheters
Elderly patients, especially those with prolonged or repeated hospital admissions
Patients with cancer or chronic renal failure
Patients undergoing cardiothoracic or intra-abdominal surgery or organ transplantation
Patients with wounds opening into the pelvic or intra-abdominal area, including surgical wounds, burns, and pressure ulcers
Patients with enterococcal bacteremia, typically associated with endocarditis
Patients exposed to contaminated equipment or to another VRE-positive patient, such as health care workers

Causes

Although there are 17 types of Enterococcus organisms, E. faecalis and E. faecium are the species most often cultured from humans (approximately 90%). E. faecium is most often vancomycin resistant. VRE enters health care facilities through an infected or colonized patient or a colonized health care worker. It can also develop following treatment with vancomycin. VRE spreads through direct contact between the patient and caregiver or between patients. It can also spread through patient contact with contaminated surfaces such as an over-bed table, where the microorganism is capable of living for weeks. VRE has also been detected on patient gowns, bed linens, and handrails.

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