Vancomycin Resistant Enterococci
What is VRE
VRE stands for Vancomycin Resistant Enterococci. It is usually divided into three subtypes by genotyping: Van A (high level resistance to both Vancomycin and Teicoplanin), Van B (high level resistance to vancomycin, but may still be sensitive to Teicoplanin in vitro). Van C (low level resistance). VRE is carried on the body surface and in the gut.
Enterococcus is not a highly pathogenic bacteria, the risk to healthy individual is very small, thus hospital staffs or relatives taking care of VRE patient should not be unduly alarmed.
Treatment is available for VRE, there are several antibiotics that are shown to be effective against VRE. But these antibiotics cannot eradicate the colonization of Enterococus from the gut. Thus one should not prescribe even more resistant bacteria in the long run.
How does VRE spread:
VRE can only spread by contact, airborne transmission does not occur. One should note that enterococcus can survive drying and will remain viable on inanimate objects for a few days.
Infection control measures
In view of the emerging problem of multi-drug-resistant bacteria that we are facing. The health care provider must to step up the effort in the rational use of antibiotic. Do remember that apart from VRE, we do have other drug resistant problems such as Methicillin Resistant Staphylococcus arureus (MRSA) and Extended Spectrum Beta-lactamase (ESBL) producing Gram ¡Vve bacteria. It would not be possible for us to enclose a detailed antibiotics guideline or reviewing antibiotics prescription pattern of all frontline officers. However, some baseline should be bewared.
1. careful use of vancomycin. Do not use vancomycin in the following condition.
ü Empirical treatment of febrile condition, except in selected febrile neutropenic patient, or when there is a high prevalence of £]-lactam resistant Gram positive organism, (stop vancomycin when the culture result are negative for such organisms)
ü Routine surgical prophylaxis unless the patient has a life threatening allergy to £]- lactams
ü Treatment of a single blood culture positive for coagulate-negative staphylococcus, always exclude contamination of blood culture during collection, which is a more likely cause
ü Systemic or local use for prevention of central or peripheral intravascular catheters
ü Selective decontamination of digestive tract
ü Eradication of MRSA colonization
ü Use of vancomycin for topical application or irrigation
ü Chest infection due to Pneumococcus in the Penicillin ¡§I¡¨ category, which should still be considered treatable with Penicillin
2. for other antibiotics: prescribe only when indicated and use as narrow spectrum as possible, in order to preserve the colonization resistance of the patient(i.e. the microbial wallpaper effect contributed by the patient¡¦s normal flora, which will prevent pathogenic bacteria to attach and colonize our GI tract). When antibiotic must be used, avoid the drug with anti-anaerobic effect unless clinically indicated. The anaerobes in the GI tract should be preserved
ü the following conditions usually do not require anaerobe coverage: urinary tract infection, chest infection (other than aspiration pneumonia), simple soft tissue infection (non gangrenous, non animal bite), urinary tract infection. Gastro-enteritis (other than clostridium difficile).