stands for vancomycin resistant enterococci. These are bacteria
that have developed a resistance to most antibiotics commonly
used for enterococcal infections. The antibiotics include
vancomycin, aminoglycosides, and ampicillin.
is the reservoir for VRE?
can affect people in two different ways--colonization or
infection. When a person carries VRE as part of their body's
normally present bacteria (also known as their normal flora),
the person is said to be colonized. If a person has
an infection that is caused by VRE (such as a blood infection),
the person is said to be infected.
does VRE spread from person-to-person?
enterococci are part of the normal flora of the gastrointestinal
and female genital tracts, most infections with these microorganisms
have been attributed to the patient's own flora. People
who have been previously treated with vancomycin are at
the highest risk for developing VRE.
can also be spread from person-to-person by direct patient-to-patient
contact, or indirectly on health care workers' hands, or
on contaminated environmental surfaces and patient-care
VRE more of a concern than other infections?
and no. VRE infections are no more virulent than other enterococcal
infections, but infections caused by VRE are very difficult,
if not impossible, to treat with the antibiotics that are
is especially troubling about VRE is that the genetic material
that makes the enterococci resistant to vancomycin, the
vanA gene, can be transferred between enterococci and other
kinds of bacteria. If this gene is transferred to Staphylococcus
aureus bacteria that are resistant to methicillin (MRSA),
the result would be a S. aureus bacteria that is
resistant to all currently available antibiotics.
can you prevent the spread of VRE?
have been established to prevent the spread of vancomycin
resistance [Centers for Disease Control and Prevention.
Recommendations for Preventing the Spread of Vancomycin
Resistance: Recommendations of the Hospital Infection Control
Practices Advisory Committee (HICPAC). MMWR 1995;44
(No. RR-12)]. These are to be implemented in addition to,
not as a substitute for, standard precaution procedures.
Each hospital needs to be familiar with the guidelines for
the prevention of vancomycin resistance and establish a
policy that reflects their unique needs.
principle recommendations advocate: 1) the prudent use of
vancomycin; 2) an ongoing education program for all hospital
staff about the problem of VRE; 3) a cooperative effort
between health care providers and hospital microbiology
laboratory personnel that will allow VRE to be promptly
and accurately detected; and, 4) the implementation of appropriate
infection-control measures to prevent person-to-person spread
who are known to carry VRE need to be educated about their
condition as VRE colonization may continue for long periods
of time. Patients may need to be discharged from hospitals
to long term care facilities or other institutions while
they are still colonized with VRE. In such cases, there
needs to be open communication between infection control
personnel at both facilities to minimize the risk of further
can I get more information?
local health department listed in your telephone directory.
Utah Department of Health, Bureau of Epidemiology (801)
DEPARTMENT OF HEALTH
BUREAU OF EPIDEMIOLOGY
fact sheet was based on the Centers for Disease Control
and Prevention's Recommendations for Preventing the Spread
of Vancomycin Resistance: Recommendations of the Hospital
Infection Control Practices Advisory Committee (HICPAC).
MMWR 1995; 44 (No. RR-12)