Vancomycin-resistant enterococci
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Vancomycin-resistant enterococci Microchapters |
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Differentiating Vancomycin-Resistant Enterococci from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Vancomycin-resistant enterococci On the Web |
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American Roentgen Ray Society Images of Vancomycin-resistant enterococci |
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Directions to Hospitals Treating Vancomycin-resistant enterococci |
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Risk calculators and risk factors for Vancomycin-resistant enterococci |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
References
http://www.cdc.gov/ncidod/dhqp/ar_vre.html
References
http://www.cdc.gov/ncidod/dhqp/ar_VRE_publicFAQ.html
http://www.cdc.gov/ncidod/eid/vol3no3/mcdonald.htm
http://www.cdc.gov/ncidod/eid/vol4no2/huycke.htm
References
http://www.cdc.gov/ncidod/dhqp/ar_VRE_publicFAQ.html
Screening
How should clinical laboratory personnel screen for VRE?
Screening for VRE can be accomplished in a number of ways. For inoculating peri-rectal/anal swabs or stool specimens directly, one method uses bile esculin azide agar plates containing 6 µg/ml of vancomycin. Black colonies should be identified as an enterococcus to species level and further confirmed as vancomycin resistant by an MIC method before reporting as VRE.
Vancomycin resistance can be determined for enterococcal colonies available in pure culture by inoculating a suspension of the organism onto a commercially available brain heart infusion agar (BHIA) plate containing 6 µg/ml vancomycin. The National Committee for Clinical Laboratory Standards (NCCLS) recommends performing a vancomycin MIC test and also motility and pigment production tests to distinguish species with acquired resistance (vanA and vanB) from those with vanC intrinsic resistance.
When should clinical laboratory personnel screen for VRE?
The decision about who and when to screen for VRE is a facility-specific decision. CDC recommendations can assist in the determination of a screening strategy appropriate for health care facilities (Recommendations for Preventing the Spread of Vancomycin Resistance Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC) MMWR 1995; 44(RR12):1-13). Infection control personnel at some healthcare facilities selectively screen newly admitted or high-risk patients (e.g., intensive care, oncology, and surgery patients) determined to be at greater risk for VRE colonization.
Why is the difference between colonization and infection important for VRE screening?
Infected patients carry VRE and show clinical signs or symptoms of disease. Colonized patients carry VRE but do not have clinical signs or symptoms of infection. This distinction is important in VRE screening. Patients are usually colonized in the gastrointestinal tract and occasionally in the urinary tract. VRE colony counts are similar in the stool of colonized or infected patients. If a hospital VRE rate is based solely on VRE isolated from clinical cultures (infected patients), the facility may be adequately reporting its infection rate, but may be underestimating the true burden (and therefore potential transmissibility) of VRE in the facility. Screening for patients colonized by VRE provides information about potential sources of illness. The goal of screening is to identify as many colonized patients as possible so that infection control measures can be implemented to decrease transmission and reduce the number of patients infected with VRE.
References
http://www.cdc.gov/ncidod/dhqp/ar_lab_vre.html
References
http://www.cdc.gov/ncidod/dhqp/ar_VRE_publicFAQ.html
http://www.cdc.gov/ncidod/eid/vol3no3/mcdonald.htm
http://www.cdc.gov/ncidod/eid/vol4no2/huycke.htm
http://www.cdc.gov/ncidod/dhqp/ar_lab_vre.html
References
http://www.cdc.gov/ncidod/dhqp/ar_lab_vre.html
Treatment
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.
Acute Pharmacotherapies
References
http://www.cdc.gov/ncidod/dhqp/ar_VRE_publicFAQ.html
Primary Prevention
If you or someone in your household has VRE, the following are some measures to prevent spread of VRE:
- Always wash your hands thoroughly after using the bathroom and before preparing food. Clean your hands after close contact with persons who have VRE. Wash with soap and water (particularly when visibly soiled) or clean with alcohol-based hand cleaner.
- Frequently clean areas of your home such as your bathroom that may become contaminated with VRE. Use a household disinfectant or a mixture of one-fourth cup bleach and one quart of water to clean those areas and surfaces that are touched frequently.
- Wear gloves if you may come in contact with body fluids that may contain VRE, such as stool. Always wash your hands after removing gloves.
- Be sure to tell any healthcare providers that you have VRE so that they are aware of your infection.
References
http://www.cdc.gov/ncidod/dhqp/ar_VRE_publicFAQ.html
Acknowledgements
The content on this page was first contributed by: C. Michael Gibson, M.S., M.D.