Vancomycin-Resistant Enterococci (VRE) are bacteria resistant to vancomycin, an antibiotic used for bacterial infections. While common, their resistance raises concerns about potential severity. VRE can cause serious infections, with lethality depending on the infection site, patient health, and available treatment.
Understanding VRE
VRE refers to Enterococcus bacteria strains resistant to the antibiotic vancomycin. These bacteria naturally reside in human intestines and the female genital tract, and are also found in the environment. They typically do not cause illness in their usual locations.
VRE commonly spreads through direct contact with an infected person or contaminated surfaces and medical equipment. Healthcare settings are common environments for VRE transmission, especially where patients have weakened immune systems or frequent contact with medical devices. VRE is not typically spread through the air.
When VRE Becomes Life-Threatening
VRE can colonize the body without symptoms, but becomes a concern when causing active, difficult-to-treat infections. These bacteria cause severe infections when invading other body parts, especially in hospitalized patients. Life-threatening infections include bloodstream infections (bacteremia), endocarditis, meningitis, and peritonitis. VRE can also infect surgical wounds and the urinary tract.
VRE’s resistance to vancomycin limits treatment options, making infections harder to clear and increasing complications and mortality. VRE bloodstream infections are associated with increased mortality rates. The progression from localized infections, like urinary tract infections, to systemic conditions such as sepsis or septic shock, underscores the seriousness of VRE’s antibiotic resistance.
Who is Most Vulnerable to Severe VRE
Certain individuals face a higher risk of severe, potentially fatal VRE infections. Those with weakened immune systems are particularly vulnerable, including cancer patients, transplant recipients, and individuals with HIV/AIDS. Their compromised immune defenses hinder effective infection fighting.
Patients with chronic conditions like kidney disease or diabetes also have increased risk. Individuals who have received prolonged antibiotic courses, including vancomycin, are more susceptible, as this can disrupt the body’s natural bacterial balance. Hospitalized patients, especially in intensive care or after complex surgeries, are at higher risk due to healthcare exposure and invasive procedures. Invasive medical devices like urinary catheters or central intravenous lines also increase vulnerability by providing entry points for bacteria.
Managing VRE and Preventing Serious Outcomes
Managing VRE infections primarily involves using non-vancomycin antibiotics, guided by laboratory testing. Common treatment options include linezolid and daptomycin, with combination therapies sometimes used depending on infection site and severity. For localized infections, such as catheter-linked urinary tract infections, removing the device can help resolve the infection.
Infection control in healthcare settings is paramount to preventing VRE spread and minimizing serious outcomes. Measures include strict hand hygiene for healthcare workers and visitors, using gloves and gowns for VRE patients, and implementing isolation precautions. Regular cleaning and disinfection of surfaces and medical equipment are also crucial. For the public, consistent handwashing and avoiding unnecessary antibiotic use reduce the risk of encountering and spreading VRE.