Vancomycin-Resistant Enterococci (VRE)

Conditions Basics

What are vancomycin-resistant enterococci (VRE)?

Vancomycin-resistant enterococci (VRE) are a type of bacteria called enterococci that have developed resistance to many antibiotics, especially vancomycin. Enterococci bacteria live in our intestines and on our skin, usually without causing problems. But if they become resistant to antibiotics, they can cause serious infections, especially in people who are ill or weak. These infections can occur anywhere in the body. Some common sites include the intestines, the urinary tract, and wounds.

Vancomycin-resistant enterococci infections are treated with antibiotics, which are the types of medicines normally used to kill bacteria. VRE infections are more difficult to treat than other infections with enterococci, because fewer antibiotics can kill the bacteria.

How is a VRE infection spread?

VRE, like many bacteria, can be spread from one person to another through casual contact or through contaminated objects. Most often, VRE infections are spread from the hands of health care workers to a patient in a hospital or other facility such as a nursing home. VRE infections are not usually spread through the air like the common cold or flu virus unless you have VRE pneumonia and are coughing, which is rare.

If you are healthy, your chances of getting a VRE infection are very low. Even if you have been exposed to VRE, or have VRE in your body, you are not likely to get an infection. VRE infections typically only occur among people who have weakened immune systems, such as people who have long-term illnesses or people who have had major surgery or other medical procedures and have been treated with multiple antibiotics.

Experts do not know exactly why some people become infected with VRE and others do not. But they do know that VRE infections are more likely to develop when antibiotics such as vancomycin are used often. If you take antibiotics when you do not need them, they may not work when you do need them. Each time you take antibiotics, you are more likely to have some bacteria that the medicine does not kill. These bacteria can change (mutate) so they are harder to kill. Then, the antibiotics that used to kill them no longer work. These bacteria are called antibiotic-resistant bacteria.

What are the symptoms?

The symptoms of a VRE infection depend on where the infection is. If VRE are causing a wound infection, that area of your skin may be red or tender. If you have a urinary tract infection, you may have back pain, a burning sensation when you urinate, or a need to urinate more often than usual. Some people with VRE infections have diarrhea, feel weak and sick, or have fever and chills.

How is it diagnosed?

If your doctor suspects that you are infected with VRE, he or she will send a sample of your infected wound, blood, urine, or stool to a lab. The lab will grow the bacteria and then test to see which kinds of antibiotics kill the bacteria. This test may take several days.

How is a VRE infection treated?

If you get a serious infection with VRE, you may be isolated in a private hospital room to reduce the chances of spreading the bacteria to others. When your doctors and nurses are caring for you, they may use extra precautions such as wearing gloves and gowns.

VRE infections may be difficult to cure because the bacteria do not respond to many antibiotics. If you have an infection, your doctor will order antibiotics that may be given by mouth or into a vein through an I.V. (intravenously). Sometimes more than one antibiotic is prescribed to help stop the infection. Part of your treatment may include sending samples of your blood, urine, or stool to a lab to see if you still have VRE in your body.

Some people get rid of VRE infections on their own as their bodies get stronger. This can take a few months or even longer. Other times, an infection will go away and then come back. Sometimes the infection will go away, but the bacteria will remain without causing infection. This is called colonization.

How can you prevent it?

As more antibiotic-resistant bacteria develop and more cases of VRE infections are documented, hospitals and other health care facilities are taking extra care to practice infection control, which includes frequent hand-washing and isolation of patients infected with VRE.

Even though most healthy people are not at risk for becoming infected or colonized with VRE, you can take steps to prevent getting a VRE infection.

• Practice good hygiene.
  • Keep your hands clean by washing them thoroughly with soap and clean, running water or using an alcohol-based hand sanitizer. Hand-washing is the best way to avoid infection of any kind.
  • Keep cuts and scrapes clean and covered with a bandage and avoid contact with other people's wounds or bandages.
  • Do not share personal items such as towels or razors.
  • Keep your environment clean by wiping all frequently touched surfaces (such as countertops, doorknobs, and light switches) with a disinfectant, especially if someone in the house has a VRE infection.
• Be smart about using antibiotics. Know that antibiotics can help treat bacterial infections, but they cannot cure viral infections. Always ask your doctor if antibiotics are the best treatment. And avoid pressuring your doctor into prescribing antibiotics when he or she thinks they won't help you get better.
• Always take all your antibiotic medicine as prescribed by your doctor. If you use only part of the medicine, it may not cure your infection. Also, it may cause antibiotic-resistant bacteria to develop.
• Do not save any antibiotics, and do not use antibiotics that were prescribed for someone else or for a different problem.
• If you are in the hospital, remind doctors and nurses to wash their hands before they touch you.