Vancomycin Resistant Enterococcus

Vancomycin resistant enterococcus (VRE) infection and colonization are increasing in incidence throughout the U.S. Organisms with high level resistance are typically resistant to multiple antibiotics including penicillins and aminoglycosides in addition to vancomycin. Some are resistant to all commercially available antimicrobials. Several risk factors for infection have been identified including severe underlying disease or immunosuppression, prolonged hospitalization, surgical procedures and indwelling catheters, and treatment with multiple antibiotics including vancomycin. VRE is also most often found in large teaching hospitals (>500 beds). Mortality rates from bloodstream infection have been reported as high as 73%.

The organism has mainly been isolated from urine and wound specimens. Treatment is controversial and options may be limited to antibiotic combinations or experimental antimicrobials. Control and prevention are vital. Guidelines for preventing the spread of vancomycin resistance have recently been published by the Centers for Disease Control and Prevention.

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