VRE in Healthcare Settings

Vancomycin-resistant Enterococci are specific types of antimicrobial-resistant bacteria that are resistant to vancomycin, the drug often used to treat infections caused by enterococci. Enteroccocci are bacteria that are normally present in the human intestines and in the female genital tract and are often found in the environment. These bacteria can sometimes cause infections. Most vancomycin-resistant Enterococci infections occur in hospitals. [Vancomycin-resistant Enterococci is also called VRE]

General Information

What is vancomycin-resistant enterococci?

Enteroccocci are bacteria that are normally present in the human intestines and in the female genital tract and are often found in the environment. These bacteria can sometimes cause infections. Vancomycin is an antibiotic that is used to treat some drug-resistant infections caused by enterococci. In some instances, enterococci have become resistant to this drug and thus are called vancomycin-resistant enterococci (VRE). Most VRE infections occur in hospitals.

What types of infections does VRE cause?

VRE can live in the human intestines and female genital tract without causing disease (often called colonization). However, sometimes it can cause infections of the urinary tract, the bloodstream, or of wounds associated with catheters or surgical procedures.

Are certain people at risk of getting VRE?

The following persons are at increased risk becoming infected with VRE:

• People who have been previously treated with the antibiotic vancomycin or other antibiotics for long periods of time.
• People who are hospitalized, particularly when they receive antibiotic treatment for long periods of time.
• People with weakened immune systems such as patients in intensive care units, or in cancer or transplant wards.
• People who have undergone surgical procedures such as abdominal or chest surgery.
• People with medical devices that stay in for some time such as urinary catheters or central intravenous (IV) catheters.
• People who are colonized with VRE.

What is the treatment for VRE?

People with colonized VRE (bacteria are present, but have no symptoms of an infection)  do not need treatment. Most VRE infections can be treated with antibiotics other than vancomycin. Laboratory testing of the VRE can determine which antibiotics will work. For people who get VRE infections in their bladder and have urinary catheters, removal of the catheter when it is no longer needed can also help get rid of the infection.

How is VRE spread?

VRE is often passed from person to person by the contaminated hands of caregivers. VRE can get onto a caregiver’s hands after they have contact with other people with VRE or after contact with contaminated surfaces. VRE can also be spread directly to people after they touch surfaces that are contaminated with VRE. VRE is not spread through the air by coughing or sneezing.

How can patients prevent the spread of VRE?

If a patient or someone in their household has VRE, the following are some things they can do to prevent the spread of VRE:

• Keep their hands clean. Always wash their hands thoroughly after using the bathroom and before preparing food. Clean their hands after contact with persons who have VRE. Wash with soap and water (particularly when visibly soiled) or use alcohol-based hand rubs.
• Frequently clean areas of the home, such as bathrooms, that may become contaminated with VRE.
• Wear gloves if hands may come in contact with body fluids that may contain VRE, such as stool or bandages from infected wounds. Always wash their hands after removing gloves.
• If someone has VRE, be sure to tell healthcare providers so that they are aware of the infection. Healthcare facilities use special precautions to help prevent the spread of VRE to others.

What should patients do if they think they have vancomycin-resistant enterococci (VRE)?

Anyone who thinks they have VRE must talk with their healthcare provider.

Monitoring VRE

CDC’s National Healthcare Safety Network Patient Safety Component includes surveillance methods to identify and track device-associated infections, such as central-line associated bloodstream infections.