What is the main antibiotic used to treat VRE?
Two novel antimicrobial agents (quinupristin/ dalfopristin and linezolid) have emerged as approved therapeutic options for vancomycin-resistant Enterococcus faecium on the basis of in vitro susceptibility and clinical efficacy from multicentre, pharmaceutical company-sponsored clinical trials.
What is VRE and how is it treated?
Enterococci are bacteria (germs) that commonly live in the gastrointestinal tract (bowels) of most people (this is called colonisation) without causing illness. Vancomycin is an antibiotic used to treat infections caused by enterococci.
Can VRE be cured?
You need to take the full course of antibiotics. VRE infections may be hard to cure. Bacteria do not respond to many antibiotics. You may need more than one antibiotic to stop the infection.
Is VRE easy to get rid of?
These hard-to-kill bacteria are called vancomycin-resistant enterococci (VRE). According to the U.S. National Library of Medicine, VRE infections can be difficult to treat because there are fewer antibiotics that can fight this resistant bacteria.
Do patients with VRE need to be isolated?
Initiate the following isolation precautions to prevent patient-to-patient transmission of VRE: Place VRE-infected or colonized patients in private rooms or in the same room as other patients who have VRE (8).
How does a person get VRE?
VRE are often spread indirectly from person to person on the hands of caregivers or contact with contaminated items (e.g., medical equipment) or surfaces (e.g., toilet seats, door knobs). VRE can also spread directly from person to person by contact with body fluids containing VRE (e.g., blood, feces, urine).
Do you have VRE for life?
People with an active infection can be treated with an antibiotic (medicine) and the infection may go away. People that are colonized with VRE may have it for long time. Talk to your healthcare provider for more information.
How long does VRE last for?
The VRE germ can survive on hard surfaces for five to seven days and on hands for hours.
Can VRE be fatal?
This applies to both antibiotic-resistant as well as nonresistant or sensitive strains. However, when VRE infects the urinary tract, surgical wounds or the bloodstream of hospitalized patients, it may be difficult to treat and, occasionally, may be life threatening.
How serious is VRE?
Sometimes, the bacteria become resistant to the antibiotic. That means they can live even though the drug is designed to kill them. These superbugs are called vancomycin-resistant enterococci, or VRE. They're dangerous because they're more difficult to treat than regular infections.
What is the difference between MRSA and VRE?
MRSA can be spread by touching articles that have been contaminated by the skin of an infected or colonized person, such as towels, sheets, and wound dressings; VRE can be transmitted by touching articles soiled by an infected person's feces.
Is VRE a hospital acquired infection?
Vancomycin-Resistant Enterococcus (VRE) is considered one of the main pathogens of hospital-acquired infections (HAI), responsible for high morbidity and mortality rates.
What is the difference between MRSA and VRE?
MRSA can be spread by touching articles that have been contaminated by the skin of an infected or colonized person, such as towels, sheets, and wound dressings; VRE can be transmitted by touching articles soiled by an infected person's feces.
How long does VRE last for?
The VRE germ can survive on hard surfaces for five to seven days and on hands for hours.
Is VRE a superbug?
When enterococci become resistant to the antibiotic Vancomycin, we call the bacteria Vancomycin Resistant Enterococci (VRE). VRE are a type of superbug. These are bugs that are resistant to antibiotics. This means that some antibiotics that were used to treat them no longer work very well.
How common is VRE?
How Common Is VRE? An estimated 20,000 people in the United States become infected with it each year. A little fewer than 10% of people who get it die from it. People who stay in a hospital have the highest odds of getting VRE.
What is CDC doing to address VRE infections?
This surveillance system collects reports of VRE from device-associated infections, such as central-line associated bloodstream infections.
What areas of the home can be contaminated with VRE?
frequently cleaning areas of the home, such as bathrooms, that may become contaminated with VRE
How are these infections treated?
In order to identify the best antibiotic to treat a specific infection, healthcare providers will send a specimen (often called a culture) to the laboratory and test any bacteria that grow against a set of antibiotics to determine which are active against the germ. The provider will then select an antibiotic based on the activity of the antibiotic and other factors like potential side effects or interactions with other drugs.
How many deaths from VRE in 2017?
In 2017, VRE caused an estimated 54,500 infections among hospitalized patients and 5,400 estimated deaths in the United States [ Source: 2019 AR Threats Report ].
Why are enterococci resistant to antibiotics?
Antibiotic resistance occurs when the germs no longer respond to the antibiotics designed to kill them.
What is a VRE infection?
Serious infection with vancomycin-resistant enterococci (VRE) usually occurs in patients with significantly compromised host defences and serious co-morbidities, and this magnifies the importance of effective antimicrobial treatment. Assessments of antibacterial efficacy against VRE have been hamper …
What is the drug class for VRE?
Several investigational agents are currently in phase II or III trials for VRE infection. This category includes daptomycin (an acidic lipopeptide), oritavancin (LY-333328; a glycopeptide), and tigilcycline (GAR-936; a novel analogue of minocycline).
Does quinupristin kill VRE?
Myalgia/arthralgia was the most frequent treatment-limiting adverse effect. In vitro studies which combine quinupristin/dalfopristin with ampicillin or doxycyline have shown enhanced killing effects against VRE; however, the clinical use of combined therapy remains unestablished.
What is the treatment for a VRE infection?
Treatment and Medication Options for VRE. When someone develops a VRE infection, doctors typically turn to antibiotics that are alternatives to vancomycin.
Why is VRE so hard to treat?
National Library of Medicine, VRE infections can be difficult to treat because there are fewer antibiotics that can fight this resistant bacteria. In fact, VRE is listed as one of the key antibiotic-resistant pathogens that pose a threat to human health in the Centers for Disease Control and Prevention’s 2019 Antibiotic ...
How Is VRE Diagnosed?
To confirm a VRE infection, your doctor will send a sample of your infected wound, blood, urine, or stool to the lab for analysis. At the lab, technicians will grow the bacteria and test it to see which antibiotics can kill the bacteria. If vancomycin can’t kill it, that confirms the existence of VRE.
What are the symptoms of VRE?
VRE can infect the bloodstream, the urinary tract (as a UTI ), and wounds associated with catheters or surgery. Bloodstream infections can cause: Fever. Chills.
How does VRE evolve?
To understand how antibiotic-resistant bacteria such as VRE emerges, it helps to first understand how bacteria and fungi change in response to medicines designed to kill them. According to the CDC Antibiotic Resistance Threats Report, germs naturally evolve constantly, and can develop new ways to avoid the effects of antibiotics. Once that happens, the resistant germ survives and multiplies, and the surviving germs, which now have resistance traits in their DNA, pass on this genetic information to subsequent generations. These resistant germs can continue to spread and pose an increasing threat to people’s health.
What does VRE stand for?
Copy Link. Medically Reviewed. VRE stands for vancomycin - resistant enterococci. Enterococci are bacteria that normally live in the intestines and in the female genital tract, and are also present in soil and water. Most of the time, these germs don’t cause any harm, but if they get into certain places in the body, such as the urinary tract, ...
How is VRE spread?
VRE is typically not spread through the air like a cold or the flu and it cannot be spread through casual contact such as hugging. It is spread by direct contact with an infected person’s bodily fluids, such as blood, phlegm, urine, or stool, or by touching surfaces that have been contaminated by the bacteria.
How to prevent VRE?
Good hand hygiene will help prevent your family and friends from getting VRE. You should always perform hand hygiene by washing your hands with soap and water:
How can the spread of VRE be prevented?
Early detection of people who carry VRE is essential to stop any spread. This is why we screen for VRE in WA hospitals.
How is VRE spread?
VRE can be spread from person to person through direct contact with an infected or colonised person.
What happens if you have VRE?
If VRE is found in a specimen taken from you while you are in hospital, your healthcare team will continue to provide the same level of care. However, some extra precautions will be taken:
How to tell if you have VRE?
People carrying VRE in their bowel or other body sites show no signs or symptoms and it is impossible to tell if a person has VRE by looking at them. If infection is suspected then a doctor will take a swab or specimen of, for example, blood, or wound, or urine or sputum and send it to the laboratory for testing.
What are the symptoms of VRE?
Typically, signs and symptoms can include fever, shivering, and low blood pressure.
What is a VRE?
Vancomycin-resistant Enterococci (VRE) Enterococci are bacteria (germs) that commonly live in the gastrointestinal tract (bowels) of most people (this is called colonisation) without causing illness. Vancomycin is an antibiotic used to treat infections caused by enterococci. When enterococci become resistant to vancomycin (meaning ...
How can VRE be transmitted?
There are reports that VRE can be transmitted by direct patient contact, touching of contaminated surfaces/equipment or through hand transfer after contact with the affected patient. In almost every hospital in the US, VRE has become a serious problem. In response to this epidemic, almost every hospital now has an infectious disease committee that oversees the use of antibiotics and audits procedures at the bedside for sterility. It is here that the role of the infectious disease nurse and pharmacist is vital. The current recommendations are to 1) only use vancomycin when absolutely needed, and permission must be obtained from the board-certified infectious disease pharmacist and clinician infectious disease specialist 2) educate all healthcare workers about VRE 3) implement infection control measures including hand washing, gloves, and gowns when coming into contact with patients who have VRE and 4) maintain a clean working environment with strict aseptic control. There is evidence to support the use of an interprofessional approach to prevent nosocomial spread of VRE. Many hospitals have now enforced the use of contact isolation and regular surveillance cultures. [17][18][19](Level V)
What are the risk factors for vancomycin-resistant Enterococcus?
The most commonly observed risk factor is previous antimicrobial therapy. This mechanism likely is due to alteration in bowel flora. Furthermore, patients at increased risk are those with severe underlying illnesses or immunosuppression. This also includes patients with a long hospital stay, admission to long-term care facilities, extended use of antibiotics, and proximity to other patients with vancomycin-resistant Enterococcus. [8][9]
Is VRE a problem?
Despite the proactive measures, VRE continues to be a problem in many hospitals. Short-term data show that the key to preventing VRE is the cautious use of the antibiotics and remaining compliant with infection control measures, especially in high-risk patients. [20][21](Level 5)
Can you present with a physical exam for vancomycin resistant enterococcus?
Patients with an underlying vancomycin-resistant Enterococcus infection will present with a variety of history and physical exam findings dependent on the clinical manifestations as described below. Specifically, the focus should be placed on using the patient’s medical history and physical exam to elucidate the source of infection.
Is vancomycin resistant enterococcus a challenge?
In particular, vancomycin-resistant Enterococcus (VRE) has become a challenge to manage in the hospital setting. Enterococci are facultative anaerobic gram-positive cocci in pairs/chains that live in the gastrointestinal (GI) tract and ordinarily function commensally with humans. However, they can cause a variety of infections, most commonly urinary tract infection (UTI), intraabdominal infection, bacteremia, or endocarditis. Rarely, they can cause meningitis, osteomyelitis, septic arthritis, or pneumonia. Additionally, vancomycin-resistant Enterococcus often exists as a colonizing organism that does not always contribute to infection, making it more difficult to determine when and how to treat these infections. Despite these difficulties, infection of vancomycin-resistant Enterococcus has been shown to increase both cost and mortality when compared to vancomycin-susceptible isolates. With increasing rates of vancomycin resistance among Enterococcus isolates, good stewardship combined with aggressive treatment with targeted antibiotics is necessary to treat this frequently encountered infection.[1][2][3]
How to wash your hands after a VRE?
Wash your hands with soap and water after using the bathroom and before making food -- especially if you’re in contact with someone who has VRE. A good rule of thumb is to wash up long enough to sing “Happy Birthday to You” twice.
What happens if a lab test is positive for VRE?
If the sample tests positive -- meaning you have VRE -- they’ll do more tests to find out which antibiotic will best treat it .
Can VRE cause urinary tract infections?
VRE comes with a number of symptoms. Yours might actually be caused not by VRE, but by other infections it can trigger, like urinary tract infections, bloodstream infections, and wound infections. The time between when you’re infected and when you develop symptoms varies, too.
How to get rid of VRE in your home?
Frequently clean areas of your home, such as your bathroom, that may become contaminated with VRE. Wear gloves if you might come in contact with body fluids (such as stool or bandages from infected wounds) that could contain VRE. Always wash your hands after removing gloves.
What is a VRE?
What are Vancomycin-resistant Enterococci (VRE)? Some enterococci are no longer killed by vancomycin and are known as vancomycin-resistant enterococci or VRE. These germs are often resistant to many antibiotics in addition to vancomycin. Most VRE infections occur in hospitals.
What is a VRE BSI?
A VRE BSI is when a patient has a positive test for VRE in the blood along with evidence of an infection, such as a fever. VRE BSIs usually occur in patients with the greatest risk of a VRE infection, such as following organ transplantation.
What are the risks of getting VRE?
The following people are at an increased risk of 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, especially when they receive antibiotics for long periods of time. People with weakened immune systems such as patients in ...
What to do if you don't see your provider clean their hands?
If you do not see your providers clean their hands, please ask them to do so.
Do hospitals report VRE?
All California general acute care hospitals are required to report VRE bloodstream infection (BSI) cases that occur following hospitalization so that CDPH can calculate the rates of VRE BSI at each hospital and make that information available to the public (Health and Safety Code Section 1288.55).
Can you get a VRE infection if you are not taking antibiotics?
VRE does not pose a threat to someone who is healthy, as it is no more likely to cause an infection than the enterococci that are normally present in your intestines. A person who is not taking antibiotics will not ...
How to prevent VRE?
The best way to prevent the spread of VRE, and all infections, is to clean your hands often. This includes washing hands with soap and water or using an alcohol-based hand rub. Health care workers should follow specific infection control precautions. These might include wearing gowns and gloves when entering a room of patients with VRE infection.
How to identify a VRE infection?
The only way to identify a VRE infection is to collect and test appropriate specimens in the laboratory. For example, a doctor might collect a urine sample for testing if he or she thinks a person has a urinary tract infection. The laboratory can also test to determine which antibiotic will be the most effective to treat the illness. This is how they will know that the bacteria is resistant to vancomycin.
How is VRE spread?
VRE is usually spread via the hands of health care workers. Health care worker hands can become contaminated after contact with other people with VRE or with contaminated surfaces or equipment. VRE is not spread through the air by coughing or sneezing.
Can you treat VRE with antibiotics?
People who are colonized (bacteria are present but without symptoms of an infection) with VRE do not usually need treatment.
How to reabsorb extravasated vesicant?
Elevation of the limb may aid in reabsorption of the infiltrate or extravasated vesicant by decreasing capillary hydrostatic pressure. Apply sterile dressing over the area of extravasation, regularly assess the extravasation site during every shift, and take medical photographs and consult the department of cosmetic surgery if necessary.
How to stop IV fluids from extravasation?
At the first sign of extravasation, the following steps are recommended: (1) stop administration of IV fluids immediately, (2) disconnect the IV tube from the cannula, (3) aspirate any residual drug from the cannula, (4) administer a drug-specific antidote, and (5) notify the physician (Fig. 1). Open in a separate window.
What is local warming therapy?
The use of local warming therapy (dry heat) is based on the theory that it enhances vasodilation, thus enhancing the dispersion of the vesicant agent and decreasing drug accumulation in the local tissue. The use of local warming is recommended for the extravasation of non–DNA-binding vesicants.
How often does extravasation occur in adults?
The frequency of extravasation in adults is reported to be between 0.1% and 6%. Some data suggest that the incidence is decreasing probably due to improvements in the infusion procedure, early recognition of the drug leakage, and training in management techniques.
What are the items required for extravasation?
Documentation procedure may differ between treatment centers (documentation form); however, certain items are mandatory for patient safety and legal purposes: (1) patient name and number, (2) date and time of the extravasation, (3) name of the drug extravasated and the diluent used (if applicable), (4) signs and symptoms (also reported by the patient), (5) description of the IV access, (6) extravasation area (and the approximate amount of the drug extravasated), and (7) management steps with time and date.
When to report extravasation of chemo?
Patients must be informed to report any changes in sensation, signs, or symptoms during the IV administration of any chemotherapeutic drug and to alert the healthcare professionals to early signs of extravasation. Particular information must be given when a vesicant drug is administered. Extravasation must be suspected if any of the following specific signs or symptoms are presented (Table 1).
How to prevent extravasation of cytotoxic drugs?
Most extravasations can be prevented with the systematic implementation of careful, standardized, and evidence-based administration techniques. The staff involved in the infusion and management of cytotoxic drugs must be trained to implement several preventive protocols for the minimization of the risk of extravasation. It is important to remember that the degree of damage is dependent on the type of the drug, the drug concentration, the localization of the extravasation, and the length of time for which the drug develops its potential for damage.
