Vancomycin-Resistant Enterococcus (VRE)

What is vancomycin-resistant enterococcus (VRE)?

Enterococcus is a type of bacteria. It commonly lives in the intestines and in the female genital organs. Most of the time it does not cause infections. When it does cause an infection, antibiotics are used to treat the infection. Vancomycin is an antibiotic often used to treat the infection. However, some enterococcus bacteria have become resistant to vancomycin. This means the antibiotic is not able to kill the bacteria and cure the infection. These bacteria are called vancomycin-resistant enterococcus, or VRE.

What is the cause?

When bacteria are exposed to antibiotics intended to kill them, some of them can change and become resistant to the antibiotics.

You are more likely to have a VRE infection if:

• You have been treated with antibiotics for a long time.
• You have been hospitalized often or for a long time. You are especially at risk if you have been getting antibiotics.
• You have a weakened immune system. Things like severe illness, cancer, and organ transplant can weaken your immune system.
• You have had major chest or abdominal surgery.
• You have a medical device, such as a urinary catheter or an IV line, that has been in your body for weeks.
• You are on dialysis.
• You have a serious medical problem, such as diabetes, kidney disease, or a skin problem that makes it easy for you to get skin infections.

What are the symptoms?

The symptoms of VRE infection depend on where the infection is. You might have the infection in your urinary tract, skin, intestine, or blood.

At first the symptoms of infection are like the symptoms of other infections:

• fever and chills
• sometimes headache or body aches

In older adults the infection may cause confusion. If you have a pocket of infection (an abscess), you may have redness and painful swelling. If you have an open wound, pus may be draining from it. The pus may smell bad.

How is it diagnosed?

VRE is diagnosed with lab tests of a sample of infected body fluid. The sample that is tested may be urine, blood, or stool. Or it may be pus from an abscess. Lab tests can show what kind of bacteria are causing the infection. They can also find out what antibiotics should work. The tests may take 48 to 72 hours.

If the infection may be coming from medical equipment, like a central IV line or a catheter, the equipment may be removed and also tested in the lab.

How is it treated?

VRE is treated with antibiotics that lab tests show will work against the resistant bacteria.

If the medical equipment you have been using is infected, it will be removed.

VRE infections can get very serious very quickly when the usual antibiotics do not stop the infection. Symptoms can get much worse while you wait for test results to learn what medicine is likely to work.

Some strains of enterococcus may have become resistant to all available antibiotics. These infections are very hard to cure. This is why prevention of VRE is so important.

How long will the effects last?

The effects of the infection depend on how serious it is, what part of the body is infected, and if there are antibiotics that can kill the bacteria. If you were infected in the hospital, you will likely need to stay at the hospital for a longer time. It will probably also take you longer to recover after you go home.

How should I take care of myself?

You must be sure to follow your healthcare provider’s directions for:

• taking your antibiotics
• taking care of your wound if you have one
• resting
• going back to your activities slowly

When you are discharged from the hospital, you should get instructions for when to contact your healthcare provider. Generally, you should call your provider right away if:

• Your infection symptoms are coming back.
• You have a fever of 100.5°F (38°C) or higher
• You have chills and sweats.
• You are having side effects from your antibiotic.

VRE can be a life-threatening infection. You should feel comfortable discussing your treatment and any problems or concerns you have. Your healthcare provider wants and needs to know if you are having problems with your treatment and recovery plan. After you leave the hospital, be sure to go to all of your followup appointments.

How can I help prevent the spread of VRE?

While you are in the hospital, you and your family need to wash your hands often with soap and water or an alcohol-based hand rub. This is especially important before and after touching part of your body or anything that has been in contact with you. The VRE can live on surfaces for hours to days. They can easily be transferred from you to a surface such as the hospital bedrail and then to another person.

It is very appropriate for you to remind all healthcare staff to wash their hands before and after caring for you. This includes, for example, doctors, nurses, lab techs, aides, and respiratory therapists.

When you go home from the hospital, some things you and your family and friends can do to prevent the spread of VRE are:

• Keep your hands clean, especially after using the bathroom or before preparing food. Use soap and water or alcohol-based hand rubs.
• Frequently clean areas of your home, such as your bathroom, that may be contaminated with VRE.
• Wear gloves if you might come in contact with body fluids that could contain VRE—for example, bowel movement or bandages from infected wounds. Always wash your hands after removing gloves.
• If you have VRE, be sure to tell anyone who is caring for you or giving you treatment. Healthcare facilities use special precautions to help prevent the spread of VRE to others.