Vancomycin-resistant enterococci (VRE)

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What is VRE?

Enterococcus bacteria is a germ that lives in the intestinal tract and the mouth. Sometimes the bacteria causes no problem, or it causes a mild infection. Some Enterococcus infections can be easily treated with antibiotics. But vancomycin-resistant enterococci (VRE) can’t. It’s called vancomycin-resistant because the antibiotic vancomycin, which used to be effective treatment, no longer works. VRE germs are often resistant to many other antibiotics as well. There are two different ways VRE can appear in the body:

  • Colonization: When a person carries the VRE bacteria but is healthy. This person can spread VRE to others.

  • Infection: When a person gets sick because of the bacteria, it's called being infected with VRE. This person can also spread VRE to others. If not treated properly, VRE infections can be very serious.

What are the symptoms of VRE infection?

VRE causes different symptoms, depending on where the infection is. Common places and symptoms include

  • Urinary tract: pain and burning when urinating, the need to urinate more often, fever

  • Skin wound: redness of the skin around the wound and oozing of fluid from the wound

  • Blood: high fever, chills, nausea and vomiting, shortness of breath, confusion

  • Heart: Infection of the lining of the heart (endocarditis)

Who’s at risk?

Anyone can get a VRE infection. But certain factors make infection more likely, including:

  • Current or recent care at a healthcare facility

  • A recent surgery

  • Having the VRE germ in your system and getting sick with something else

  • Using antibiotics for a long period of time

  • Having a weakened immune system

  • Having a medical device that stays in the body for a time, such as urinary or intravenous (IV) catheters

How does VRE spread?

Ways that VRE can spread include:

  • Someone who is colonized or infected with VRE touches you with unwashed hands.

  • You touch objects or surfaces that have the germs.

  • Healthcare workers touch you without washing their hands properly after contact with an infected patient, object, or surface.

How is VRE treated?

Because VRE germs are resistant to many kinds of antibiotics, your care team will tell you how you’ll be treated. Most likely you will take a combination of several antibiotics.

Controlling and Preventing VRE: In the hospital

Hospitals and nursing homes control and prevent VRE by doing the following:

  • Handwashing. This is the single most important way to prevent the spread of germs.

  • Protective clothing. Health care workers and visitors may wear gloves and a gown when entering the room of a patient with VRE. They remove these items before leaving.

  • Private rooms. Patients with VRE infections are placed in private rooms or in a room with others who have the same infection.

  • Avoid antibiotic overuse. Too much use can cause germs to resist some antibiotics.

  • Monitoring. Hospitals monitor the spread of VRE and educate all staff on the best ways to prevent it.

What you can do as a patient?

  • Ask all hospital staff to wash their hands before touching you. Don’t be afraid to speak up!

  • Wash your own hands often with soap and warm water, or use an alcohol-based hand gel. This is especially important:

    • After using the bathroom

    • After touching a bandage

    • Before eating

  • Encourage family and friends to wash hands as well

  • If you need to have a test done, such as an X-ray, follow instructions from staff. You may need to change into a clean hospital gown and wash your hands just before leaving your room.

Controlling and Preventing VRE: at Home

Patients:

  • Wash your hands often with soap and warm water, or use an alcohol-based hand gel. This is especially important:

    • After using the bathroom

    • After touching a bandage

    • Before eating

  • Follow instructions we give you for caring for surgical wounds or any tubes that you have, such as a catheter or dialysis port.

  • Keep cuts and scrapes clean and covered until they heal.

  • Do not share towels, razors, clothing or athletic equipment.

  • Take all antibiotics your doctor prescribed. Don’t take half doses or stop the antibiotics, even if you feel better.

Caregivers:

  • Wash your hands well with soap and warm water before and after any contact with the patient. You can use an alcohol-based hand gel if your hands aren’t visibly dirty.

  • Wear disposable gloves when changing a bandage, touching an infected wound or handling dirty laundry. Throw away the gloves after each use. Then wash your hands well.

  • Change the patient’s bedding once a week, or more often if it’s soiled with feces or body fluids. Wash and dry it alone in a washer and dryer using the warmest temperatures recommended on the labels. Use liquid bleach during the wash cycle if the label permits.

  • Clean surfaces like tabletops and sinks really well. Keep bathrooms, toilets and bedside commodes clean. A mixture of 1/4 cup of bleach to 1 quart of water works great for this.

Understanding drug resistance

Hard-to-kill (resistant) germs, such as VRE, develop when antibiotics are taken longer than needed. They can also develop when antibiotics are taken when they aren't needed, or are not taken exactly as directed. This is because any germs that survive treatment with an antibiotic can multiply and thus create more resistant germs. The more often antibiotics are used, the more chances resistant germs have to develop. This is why your care team may not prescribe antibiotics unless he or she is certain that they are needed.

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