What does vre mean in medical terms?

Contents

Vancomycin-resistant enterococci – hospital

VRE can get onto the hands by touching a person who has VRE or by touching a surface that is contaminated with VRE. The bacteria then spread from one person to another by touch.

The best way to prevent the spread of VRE is for everyone to keep their hands clean.

  • Hospital staff and health care providers must wash with soap and water or use an alcohol-based hand sanitizer before and after caring for every patient.
  • Patients should wash their hands if they move around the room or the hospital.
  • Visitors also need to take steps to prevent spreading germs.

Urinary catheters or IV tubing are changed on a regular basis to minimize the risk of VRE infections.

Patients infected with VRE may be placed in a single room or be in a semi-private room with another patient with VRE. This prevents the spread of germs among hospital staff, other patients, and visitors. Staff and providers may need to:

  • Use proper garments, such as gowns and gloves when entering an infected patient’s room
  • Wear a mask when there is a chance of splashing bodily fluids

Department of Health

Vancomycin-Resistant Enterococcus (VRE)

Last Reviewed: November 2011

What is VRE?

Enterococci are bacteria that are naturally present in the intestinal tract of all people. Vancomycin is an antibiotic to which some strains of enterococci have become resistant. These resistant strains are referred to as VRE.

Are VRE infections serious?

In general, enterococci are not very harmful or virulent. 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. New antibiotics to treat VRE are under development.

Who gets VRE?

Serious VRE infections usually occur in hospitalized patients with serious underlying illnesses such as cancer, blood disorders, kidney disease or immune deficiencies. People in good health are not at risk of infection, but health care workers may play a role in transmitting the organism, if careful hand washing and other infection control precautions are not practiced.

How is VRE spread?

VRE is usually spread by direct contact with hands, environmental surfaces or medical equipment that has been contaminated by the feces of an infected person.

What type of prevention is needed when caring for patients with VRE?

When providing care in a private home, hospital or nursing home, health care workers should use disposable gloves and wash their hands with soap after caring for a person with VRE. A disposable gown should also be used if the type of care involves washing or turning the patient, or changing diapers. Routine cleaning of bed rails, toilets and commodes with a bleach solution or hospital-grade disinfectant is also important. In the hospital setting, equipment such as rectal thermometers and blood pressure cuffs should be assigned solely to the infected patient.

Are special precautions needed for home care of patients with VRE?

Standard precautions including hand washing and gloving should be followed. Otherwise, healthy household members are not at risk of VRE infection. Dishes and utensils can be washed in a dishwasher or with warm soapy water and rinsed. Bed linen and clothing can be washed in a washing machine using a standard detergent for clothing.

Can nursing homes or hospitals refuse to accept patients with VRE?

No. Such discrimination is unnecessary and may be illegal. Nursing homes and hospitals are expected to follow state and federal guidelines for VRE patients which include standard precautions and proper room assignment.

Where can I get further information on VRE?

For general information, contact the New York State Department of Health, Bureau of Communicable Disease Control, at (518) 473-4439. Patients in hospitals or nursing homes may contact the facility’s infection control nurse.

Vancomycin-resistant enterococci (VRE) screening and isolation in the general medicine ward: a cost-effectiveness analysis

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Vancomycin-Resistant Enterococci (VRE)

Overview

What are vancomycin-resistant enterococci (VRE)?

Vancomycin-resistant enterococci (VRE) are a type of bacteria called enterococci that have developed resistance to many antibiotics, especially vancomycin. Enterococci bacteria live in our intestines and on our skin, usually without causing problems. But if they become resistant to antibiotics, they can cause serious infections, especially in people who are ill or weak. These infections can occur anywhere in the body. Some common sites include the intestines, the urinary tract, and wounds.

Vancomycin-resistant enterococci infections are treated with antibiotics, which are the types of medicines normally used to kill bacteria. VRE infections are more difficult to treat than other infections with enterococci, because fewer antibiotics can kill the bacteria.

How are VRE infections spread?

VRE, like many bacteria, can be spread from one person to another through casual contact or through contaminated objects. Most often, VRE infections are spread from the hands of health care workers to a patient in a hospital or other facility such as a nursing home. VRE infections are not usually spread through the air like the common cold or flu virus unless you have VRE pneumonia and are coughing, which is rare.

If you are healthy, your chances of getting a VRE infection are very low. Even if you have been exposed to VRE, or have VRE in your body, you are not likely to get an infection. VRE infections typically only occur among people who have weakened immune systems, such as people who have long-term illnesses or people who have had major surgery or other medical procedures and have been treated with multiple antibiotics.

Experts do not know exactly why some people become infected with VRE and others do not. But they do know that VRE infections are more likely to develop when antibiotics such as vancomycin are used often. If you take antibiotics when you do not need them, they may not work when you do need them. Each time you take antibiotics, you are more likely to have some bacteria that the medicine does not kill. These bacteria can change (mutate) so they are harder to kill. Then, the antibiotics that used to kill them no longer work. These bacteria are called antibiotic-resistant bacteria.

What are the symptoms?

The symptoms of a VRE infection depend on where the infection is. If VRE are causing a wound infection, that area of your skin may be red or tender. If you have a urinary tract infection, you may have back pain, a burning sensation when you urinate, or a need to urinate more often than usual. Some people with VRE infections have diarrhea, feel weak and sick, or have fever and chills.

How are VRE infections diagnosed?

If your doctor suspects that you are infected with VRE, he or she will send a sample of your infected wound, blood, urine, or stool to a lab. The lab will grow the bacteria and then test to see which kinds of antibiotics kill the bacteria. This test may take several days.

How are VRE infections treated?

If you get a serious infection with VRE, you may be isolated in a private hospital room to reduce the chances of spreading the bacteria to others. When your doctors and nurses are caring for you, they may use extra precautions such as wearing gloves and gowns.

VRE infections may be difficult to cure because the bacteria do not respond to many antibiotics. If you have an infection, your doctor will order antibiotics that may be given by mouth or into a vein through an IV (intravenously). Sometimes more than one antibiotic is prescribed to help stop the infection. Part of your treatment may include sending samples of your blood, urine, or stool to a lab to see if you still have VRE in your body.

Some people get rid of VRE infections on their own as their bodies get stronger. This can take a few months or even longer. Other times, an infection will go away and then come back. Sometimes the infection will go away, but the bacteria will remain without causing infection. This is called colonization.

How can you prevent VRE infections?

As more antibiotic-resistant bacteria develop and more cases of VRE infections are documented, hospitals and other health care facilities are taking extra care to practice infection control, which includes frequent hand-washing and isolation of patients infected with VRE.

Even though most healthy people are not at risk for becoming infected or colonized with VRE, you can take steps to prevent getting a VRE infection.

  • Practice good hygiene.
    • Keep your hands clean by washing them thoroughly with soap and clean, running water or using an alcohol-based hand sanitizer. Hand-washing is the best way to avoid infection of any kind.
    • Keep cuts and scrapes clean and covered with a bandage and avoid contact with other people’s wounds or bandages.
    • Do not share personal items such as towels or razors.
    • Keep your environment clean by wiping all frequently touched surfaces (such as countertops, doorknobs, and light switches) with a disinfectant, especially if someone in the house has a VRE infection.
  • Be smart about using antibiotics. Know that antibiotics can help treat bacterial infections, but they cannot cure viral infections. Always ask your doctor if antibiotics are the best treatment. And avoid pressuring your doctor into prescribing antibiotics when he or she thinks they won’t help you get better.
  • Always take all your antibiotic medicine as prescribed by your doctor. If you use only part of the medicine, it may not cure your infection. Also, it may cause antibiotic-resistant bacteria to develop.
  • Do not save any antibiotics, and do not use antibiotics that were prescribed for someone else or for a different problem.
  • If you are in the hospital, remind doctors and nurses to wash their hands before they touch you.

Vancomycin Resistant Enterococcus

This material must not be used for commercial purposes, or in any hospital or medical facility. Failure to comply may result in legal action.

Medically reviewed by Drugs.com. Last updated on Sep 24, 2019.

  • Care Notes

What is a vancomycin resistant enterococcus (VRE)?

VRE is a strain of bacteria that can cause infection. Usually the antibiotic vancomycin is used to kill the bacteria. However, VRE is resistant to vancomycin and makes it difficult to treat. VRE most commonly causes an infection in the urinary tract, blood, or a wound. VRE infection can easily be spread from person to person. It most often occurs in hospitals.

What increases my risk for a VRE infection?

  • Treatment with vancomycin or other antibiotics for an extended length of time
  • A medical device such as a central line, urinary catheter, or wound drain
  • A weak immune system
  • Age over 55
  • Surgery in your abdomen or chest
  • A long hospital stay or living in a long-term care facility

What else do I need to know about VRE?

You can have an active VRE infection or you can be a carrier of VRE bacteria and not have symptoms.

  • Active VRE infection makes you contagious. This means your infection can spread to another person. VRE spreads if the person touches something that comes in contact with your urine, bowel movements, or infected wound. For example, VRE can be transferred on towels, wash cloths, and surfaces that touch body fluids.
  • VRE bacteria can live in the intestines, urinary tract, vagina, or mouth without causing infection. The bacteria may cause an active infection when the immune system becomes weak and the bacteria spreads. This may happen during an illness, surgery, or treatment with medicines that weaken the immune system.

What are the signs and symptoms of a VRE infection?

Symptoms may depend on where the infection is. You may have any of the following:

  • Fever, chills, and body aches
  • Weakness or dizziness
  • Urinating more often than usual or pain when you urinate
  • Urine that smells bad, or blood in your urine
  • Pain or pressure in your abdomen
  • Red, warm skin around a wound, or soreness, swelling, and drainage from a wound

How is a VRE infection diagnosed?

  • Blood tests check for VRE and help healthcare providers plan which antibiotics are best for treatment.
  • A sample of your bowel movement, urine, or wound check for VRE bacteria.

How is a VRE infection treated?

You will not need treatment if you carry the bacteria but do not have an active infection. Antibiotics will be given to treat an active infection. If a medical device has caused your infection, it may be removed or changed.

How do I prevent the spread of VRE?

Do the following if you or someone you care for has an active VRE infection:

  • Wash your hands often. This is the most important thing you can do to prevent the spread of infection. Wash your hands after you use the bathroom or touch body fluids such as urine or bowel movement. Wash your hands after you clean an infected wound or change the bandage. Wash your hands before you prepare or eat food. Carry germ-killing gel with you and use it to clean your hands when you do not have soap and water. Tell others to wash your hands after they visit you.
  • Wear disposable gloves when you clean a wound, change a bandage, or handle body fluids. Do this if you care for someone with an active VRE infection. If you are infected with VRE, you do not need to wear gloves. Instead, make sure you wash your hands often. Throw away gloves after you use them. Put on a new pair with each task. Never use the same pair of gloves.
  • Clean bathroom surfaces daily. This includes the counter, bathtub, and shower. Use a bleach-based cleaner. You can also create a cleaning solution by mixing 1 part bleach to 10 parts water.
  • Tell all healthcare providers that you have a VRE infection. Healthcare providers will place you in a private hospital room to prevent the spread of infection to others.

Call 911 for any of the following:

  • You have shortness of breath or trouble breathing.

When should I seek immediate care?

  • You feel weak, dizzy, or confused.
  • Your heart is beating faster than usual.
  • You have severe pain.

When should I contact my healthcare provider?

  • You have a fever.
  • You have new symptoms.
  • Your symptoms do not improve with treatment.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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Learn more about Vancomycin Resistant Enterococcus

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  • Vancomycin Intermediate Staphylococcus Aureus Infection
  • Vancomycin Resistant Staphylococcus Aureus Infection

Hygiene measures at home

To avoid spreading VRE at home, take the following hygiene measures:

  • Wash your hands often with soap and water or an antiseptic product. This is the simplest and most effective way to protect yourself against VRE. This measure must be applied by both the carrier or infected person and their family members.
  • Frequently clean the room and bathroom with a household cleaning product or disinfectant. Pay special attention to surfaces and objects that are touched frequently by the carrier or infected person: toilet, grab bar, toilet flush handle, door handles, light switches, bedside table and telephone.
  • Wash the carrier’s or infected person’s clothes and bed linen in warm or hot water with household laundry detergent.
  • Dispose of dressings soiled with the carrier’s or infected person’s secretions in a sealed plastic bag and wash your hands afterwards.

If you are receiving home care, make sure care providers take special precautions when treating someone who is a carrier or is infected with VRE. Gloves and a gown may be required to avoid spreading the bacteria to other people.

You will find additional hygiene measures on the Preventing transmission of viruses and bacteria page.

Measures put in place in healthcare facilities

If you are having a consultation in a healthcare institution, tell the healthcare staff that you or the person with you is a carrier or is infected with VRE.

When a hospital admits a person who is a carrier or is infected with VRE, various measures must be put in place:

  • Isolate the carrier or infected person in a private room or in a room with other patients who are carriers or are infected with VRE, depending on the healthcare setting and the patient’s condition.
  • Clean and disinfect the carrier’s or infected person’s room and bathroom frequently.
  • Require gloves and long-sleeved gowns for staff and visitors, depending on the situation.
  • Post a sign on the door of the carrier’s or infected person’s room to remind staff members and visitors to wash their hands and follow the measures put in place.

These measures are maintained until laboratory test results show that the patient is no longer a carrier or infected with the bacteria.

In nursing homes, measures are adapted to the setting and the person’s condition.

When it is time for a person who has been treated for a VRE infection to return home, they will be given a list of measures to take to avoid spreading the illness. The doctor or health professional may suggest additional measures if another person at home is ill or has a weakened immune system.

What Is VRE (Vancomycin-Resistant Enterococcus)?

VRE causes difficult-to-treat urinary tract, wound, and bloodstream infections.

Vancomycin-resistant Enterococcus, or VRE, is a strain of Enterococcus “superbugs” that have become resistant to the antibiotic vancomycin.

Enterococcus is a group of bacteria normally found in the environment, human intestines, and female urinary tract.

While they rarely cause illness in healthy people, Enterococcus bacteria can cause serious infections in healthcare settings (aka “nosocomial” infections) among people who are already ill or injured.

Each year, there are an estimated 66,000 healthcare-associated Enterococcus infections in the United States, according to the Centers for Disease Control and Prevention (CDC).

About 20,000 of these infections are caused by vancomycin-resistant strains — particularly Enterococcus faecium, which causes 77 percent of drug-resistant infections.

Each year, VRE kills approximately 1,300 people in United States, according to the CDC.

Who’s At Risk for VRE?

Enterococcus bacteria rarely, if ever, affect people who are healthy, according the National Institute of Allergy and Infectious Diseases (NIAID).

Instead, infections by VRE — as well as by non-resistant Enterococcus strains — occur mostly in hospital settings and affect people who are already ill, such as those receiving intensive treatment for diabetes, chronic kidney failure, and other issues.

Some people have an increased risk of getting a VRE infection, including those who:

  • Are hospitalized, especially if they receive long-term antibiotic treatments
  • Were previously treated with vancomycin, or treated for a long period with a combination of other antibiotics, such as penicillin and gentamicin
  • Have a weakened immune system from diseases or drug treatments
  • Have undergone surgery or other invasive procedures
  • Are using long-term hospital medical devices, such as urinary and intravenous catheters
  • Are colonized with VRE (the bacteria is living in the body, but people experience no symptoms)

VRE Symptoms

Enterococcus infections, including VRE infections, cause a range of different symptoms depending on the location of the infection.

This includes infections of the bloodstream, urinary tract infections (UTI), and wound infections associated with catheters or surgery.

Wound infections associated with catheters and surgery can cause:

  • Soreness and swelling at wound site
  • Red, warm skin around wound
  • Fluid leakage

Urinary tract infections can cause:

  • Frequent or intense urge to urinate
  • Pain or burning sensation while urinating
  • Cloudy, dark, bloody, or foul-smelling urine
  • Fatigue
  • Lower back or abdominal pain

Bloodstream infections can cause:

  • Fever
  • Chills
  • Body aches
  • Rapid pulse and breathing
  • Nausea and vomiting
  • Diarrhea
  • Decreased urination

VRE Treatment

People who are simply colonized by VRE require no treatment, as the bacteria aren’t causing any disease.

VRE infections are treated with non-vancomycin antibiotics.

However, each case is different, and the bacteria may be resistant to other antibiotics, including some:

  • Penicillins
  • Cephalosporins
  • Clindamycins
  • Aminoglycosides
  • Macrolides
  • Tetracyclines
  • Quinolones

Finding an effective treatment requires testing a specimen of bacteria against different antibiotics in a laboratory to see which drugs kill the bacteria.

Vancomycin-Resistant Enterococci (VRE) Overview

Enterococci bacteria grabbed the attention of public health officials in the 1980s because of their ability to survive in humans and animals and knack for sharing those survival tricks with other bacteria.

While enterococci are not as familiar as staphylococcus (staph) or Escherichia coli (E. coli) bacteria, enterococci infections are among the most common type acquired by hospitalized patients. Enterococci, in general, are much less capable of causing disease than staph or E. coli but still can complicate and prolong hospital stays. Virtually the only people who develop illness from Enterococcus are those who are already ill, such as individuals in a hospital intensive-care unit or those who are elderly, have diabetes, have chronic kidney failure, and so forth. So, unlike other forms of resistant bacteria, there is little chance or concern among physicians of Enterococcus becoming epidemic in healthy populations.

But enterococci are of great interest because, as with many of its bacterial counterparts, it can resist and evade several forms of antibiotic therapy, including vancomycin, the antibiotic of last resort for resistant infections.

Enterococcal infections that result in human disease can be fatal, particularly those caused by strains of vancomycin-resistant enterococci (VRE). During 2004, VRE caused about one of every three infections in hospital intensive-care units, according to the Centers for Disease Control and Prevention.

In 1984, enterococci was given its own genus identity. In 1986, the first VRE strains appeared in Europe and, in 1989, the first case of VRE was reported in the United States. Between 1989 and 1993, the percentage of enterococcal tests that were positive for VRE in the United States rose from 0.3 percent to 7.9 percent.

Researchers seek to develop improved therapeutics as well as gain a better understanding of VRE’s genetic survival characteristics and how those resistance genes are passed to other pathogens.

Why is the latter element important? As of 2007, the United States had reported seven cases of vancomycin-resistant Staphylococcus aureus (VRSA) infection, a serious development that has healthcare providers fearful of losing ground in their attempt to control the spread of S. aureus. In one of the cases, scientists confirmed the transfer of a key antibiotic resistance gene from Enterococcus to Staphylococcus.

VRE Risks

Enterococci can survive for months. It primarily resides in the human digestive system and the female genital tract; the enterococci make up a significant part of the normal bacterial population of these sites in healthy people.

However, colonization can progress to infection, particularly for people with certain risk factors. The infection can lead to diseases of the urinary tract, bloodstream, heart valves (endocarditis), and brain (meningitis), as well as to serious infections in open wounds.

Some of the risks for acquiring VRE infection are

  • Persons who have been previously treated with vancomycin and combinations of other antibiotics, such as penicillin and gentamicin
  • Persons who are hospitalized, particularly when they receive antibiotic treatment for long periods of time
  • Persons with weakened immune systems, such as patients in intensive-care units, cancer, or transplant wards
  • Persons who have undergone surgical procedures, such as abdominal or chest surgery
  • Persons with medical devices that stay in for some time, such as urinary catheters or central intravenous catheters

Enterococcal infections are more common in elderly people, particularly those in long-term care facilities and skilled nursing homes because they are more likely to experience infection risk factors, such as exposure to medical instruments.

Background:

Vancomcyin-resistant enterococcus (VRE) is a significant pathogen in nosocomial urinary tract infections (UTI). Oral therapy for VRE UTIs is limited and expensive. Oral fosfomycin is FDA approved for the treatment of uncomplicated UTIs and demonstrates in-vitro activity against enterococci. Fosfomycin may be a cost-effective treatment option for VRE UTIs, however data are lacking. The objective of this study was to determine the clinical efficacy of fosfomycin for the treatment of VRE UTI.

Methods:

A retrospective chart review of patients with VRE UTI treated with fosfomycin from December 2009 to April 2011 was conducted. UTI definition included urinalysis with pyuria (greater than 5 leukocytes/microliter) a urine culture with VRE greater than 50,000 colony forming units susceptible to fosfomycin, and one of the following clinical parameters: a white blood cell count greater than 11,000 cells/microliter, a temperature greater than 100.5F, or subjective complaints of dysuria, frequency, and/or urgency. Patients were included if they received at least 1 dose of fosfomycin, and were excluded if they received antibiotics with anti-VRE activity. Uncomplicated and complicated urinary tract infections were evaluated. Clinical cure was defined as resolution of symptoms within 10 days of therapy.

Results:

A total of 39 patients met inclusion criteria. The clinical cure rate for VRE UTI treated with fosfomycin was 82.0% (32/39). Of the cohort, 29/39 (74%) patients had complicated UTI, 26% had uncomplicated UTI. The clinical cure rate was 100% (10/10) for uncomplicated UTIs, compared to 76% (22/29) for complicated UTIs. There were 7 patients with relapse or reinfection; 3 of whom were kidney transplant recipients and 3 on hemodialysis. Treatment duration was similar in both groups (6.0 days, uncomplicated UTI v. 5.1 days, complicated UTI). The cost of a week of fosfomycin therapy was $120, compared to $1575 for daptomycin and $980 for linezolid.

Conclusion:

Fosfomycin is a cost-effective alternative to daptomycin and linezolid for the treatment of VRE UTIs, including complicated UTIs. Kidney transplant and hemodialysis patients may be at higher risk of relapse; a longer treatment duration may reduce the risk of relapse in this patient population.

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