Vancomycin Resistant Enterococci

Enterococci are the group of bacteria that are normally present in the human intestines and female genital tract. This group survive on the hands of health care workers and on inanimate objects too. The majority of Enterococci are opportunistic pathogens. However, Enterococci are continually developing novel strategies to evade the antibiotics that are used to treat the infections they cause. The rise of Enterococci as nosocomial pathogens and the development of resistance have been attributed to individuals who have had their immune systems compromised by prolonged antibiotic treatment, hospitalization, surgery, or the insertion of medical devices.

The emergence of acquired vancomycin resistance in the late 1980s led to significant improvements in enterococcal diagnostics in clinical microbiology laboratories, enterococcal infection control, and enterococcal infection management.

Vancomycin Resistant Enterococci (VRE) can spread from one person to another through contact with contaminated surfaces or equipment or hands. Some people carry VRE on their body without causing symptoms, which is called being colonized and they do not require antibiotics. 

Hospitals must adopt a very aggressive strategy and meet high performance requirements in order to detect and contain VRE. Special awareness and educational sessions should be a regular practice for hospital staff. If hospitals' geographic areas observe a high VRE prevalence, all enterococcal isolates should undergo susceptibility testing.

Identification of VRE to species level aids in conforming whether an isolate has intrinsic or acquired resistance. For the purposes of infection control, understanding the nature of resistance is essential. Although isolation of individuals who have been found to have VRE infection or colonization is advised, knowing the many VRE variants allows us to realize that not all phenotypes are fatal.

References:

1.Moellering RC Jr. Vancomycin-resistant enterococci. Clin Infect Dis. 1998 May;26(5):1196-9. 

2.Gold HS. Vancomycin-resistant enterococci: mechanisms and clinical observations. Clin Infect Dis. 2001 Jul 15;33(2):210-9. 

3.Levitus M, Rewane A, Perera TB. Vancomycin-Resistant Enterococci. 2022 Jul 18. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan. PMID: 30020605

4.Sood S, Malhotra M, Das BK, Kapil A. Enterococcal infections & antimicrobial resistance. Indian J Med Res. 2008;128(2):111-121.