Vancomycin resistant enterococcus

Vancomycin-Resistant Enterococcus
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Fever, fatigue, urinary tract infections, wound infections
Complications	Sepsis, endocarditis
Onset
Duration
Types	N/A
Causes	Enterococcus species resistant to vancomycin
Risks	Hospitalization, antibiotic use, weakened immune system
Diagnosis	Culture and sensitivity testing
Differential diagnosis	N/A
Prevention	N/A
Treatment	Linezolid, daptomycin
Medication	N/A
Prognosis	Variable
Frequency	Increasing
Deaths	N/A

Vancomycin-Resistant Enterococcus (VRE) refers to strains of the Enterococcus genus of bacteria that have developed resistance to the antibiotic vancomycin. These bacteria are significant in healthcare settings due to their ability to cause infections that are difficult to treat.

Overview

Enterococcus species are Gram-positive cocci that are part of the normal flora of the human gastrointestinal tract. They can cause a variety of infections, particularly in hospitalized patients. The development of resistance to vancomycin, a glycopeptide antibiotic, poses a significant challenge in the treatment of these infections.

Epidemiology

VRE infections are most commonly acquired in healthcare settings, particularly in hospitals and long-term care facilities. The prevalence of VRE has been increasing globally, with higher rates observed in the United States and Europe. Risk factors for VRE colonization and infection include prolonged hospitalization, use of broad-spectrum antibiotics, and immunosuppression.

Pathophysiology

The resistance to vancomycin in Enterococcus species is primarily mediated by the acquisition of the vanA or vanB gene clusters. These genes alter the target site of vancomycin, reducing its binding affinity and thereby conferring resistance. The most common species associated with VRE are Enterococcus faecium and Enterococcus faecalis.

Clinical Manifestations

VRE can cause a range of infections, including:

• Urinary tract infections
• Bacteremia
• Endocarditis
• Wound infections
• Intra-abdominal infections

Symptoms vary depending on the site of infection but may include fever, fatigue, and localized pain or discomfort.

Diagnosis

The diagnosis of VRE involves the isolation of Enterococcus species from clinical specimens followed by antimicrobial susceptibility testing to confirm resistance to vancomycin. Molecular methods, such as PCR, can be used to detect resistance genes directly.

Treatment

Treatment of VRE infections can be challenging due to limited antibiotic options. Alternatives to vancomycin include:

• Linezolid
• Daptomycin
• Tigecycline

The choice of antibiotic depends on the site of infection, the susceptibility profile of the isolate, and patient-specific factors.

Prevention

Preventive measures are crucial in controlling the spread of VRE in healthcare settings. These include:

• Strict adherence to hand hygiene protocols
• Use of personal protective equipment (PPE)
• Environmental cleaning and disinfection
• Antimicrobial stewardship programs to minimize unnecessary antibiotic use

Prognosis

The prognosis of VRE infections varies depending on the severity of the infection, the patient's underlying health status, and the timeliness of appropriate treatment. Invasive infections such as bacteremia and endocarditis are associated with higher morbidity and mortality rates.

See Also

• Antibiotic resistance
• Nosocomial infection
• Infectious disease

External Links

• [CDC - Vancomycin-Resistant Enterococci (VRE) in Healthcare Settings]
• [WHO - Antimicrobial Resistance]