Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
What are the risk factors for vancomycin-resistant enterococci (VRE) infections?
The healthy bowel harbors more than 400 different species of
bacteria which compete with each other and help keep any one organism from
overgrowing. However, if a patient takes antibiotics, some bacterial species are
killed off and the balance among the bacteria is disrupted. In this case, a
single species like VRE may increase to the point where it can invade the
bloodstream or cause a local infection. Thus, prior use of antibiotics is a risk
factor for infection with VRE. Other risk factors include having a compromised
immune system, cancer, a chronic disease like diabetes, or kidney failure.
Infection is also more likely if there is a small break in the mucosal membrane
(lining) of the bowel or if the patient undergoes a gastrointestinal surgery or
procedure. Indwelling devices, such as urinary catheters or intravenous lines,
increase the risk of infection because they disrupt the normal mucosal or skin
barriers and provide a type of artificial reef on which the organisms can
grow.
How are vancomycin-resistant enterococci (VRE) transmitted?
VRE can be
transmitted from person to person, especially in a hospital or chronic-care
facility. Microscopic amounts of fecal material from an infected or colonized
patient can contaminate the hospital environment and be spread on the hands of
health-care personnel. Patients who have VRE may inadvertently contaminate their
beds and bathrooms. If the environment is not adequately cleaned, the next
patient in the room may be at risk.
What are the symptoms and signs of a vancomycin-resistant enterococcal (VRE)
infection?
The symptoms of VRE infection vary according to the site of infection. If VRE has invaded the bloodstream, the patient will have fever, a fast heart rate,
and feel very sick. This syndrome is called sepsis. In severe cases, the blood
pressure may fall causing shock, although this is less common with VRE than with
some other bacteria. Patients with urinary infections may experience
burning
with urination, back pain, or fever.
Meningitis is uncommon and causes headache,
stiff neck, confusion, and/or fever. Infection of a heart valve (endocarditis)
causes prolonged sepsis and may cause the valve to leak or fail. Endocarditis is
more common if the patient already has a damaged heart valve or an artificial
valve. Infected wounds are inflamed and contain pus. Pneumonia causes fever,
difficulty breathing, and cough.
Urinary tract infection (UTI) is an infection of the kidney, ureter, bladder, and/or urethra. Not
everyone with a UTI has symptoms. Common symptoms include a frequent urge to
urinate and a painful, burning when urinating.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Staphylococcus or Staph is a group of bacteria that can cause a multitude of diseases. Staph infections can cause illness directly by infection or indirectly by the toxins they produce. Symptoms and signs of a Staph infection include redness, swelling, pain, and drainage of pus. Minor skin infections are treated with an antibiotic ointment, while more serious infections are treated with intravenous antibiotics.
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
MRSA (methicillin resistant Staphylococcus aureus) bacteria causes skin infections with the following signs and symptoms: cellulitis, abscesses, carbuncles, impetigo, styes, and boils. Normal skin tissue doesn't usually allow MRSA infection to develop. Individuals with depressed immune systems and people with cuts, abrasions, or chronic skin disease are more susceptible to MRSA infection.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
Sepsis (blood poisoning) is a potentially deadly infection with signs and symptoms that include elevated heart rate, low or high temperature, rapid breathing and/or a white blood cell count that is too high or too low and has more than 10% band cells. Most cases of sepsis are caused by bacterial infections, and some cases are caused by fungal infections. Treatment requires hospitalization, IV antibiotics, and therapy to treat any organ dysfunction.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Encephalitis is a brain inflammation that causes sudden fever, vomiting, headache, light sensitivity, stiff neck and back, drowsiness, and irritability. Meningitis is an infection that causes inflammation of the meninges that surround the brain and spinal cord. Symptoms of meningitis include high fever, headache, nausea, vomiting, and stiff neck.
Medical shock is a life-threatening medical condition. There are several types of medical shock, septic shock, anaphylactic shock, cardiogenic shock, hypovolemic shock, and neurogenic shock. Causes of shock include heart attack, heart failure, heavy bleeding (internal and external), infection, anaphylaxis, spinal cord injury, severe burns, chronic vomiting or diarrhea. Low blood pressure is the key sign of sock. Treatment is dependant upon the type of shock.
ICU psychosis is a disorder (also a form of delirium or acute brain failure) in which patients in an intensive care unit or a similar setting experience a cluster of serious psychiatric symptoms. These symptoms include anxiety, reastlessness, hearing voices, hallucinations, nightmares, paranoia and more. Causes of ICU psychosis are generally from a combination of environmental and medical conditions.
Endocarditis, a serious infection of one of the four heart valves is caused by growth of bacteria on one of the heart valves; leading to an infected massed called a "vegetation." The infection can be caused by having bacteria in the bloodstream after dental work, colonoscopy, or other similar procedures. Endocarditis symptoms include fever, fatigue, weakness, chills, aching muscles and joints, night sweats, edema in the legs, feet, or abdomen, malaise, shortness of breath and small skin lesions. Treatment for endocarditis is generally aggressive antibiotic treatment.
Drug resistance (antimicrobial resistance) is the ability of bacteria, fungi, parasites, and viruses to grow, even in the presence of a drug that would normally kill it (or limit it's growth). Drug resistance is a growing problem, particularly for infections such as MRSA, VRE (vancomycin-resistant enterococci), tuberculosis, HIV, STDs, gonorrhea, flu, pneumonia, malaria, E. coli, salmonella, Campylobacter, which causes diarrhea and gastroenteritis. Learn how to protect yourself from resistance to drugs.
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