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Medical Author:

Mary D. Nettleman, MD, MS, MACP

Mary D. Nettleman, MD, MS, MACP

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.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

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.

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In this Article

• What are vancomycin-resistant enterococci (VRE)?
• What causes a vancomycin-resistant enterococcal (VRE) infection?
• What are risk factors for vancomycin-resistant enterococci (VRE) infections?
• How are vancomycin-resistant enterococci (VRE) transmitted?
• What are the symptoms and signs of a vancomycin-resistant enterococcal (VRE) infection?
• How is a vancomycin-resistant enterococcal (VRE) infection diagnosed?
• What is the treatment for a vancomycin-resistant enterococcal (VRE) infection?
• What is the prognosis of a vancomycin-resistant enterococcal (VRE) infection?
• Can vancomycin-resistant enterococci (VRE) infections be prevented?
• What precautions should people take when tending to someone with a vancomycin-resistant enterococcal infection?
• What research is being done on vancomycin-resistant enterococci (VRE)?
• Where can people find more information on vancomycin-resistant enterococci (VRE) infections?
• Vancomycin-Resistant Enterococci (VRE) At A Glance
• Patient Comments: Vancomycin Resistant Enterococci (VRE) - Treatments
• Patient Comments: Vancomycin - Symptoms
• Vancomycin-Resistant Enterococci (VRE) Index

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.

Diagnosis requires culturing the organism. VRE is easily grown on culture plates in a laboratory. To get material to culture, a sample of the infected tissue is taken. For a wound infection, a swab is usually rubbed over the surface to get infected material. Blood is drawn and cultured to detect sepsis or endocarditis. Urine or sputum samples are taken to identify urinary infections or pneumonia. If VRE is cultured from blood or spinal fluid, it almost invariably indicates infection. However, if VRE is cultured from sputum, urine, or a wound, it could indicate either colonization or infection. The physician will ask the patient questions and perform a physical exam to help determine if any signs or symptoms of infection are present. Radiological studies such as X-rays or CT scans may be used to detect pneumonia or abscesses.