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.
How is a vancomycin-resistant enterococcal (VRE) infection diagnosed?
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.
What is the treatment for a vancomycin-resistant enterococci (VRE) infection?
VRE are resistant to a wide array of antibiotics. Fortunately, newer antibiotics
have been developed to bridge this gap, but sometimes they must be used in
combination with other antibiotics. Most microbiological laboratories will
supply the physician treating the patient with a list of antibiotics the VRE are
resistant and susceptible to. If the laboratory does not or cannot provide an
alternative antibiotic for VRE treatment, the state lab or the CDC should be
notified as they may be able to provide additional help and suggestions for
treatment. Currently, clinicians have had some success in treating VRE with
combinations of teicoplanin (Teichomycin) and amoxicillin (Amoxil, Dispermox, Trimox) or a combination of
ampicillin (Omnipen, Polycillin, Principen),
imipenem, and vancomycin (Vancocin). However, VRE antibiotic susceptibilities done for each
infection should help guide the selection of treatment protocols. In addition,
consultation with an infectious-disease expert is usually done.
Other procedures can augment the antimicrobial treatment of VRE-infected
patients. If there is a collection of pus, such as an abscess, it is important
that it be drained. If the infection is associated with an intravenous line, the
line should be removed if at all possible. Similarly, it is desirable to remove
urinary catheters to facilitate treatment. Patients who are colonized but not
infected do not require treatment. There is no established way to eradicate
colonization of the stool once it occurs.
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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