Vancomycin-Resistant Enterococci (VRE) (cont.)
Transmission of of vancomycin-resistant enterococci
VRE is transmitted from person to person most commonly by healthcare workers
whose hands have inadvertently become contaminated, either from feces, urine, or
blood of a person carrying the organism. It can also be spread indirectly via
hand contact with open wounds or by touching contaminated environmental
surfaces, where the bacterium can survive for weeks. VRE is not transmitted
through the air.
Of more than a dozen forms of enterococci bacteria, two are the
primary concern for human disease: E. faecium and E. faecalis. E.
faecium is the most frequent species of VRE found in hospitals.
Diagnosis of of vancomycin-resistant enterococci
Enterococci have two types of resistance to vancomycin: acquired and
intrinsic (natural). Some types of enterococci bacteria acquire the
resistance when other bacteria come in contact with enterococci and share
genetic information - scientists believe enterococci acquired the gene that
resists vancomycin from bacteria in the digestive tract. Acquired resistance has
been noted with two clinically important forms of enterococci: E. faecium and
E. faecalis.
Of the dozen or so types of enterococci bacteria, some, such as E.
gallinarum and E. casseliflavus, have an inherent, low-level resistance to
vancomycin. These are very uncommon strains, however, and are of limited
clinical significance.
If you have an enterococcal infection, it is crucial
that your healthcare providers quickly identify the strain, so that they can determine how best to
treat you and prevent patient-to-patient transmission. They will want to know if
the strain infecting you is resistant to vancomycin, and if so, is the
resistance intrinsic or acquired? If the resistance is acquired, does the strain
contain specific genes that can share resistance traits with other bacteria,
thus making it able to spread disease?
Tests are available to make those diagnoses.
Some healthcare practitioners, as part of their normal infection control
procedures, will test you for the presence of VRE to learn whether you might be
infected or colonized with the bacterium. This helps facilities know whether
specific procedures should be used to reduce the potential spread of VRE.
Next: Treatment of of vancomycin-resistant enterococci »
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