Vancomycin-Resistant Enterococci

  • Medical Author:
    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.

  • Medical Author: 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.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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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.

How do physicians diagnose vancomycin-resistant enterococcal (VRE) infections?

Diagnosis requires culturing the organism. VRE is easily grown on culture plates in a laboratory. Definitive diagnosis requires that the organisms show resistance to vancomycin; usually sensitivities to additional antibiotics are determined at the same time. 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 tract 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 of these areas are present. Imaging studies such as X-rays or CT scans may be used to detect pneumonia or abscesses.

Medically Reviewed by a Doctor on 5/11/2015

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