Vancomycin-Resistant Enterococci (VRE) (cont.)

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What is the treatment for a vancomycin-resistant enterococcal (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.

Linezolid, daptomycin, tigecycline, oritavancin, televancin, quinupristin-dalfopristin and teicoplanin (not available in the U.S.) are antimicrobials that have been used with success against various VRE strains. Clinicians have also had some success in treating VRE with various combinations of antibiotics. However, VRE antibiotic susceptibility tests 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 of the urinary tract infection. 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.

Medically Reviewed by a Doctor on 5/11/2015

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