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 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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