Vancomycin-resistant enterococcus infection
Vancomycin-resistant enterococcus (VRE) is a mutation of a common bacterium normally found in the GI tract that's spread easily by direct person-to-person contact. Facilities in more than 40 states have reported VRE infection, with 30% of enterococcus infections in intensive care units (ICUs) and 25% of enterococcus infections in non-ICU areas reporting as vancomycin-resistant.
Patients most at risk for VRE infection include:
❑immunosuppressed patients or those with severe underlying disease
❑patients with a history of taking vancomycin, third-generation cephalosporins, antibiotics targeted at anaerobic bacteria (such as Clostridium difficile), or multiple courses of antibiotics
❑patients with indwelling urinary or central venous catheters
❑elderly patients, especially those with prolonged or repeated hospital admissions
❑patients with cancer or chronic renal failure
❑patients undergoing cardiothoracic or intra-abdominal surgery or organ transplant
❑patients with wounds opening into the pelvic or intra-abdominal area, including surgical wounds, burns, and pressure ulcers
❑patients with enterococcal bacteremia, typically associated with endocarditis
❑patients exposed to contaminated equipment or to another VRE-positive patient.
Causes
VRE enters health care facilities through an infected or colonized patient or a colonized health care worker. It can also develop following treatment with vancomycin. VRE spreads through direct contact between the patient and caregiver or between patients. It can also spread through patient contact with contaminated surfaces such as an overbed table where it's capable of living for weeks. VRE has also been detected on patient gowns, bed linens, and handrails.
Signs and symptoms
There are no specific signs and symptoms related to VRE infection. The causative agent may be found incidentally with culture results.
Diagnosis
Persons with no signs or symptoms of infection are considered colonized if VRE can be isolated from stool or a rectal swab.
Once colonized, a patient is more than 10 times as likely to become infected with VRE, for example, through a breach in the immune system.
Treatment
New antimicrobials, such as linezolid and quinupristin and dalfopristin, are available for treatment of VRE infection. Patients who are already colonized with VRE usually aren't treated with antimicrobials. Instead, the physician may stop all antibiotics and simply wait for normal bacteria to repopulate and replace the VRE strain. Combinations of various drugs may also be used, depending on the source of the infection.
To prevent the spread of VRE, some facilities perform weekly surveillance cultures on at-risk patients in the intensive care or oncology units and on patients who have been transferred from a long-term care facility. Any colonized patient is then placed in contact isolation until culture-negative or until discharged. Colonization can last indefinitely; no protocol has been established for the length of time a patient should remain in isolation.
Special considerations
❑Hand hygiene before and after care of the patient is crucial. Good hand hygiene is the most effective way to prevent VRE from spreading.
❑Use an antiseptic soap such as chlorhexidine. Bacteria have been cultured from workers’ hands after they've washed with milder soap. Alcohol-based hand sanitizers are effective as well.
❑Use contact precautions when in contact with the patient or his support equipment. Provide the patient with a private room and dedicated equipment. Disinfect the environment and the equipment frequently.
❑Change gloves when contaminated or when moving from a “dirty” area of the body to a clean one.
❑Don’t touch potentially contaminated surfaces such as an overbed table after removing your gown and gloves.
❑Be particularly prudent in caring for a patient with an ileostomy, colostomy, or draining wound that isn’t contained by a dressing.
❑Instruct the patient's family and friends to wear protective garb when they visit him, and teach them how to dispose of it. Instruct them on proper hand hygiene.
❑Provide teaching and emotional support to the patient and his family members.
❑Consider grouping (“cohorting”) infected or colonized patients together and assigning the same nursing staff to them.
❑Don’t lay equipment used on the patient on the bed or on the overbed table. Wipe the equipment with the appropriate disinfectant before leaving the room.
❑Ensure judicious and careful use of antibiotics. Encourage physicians to limit their use.
❑Instruct patients to take antibiotics for the full period prescribed, even if they begin to feel better.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
Other Book Chapters Related to Infection
Read excerpts from these other book chapters related to Infection:
Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Infection
» Next page: Introduction: Infection (Professional Guide to Diseases (Eighth Edition))
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