Vancomycin-resistant Enterococcus

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Vancomycin-resistant Enterococcus
Synonyms	VRE
Pronounce	N/A
Specialty	N/A
Symptoms	Urinary tract infection, bacteremia, endocarditis, wound infection
Complications	Sepsis, multi-organ failure
Onset
Duration
Types	N/A
Causes	Enterococcus faecium, Enterococcus faecalis
Risks	Hospitalization, antibiotic use, immunocompromised
Diagnosis	Culture, antibiotic susceptibility testing
Differential diagnosis
Prevention	Infection control, hand hygiene
Treatment	Linezolid, daptomycin, tigecycline
Medication
Prognosis
Frequency
Deaths

Bacterial strains resistant to the antibiotic vancomycin

3D structure of vancomycin

3D structure of linezolid

Vancomycin-resistant Enterococcus (VRE) refers to strains of the Enterococcus genus of bacteria that have developed resistance to the antibiotic vancomycin. These bacteria are significant in healthcare settings due to their ability to cause infections that are difficult to treat.

Background

Enterococcus species are part of the normal flora of the human gastrointestinal tract but can cause serious infections, particularly in immunocompromised individuals. The development of resistance to vancomycin, a last-resort antibiotic, poses a significant challenge in treating these infections.

Mechanism of Resistance

VRE resistance to vancomycin is primarily due to the acquisition of the vanA or vanB gene clusters, which alter the target site of the antibiotic, reducing its binding affinity. This genetic alteration is often acquired through horizontal gene transfer.

Epidemiology

VRE infections are most commonly seen in hospital settings, particularly in patients with prolonged antibiotic use, those with weakened immune systems, or those undergoing invasive procedures. The prevalence of VRE varies globally, with higher rates reported in the United States and Europe.

Clinical Significance

VRE can cause a range of infections, including urinary tract infections, bacteremia, endocarditis, and wound infections. These infections are associated with increased morbidity and mortality due to limited treatment options.

Treatment

Treatment of VRE infections often involves the use of alternative antibiotics such as linezolid or daptomycin. However, the choice of treatment depends on the site of infection and the susceptibility profile of the isolate.

Prevention and Control

Preventing the spread of VRE in healthcare settings involves strict adherence to infection control practices, including hand hygiene, use of personal protective equipment, and environmental cleaning. Screening and isolation of colonized or infected patients may also be necessary.

See also

• Antibiotic resistance
• Enterococcus
• Vancomycin