Vancomycin-resistant Enterococcus
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Vancomycin Resistant Enterococcus.pdf)
What is the enterococcus?
The enterococcus is a normally harmless bacterium that is found in the bowel or female genital tract of humans and other animals. It is part of the normal mixture/(flora) of bacteria that inhabit the body.
What is VRE?
VRE stands for vancomycin-resistant enterococcus. Vancomycin is a strong antibiotic that is used in hospitals as the main treatment for antibiotic-resistant golden staph infections (MRSA). With VRE, the enterococcus has developed the ability to grow even in the presence of vancomycin. VRE organisms are also usually resistant to most other antibiotics.
If the enterococcus is 'harmless' what is the fuss about VRE?
There are two main concerns:
- The enterococcus (including VRE) occasionally causes infection in humans. Because it is a fairly non-aggressive (non-virulent) bacterium, a person needs to be already very ill with diminished defences against infection before they become at risk from serious infection from VRE or other enterococci. Such people have usually been in hospital for an extended period.
These people may develop local infection with VRE in the abdomen, urine or in association with an intravenous line. In some, VRE may enter the bloodstream, causing septicaemia or blood poisoning. Patients with blood infection from VRE are difficult to treat effectively because they are already very weakened by disease and VRE does not respond well to antibiotics.
- Laboratory experiments in the UK have shown that VRE can pass vancomycin resistance to the Staph aureus golden staph bacterium. Vancomycin-resistant staph is an enormous problem. Cases of vancomycin-resistant staph aureus have occurred in Japan and the USA and a related bacterium now occurs in Australia..
Is the general population at risk from VRE?
No. The large majority of people who encounter VRE do not develop any sickness. People may carry VRE in their bowel for long periods without sickness and without knowledge of the fact.
Is VRE widespread in Australia?
Yes, VRE has been found in many patients in hospitals and the community in most states. Most of these patients were just carrying the germ and have not been made sick by it. Some patients died directly from the effects of VRE infection.
Why does VRE only cause a problem in hospital?
VRE has emerged in the hospital environment because strong broad spectrum antibiotics such as cephalosporins and vancomycin are used there. Unless a person has been exposed to such antibiotics, VRE is unable to compete with the other bacteria in our bodies and cannot become dominant.
How is VRE transmitted between people in hospitals?
A patient who carries VRE in his/her bowel will often contaminate his/her hands or surrounding surfaces with the germ. It can then be transferred to other patients by hospital staff through hand contact, especially if they do not wash their hands carefully.
If I need to go to hospital for an operation or other sickness should I be concerned?
No. Serious infection from enterococcus (or VRE) is uncommon in Australia. Hospitals take care to perform procedures and operations in a hygienic manner to reduce the risk of infection to patients. It is important that clinical staff wash/disinfect their hands before examining you or performing procedures or changing wound dressings. It is your right to ask them to wash it if you become aware that this is being neglected. They should also wear gloves if changing wound dressings or handling bodily fluids.
Where has VRE come from?
There are two main theories. Both are probably true.
- In the United States, it appears that VRE has emerged in hospitalised humans because of overuse of strong antibiotics in hospitals. Antibiotic-resistant bacteria only become a problem in situations where selective pressure is exerted by repeated exposure to antibiotics. There is evidence showing that some USA strains of VRE are closely related to European strains.
- In Europe, a vancomycin-like antibiotic called avoparcin was added to animal feed to enhance their growth. It has been shown that VRE can be found in these animals. Furthermore, closely related strains of VRE have been shown to be present on uncooked meat derived from these animals and in the intestines of people in these communities. Avoparcin is not used in the United States of America nor in Australia now.
What is the situation in Australia?
VRE may have arrived here via food or humans from overseas. As avoparcin was used in Australia until recently, the concern has been expressed that VRE may have been amplified in the animal population as has occurred in Europe. VRE strains have been found in some foods in Australia.
Am I at risk of disease from eating meat contaminated with VRE?
No. Eating food containing VRE does not place people in the community at risk from disease. It is an issue for severely ill hospitalised patients who need to be protected from acquiring VRE.
What can be done about resistant germs like VRE?
Resistant bacteria are an increasing problem in Australia, not just in hospitals. The main reason for their appearance is the use and misuse of antibiotics. To reduce the problem of resistance and prevent further spread of VRE, antibiotic use in animals and humans should be minimised as much as possible.
In the community, antibiotics are frequently used for illnesses caused by viruses such as 'flu', sore throats or the common cold. Antibiotics do not shorten these illnesses as they have no action against viruses. In fact, they may cause harm through allergic reactions (eg. skin rashes) or overgrowth of germs such as thrush. Doctors should be supported when they encourage patients not to take antibiotics for these conditions. Avoid taking antibiotics for these conditions. Avoid taking antibiotics unless you really need them.
In hospitals, doctors are trying to limit antibiotic use as much as possible. If they do not, then the day may come when common bacteria such as golden staph become untreatable except through surgery. The other essential preventative measure is to ensure the procedures and operations that cause breaks in the skin or the body's defences are performed in the cleanest and safest way in order to prevent the entrance of bacteria. Efforts to improve hand hygiene practice amongst health care workers are also important.
In animals, the use of antibiotics for growth promotion needs to be avoided, especially when the antibiotic is related to a similar one used in humans.
Where can I obtain further information?
Hunter Area Pathology Service, 4921 4422
Hunter Area Infection Control Office, 4921 4473
Hunter Public Health Unit, 4924 6477
(Contact any of the above for further information).
Written by: Dr John Ferguson, Microbiology, HAPS
Written: May 1998
Updated: November 2002
Last Reviewed: Sept 2005