How is vancomycin-resistant enterococcus treated

How is vancomycin-resistant enterococcus (VRE) treated?

What does VRE stand for?

Enterococci Resistant to Vancomycin. Enterococci that resist vancomycin are VRE. VRE enterococcus bacteria are resistant to penicillin, gentamicin, and vancomycin.

Vancomycin-resistant enterococcus (VRE) 

What is VRE infection?

Definition

Enterococcus bacteria that are resistant to vancomycin produce VRE infections. Enterococci are innocuous in the intestines and female genital system, but they can cause disease beyond these sites. VRE is troublesome since therapeutic choices are limited.

Causes of VRE Infection 

• Hospitals and healthcare settings: Most instances occur in immunocompromised or unwell individuals.
• Extended use of antibiotics, especially vancomycin, is a contributing factor.
• Recent surgery.
• Medical devices (catheters, IV lines).
• A weak immune system.

VRE-caused Infections

• Urinary tract infections
• Sepsis: bloodstream infections
• Heart valve infection, endocarditis
• Meningitis (rare brain infection)
• Wound infections (particularly surgical)

Symptoms vary by infection site

• Burning, frequent, murky urine are UTI symptoms.
• The symptoms include low blood pressure, fever, and chills.
• Wound: Red, pus, swelling.
• Endocarditis: Fever, tiredness, murmur.

Prevention

• Hand cleanliness, patient segregation, and strict hospital infection control.
• Careful antibiotic use reduces resistance.
• Proper medical equipment cleaning.

How VRE Infects

VRE infections happen when harmless Enterococcus bacteria become resistant to vancomycin and move out of the gut and female genital area. The key causes and contributors are:

1. Antibiotic Pressure

• Extended use of antibiotics, especially vancomycin and broad-spectrum antibiotics, can cause resistance.
• Hospital antibiotic abuse accelerates resistance.

2. Hospital Setting

• Healthcare facilities, where bacteria move quickly, cause most VRE infections.
• VRE can spread via contaminated surfaces, medical equipment, or healthcare staff.

3. Medical Gear

• Bacteria enter catheters, IV lines, and surgical drains.
• These devices can grow VRE biofilms, making infections difficult to treat.

4. Immune System Weakness

• Chronically unwell, cancer, and organ transplant patients are more vulnerable.
• VRE spreads beyond the gut due to decreased immunity.

5. Surgery

• Infections are more likely after stomach or urinary system surgeries.
• Antibiotic usage after surgery can breed resistant bacteria.

6. Resistant Strains

"Two key species are responsible:"

• Most VRE infections involve Enterococcus faecium.
• Enterococcus faecalis is a less common but equally important species.

Are VRE infections dangerous?

"VRE infections are dangerous for fragile patients. The reason:"

Why VRE dangerous

• Antibiotic resistance: VRE resists vancomycin, a common antibiotic for severe infections. Treatment options are limited.
• Healthcare-related: Most instances occur in hospitals, affecting sick, surgical, or immunocompromised patients.
• VRE causes bloodstream infections, endocarditis, and meningitis, which can be fatal. Failure to treat these can be fatal.
• Mortality risk: In 2017, 54,500 hospitalised patients in the U.S. contracted VRE and 5,400 died.

The severity depends on:

• Urinary tract infections may be safer than bloodstream infections.
• Immunocompromised patients (cancer and transplant recipients) are at higher risk.
• Treatment options: Linezolid and daptomycin work; resistance varies.

VRE infection precautions

VRE infections are vancomycin-resistant and common in hospitals; thus, strong precautions are essential to safeguard vulnerable patients.

Common Safety Measures

• Before and after patient interaction, wash hands with soap and water or alcohol-based sanitizer.
• When treating VRE patients, healthcare professionals should use gloves and gowns.
• Dedicated equipment: Avoid cross-contamination with patient-specific thermometers and stethoscopes.

Hospital Contact Precautions

• Infected patients should be isolated or grouped with other VRE.
• Only transfer patients within the hospital if required.
• Medical equipment, bed rails, and doorknobs should be disinfected.

Advice for Patients and Visitors

• Visitor hand hygiene is required before and after.
• Do not touch catheters, wounds, or medical gadgets.
• Wear safety gear as instructed by hospital staff.

Responsible antibiotic use

• Only use antibiotics as directed.
• Avoid unnecessary broad-spectrum antibiotic use to lower resistance.

VRE transmission

Hospital-acquired VRE infections are disseminated through direct or indirect contact. How transmission works:

1. Personal Interaction

• Spread by healthcare personnel touching contaminated surfaces or infected patients.
• Colonised but healthy VRE carriers can spread germs.

2. Polluted Equipment & Surfaces

• VRE has a long lifespan on bed rails, doorknobs, and medical equipment.
• If not disinfected, shared thermometers and stethoscopes can spread disease.

3. Medical Gear

• VRE enters by catheters, IV lines, and surgical drains.
• The biofilm on these devices makes infections tougher to treat.

4 Environmental Reservoirs

• Hospital floors, furniture, and instruments can harbour VRE.
• Reducing spread requires strict cleaning.

5. High-Risk Situations

• VRE is more likely in immunocompromised, surgical, or antibiotic-treated patients.
• Long hospital stays increase exposure.

VRE infection treatment

The video is about how VRE is treated.

VRE is vancomycin-resistant; thus, it requires alternate drugs and cautious medical management. The overview is structured as follows:

1. Antibiotic Choices

• Bloodstream and pneumonia treatment with linezolid.
• Bloodstream and endocarditis infections benefit from daptomycin.
• Complex intra-abdominal or cutaneous infections may require tigecycline.
• Quinupristin-dalfopristin can treat Enterococcus faecium infections (not totally effective).
• Depending on resistance, doctors may try newer or combination medicines.

2. Assistance

• Remove contaminated catheters and IV lines.
• The process involves draining abscesses or contaminated fluids.
• Monitor for signs of sepsis and endocarditis.

3. Tailored Therapy

• Treatment varies by infection site (urinary tract, bloodstream, wound).
• Comorbidities and immunological status.
• The choice of drugs is guided by laboratory antibiotic susceptibility testing.

4. Treatment Prevention

• Hospitals must implement strict infection control measures to prevent the spread of infections.
• Use antibiotics wisely to avoid resistance.

How long does VRE recovery take?

• Some people naturally clear VRE infections as they get stronger. Months or longer may be needed. Sometimes an infection returns. Sometimes the infection goes away, but the bacteria remain intact.

Also, read https://epi.utah.gov/vancomycin-resistant-enterococci-vre/.

Which People Are at Risk for VRE?

VRE infections usually afflict vulnerable people in healthcare settings. The main risk groups are:

1. Long-Term Antibiotic Users

• Extended use of antibiotics, especially vancomycin and broad-spectrum medicines, increases bacterial resistance.

2. Hospitalized Patients

• Long hospital stays increase exposure.
• Health risks increase for ICU patients.

3. Surgical Patients

• Patients who have had abdominal or cardiothoracic surgery are more vulnerable.
• Antibiotic usage after surgery can breed resistant bacteria.

4. Medical Device Patients

• VRE enters by urinary catheters, CVCs, or surgical drains.
• These devices can grow VRE biofilms, making infections difficult to treat.

5. Immunocompromised People

• Patients have impaired immune systems from cancer, organ transplants, or chronic disorders.
• Critical sickness increases risk.

Can VRE kill patients?

Vancomycin-Resistant Enterococci (VRE) infections can kill, depending on various factors:

Key Points

• Colonization vs. Infection
• Intestinal and genital VRE often live harmlessly.
• VRE in the bloodstream, urinary tract, or wounds causes serious disease.

Infection severity

• VRE-caused septicemia has a high fatality rate.
• VRE bloodstream infections have worse results than non-resistant types, according to studies.

Death Risk Factors

• Cancer, transplant, and HIV patients are in critical condition.
• Patients often require catheters or ventilators.
• Sepsis patients—VRE colonization increases mortality.

The Treatment Challenges

• Vancomycin resistance limits the alternatives to antibiotics.
• Alternative medications work differently and are difficult.

Conclusion

Vancomycin-resistant enterococci are difficult to treat and spread in hospitals. VRE infections emphasise antibiotic stewardship and hospital infection control. Resistance and its impact on high-risk patients make it a public health issue despite being curable.