ABOUT V.R.E.

V.R.E. stands for Vancomycin-resistant enterococci.
Enterococci are bacteria that are normally present in the bowels of most members of the community; they are also found in the female genital tract and in the environment. 16 different species of enterococci have been recognized, but the one which has given rise to most concern is E. faecium, because of its greater antibiotic resistance.

In normal circumstances these bacteria do not cause any health problems, but some of them have become resistant to the antibiotic vancomycin which was used to treat infections caused by them in the past. This has given rise to the name VRE - vancomycin-resistant enterococci.

Infections from VRE don’t seem to be as common in Ireland as other Health Care Acquired Infections, but with the outbreak in Sligo General Hospital over the August bank holiday of 2008, this might be about to change. At any rate, more attention may be paid to it.

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As has been said already, people can sometimes be colonized with enterococci, or even VRE, without adverse effects, but sometimes these bacteria can cause infections. These infections can be of the urinary tract, the abdomen, pelvis, the bloodstream or wounds. VRE has also been implicated in cases of cholangitis (inflammation of the bile duct), endocarditis (inflammation of the inner lining of the heart), and a type of meningitis. These infections most commonly occur in the hospital setting, and enterococci are now said to be the third most common cause of health care acquired infection (HCAI).

As with other HCAIs, there are categories of persons who have an increased risk of becoming infected by VRE. These are:

	Those who have been treated with the antibiotic vancomycin, or other antibiotics for long periods of time. This especially applies to those who are hospitalized.
	Those with weakened immune systems, with conditions such as cancer, in Intensive Care, or post transplant.
	Those who have undergone surgery, especially abdominal or chest surgery.
	Those who have invasive medical devices such as urinary catheters or central intravenous catheters.
	Those who are already colonized with VRE.

Most enterococcal infections are confined to the individual patient, but cross-infection between hospitalized patients does occur. It is passed from patient to patient mostly by the hands of care-givers. VRE can get onto a caregiver’s hands after they have been in contact with a person who has an infection, or from contact with a contaminated surface. Individual patients can directly acquire a VRE infection from touching surfaces which are contaminated. VRE is not usually spread by an infected person coughing or sneezing.

The recommendations for the prevention of the spread of VRE infections include:

	Strict hand-hygiene. As with other HCAIs, this is of paramount importance. Washing with soap and water is essential when visible dirt is present, and alcohol-based rubs otherwise. This should happen even where gloves are used.
	The environment should be properly cleaned routinely, and de-contaminated which an outbreak has occurred. Special attention should be paid to bathrooms, and toilet facilities especially when a patient has diarrhea.
	Gloves should be worn if there is a likelihood of coming in contact with body fluid that may contain VRE, such as blood, stool or bandages from infected wounds. Gloves should be disposed of after each patient and the caregiver’s hands washed.
	Isolation facilities should be available.
	Proper controls should be imposed on antibiotic prescription and use.
	Effective surveillance.

There hasn’t been as much research done on VRE as there has on MRSA and C. Dif., but as the incidences of infection rise, this will increase. You can find out more on the web-sites www.bmjjournals.com, www.cdc.gov, www.his.org.uk.