Vancomycin Resistant Enterococcus (VRE)

S. Astrid Nilsson

Vancomycin Resistant Enterococcus (YRE) has been an increasing problem in the United States since the late 1980's. The cause is believed to be the use of oral vancomycin to treat diarrhea in the acute care setting. The most common infections are bacteremias, urinary tract infections, intra-abdominal, pelvic and wound infections. High risk patients are the immunocompromised, such as those with transplants, chronic renal failure, or diabetes. Other risk factors listed by the Center for Disease Control and Prevention (CDC) are exposure to antibiotic use, the health care system and advanced age. The bacteria have an intrinsic and acquired type resistance against several antibiotics. The acquired resistance type has the ability to share its genes with other organisms, such as Staphylococcus Aureus. This transfer, although presently very rare, presents a potential huge public health threat. Currently, only two drugs are approved by the Food and Drug Administration (FDA) for the treatment of VRE infection, quinupristin/dalfopristin and linezolid, and both are very expensive. The bacteria can either colonize or infect an individual. Colonization is when the bacteria is in the body, but does not cause an illness, as in the case of an infection. Diagnosis of VRE is made by blood, wound or stool cultures, or rectal swabs. The most common form of transmission is from one patient to another via the hands of a health care worker (HCW). The most important preventative measure is by maintaining good hand. hygiene, preferably by using an alcohol based hand rub, or antimicrohial soap. Presently there is no mandatory reporting regarding VRE colonization or infection. There are no recommendations regarding the screening of HCWs for colonization (e.g. carrier status). Health care costs are rising, and there are few approved antihiotics for treatment, and aggravated to this is the lack of development and research of new antibiotics. The elderly are an increasing proportion of the U.S. population and the incidence of obesity is on the rise, which may indirectly lead to an increase of immunocompromised patients in the future. The following paper addresses the need to institute a mandatory reporting system, the need for the development of a task force involving federal, state and private institutions to address this pressing issue. Individual health care facilities need to develop a policy on how to test, assign and proceed with a VRE positive employee to prevent transmission and protec! the patients. Other recommendations are to include VRE reporting and infection rates in the accreditation process for the Joint Commission on Accreditation of Healthcare Organizations. (JCAHO), and for the CDC to convene its Hospital Infection Control Practices Advisory Committee (HICPAC) and update its recommendations. The nurse practitioner is valuable as an educator of this pressing issue, not only for the patients, but for other staff members and the public. As advocates for their patients, the nurse practitioner can work for changes in the health care system to address the need for more affordable and new antibiotics, need for research and development, as well as policy changes to include mandated reporting ofall multidrug resistant organisms, not only VRE.

Vancomycin Resistant Enterococcus (VRE)

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