Vancomycin Resistant Enterococcus

What is vancomycin resistant enterococcus?

  • Vancomycin resistant enterococcus (VRE) is a type of germ called bacteria. VRE bacteria can cause infections in your body. Antibiotic medicines are used to kill germs. When the germ enterococcus becomes resistant to (not killed by) the antibiotic vancomycin, it is called VRE. Enterococcus is normally found in your digestive tract, including your intestines and bowel. Enterococcus is also found in the female genital tract, including the uterus (womb) and vagina. A person may carry the VRE germ, but not get infected or sick. A carrier of VRE can give it to other people and make them sick.

  • A VRE infection is very contagious, meaning it can spread easily from person to person. People are most often infected with VRE in the hospital, but can also become infected outside the hospital. VRE may cause a mild, severe (very bad), or deadly infection in your body. The infections may be in your skin, urinary tract, blood, heart, or brain.

How does vancomycin resistant enterococcus spread?

VRE is found in the bowel movements (BMs), urine, and blood of an infected person. VRE is also in body fluids, such as saliva (spit) and vomit, of an infected person. VRE spreads when the germs from an infected person are touched by another person. If people have VRE germs on their hands, and do not wash their hands, the germs can spread. VRE may live on surfaces, such as bedrails, tables, doorknobs, toilets, and remote controls. VRE can live on surfaces for many weeks. If you touch these surfaces before they are cleaned, you may become infected, or spread VRE.

What increases my risk of getting a vancomycin resistant enterococcus infection?

  • Staying in the hospital: Chest, abdomen, or transplant surgery, or being in the ICU (intensive care unit), increases your risk of infection. A long hospital stay, or sharing a room with someone who has a VRE infection, also increases your risk.

  • Using antibiotic medicine: If you do not follow your caregiver's instructions when taking antibiotics, germs can become resistant. Taking vancomycin or other antibiotics for a long time may cause resistance. The antibiotic vancomycin may kill the good bacteria in your stomach, allowing VRE to grow. The VRE bacteria may spread to other parts of your body and cause an infection.

  • Having tubes or lines in your body: Medical tubes placed into your body increase your risk of getting a VRE infection. These tubes include intravenous (IV) tubes, and large tubes called central venous lines. An IV is a tube put in your vein to give liquids and medicines. You may have a central venous line if you need kidney dialysis or other treatments. Other tubes that increase your risk of getting VRE include breathing tubes and urinary catheters. A urinary catheter is a tube that drains urine from your bladder.

  • Having a weak immune system: VRE is more likely to cause an infection if you have a weak immune system. Your immune system is the part of your body that fights infection. Diabetes (high blood sugar) or certain kidney problems may weaken your immune system. Cancer, heart problems, or having had an organ or bone marrow transplant may also weaken your immune system.

  • Age: Newborn babies and people over the age of 55 have an increased risk of getting a VRE infection.

What problems can a vancomycin resistant enterococcus infection cause?

Ask your caregiver for more information about the following VRE infections:

  • Skin, soft tissue, or wound infections: Small or large infections may grow on and in the skin, muscles, and other soft tissue areas. You may also get a VRE infection in wounds caused by an injury, illness, or a cut made during surgery.

  • Endocarditis: Endocarditis is an infection and inflammation (swelling) of the inner lining of your heart.

  • Urinary tract infections: A urinary tract infection (UTI) is an infection of the kidneys, ureters, or bladder. These organs make and store your urine.

  • Abdominal organ infections: The organs in your abdomen, such as your liver, stomach, and intestines, may get infected.

  • Bacteremia: Bacteremia occurs when VRE germs enter your blood stream, and cause a blood infection.

  • Meningitis: Meningitis is inflammation of the coverings of the brain and spine.

What are the signs and symptoms of a vancomycin resistant enterococcus infection?

If you are a VRE carrier, but have no active infection, you may not have signs or symptoms. Signs and symptoms of a VRE infection depend on where the infection is in your body. They may include:

  • Back pain, urinating often or trouble urinating, and pain when you urinate.

  • Fever (high body temperature) and chills.

  • Joint (where two bones meet), muscle, or chest pain.

  • Red, warm skin around the infected area.

  • Soreness, swelling, and drainage from the infected area.

How is a vancomycin resistant enterococcus infection diagnosed?

You may need the following tests:

  • Blood tests: Samples of your blood may be taken to learn if you have a VRE infection.

  • Cultures: Your caregiver may swab the area around your anus, or just inside your rectum, to check for infection. Your rectum holds your BMs until they pass out of your body through your anus. Your caregiver may also swab your skin or a wound to check for a VRE infection. A sample of your BM or urine may also be tested for VRE.

How is a vancomycin resistant enterococcus infection treated?

If you are a VRE carrier, you may not need treatment. Your treatment may depend on where the infection is in your body. With treatment, signs and symptoms, such as fever, back pain, and problems when you urinate, may decrease. Your wounds may heal with treatment and prevent the spread of the infection. Treatment may include the following:

  • Antibiotics: Antibiotic medicine kills the VRE germs causing your infection. You may need to use more than one antibiotic medicine at a time.

  • Chlorhexidine baths: In the hospital, caregivers may give you chlorhexidine baths each day to prevent your VRE infection from spreading. Chlorhexidine is a germ-killing liquid that can kill bacteria on your skin. During a chlorhexidine bath, your caregiver washes your body from the neck down.

  • Isolation: In the hospital, caregivers and visitors will wear gowns and gloves when in your room. People who enter your room may also wear masks. Supplies in your room will not be shared with other patients. This prevents spreading your infection to other people. Visitors must also wash their hands before leaving your room to keep germs from spreading.

What are the risks of being treated for a vancomycin resistant enterococcus infection?

  • Certain treatments may dry your skin. Antibiotic medicine given in an IV may cause pain, redness, and swelling. Antibiotic medicines used to treat a VRE infection may cause itchy skin, a rash, throat swelling, and trouble breathing. Antibiotics may cause nausea (upset stomach), diarrhea, and kidney or liver problems. You may have muscle or joint pain. The antibiotics may not kill the VRE germs, and your infection may get worse.

  • If your VRE infection is not treated, it can get worse. The infection may spread to your urinary tract, blood, or brain. The bacteria may infect the lining and valves of your heart. Organs in your body may stop working. If you do not get treatment for a VRE infection, you may die. Talk with your caregiver if you have questions or concerns about your VRE infection or treatment.

How do I prevent getting or spreading vancomycin resistant enterococcus?

  • Take antibiotics as directed by your caregiver: Always take your antibiotics exactly as ordered by your caregiver. Finish all of the medicine as prescribed, even if you feel better. Not doing this may cause the germs to become harder to kill. Never take prescription medicine without a caregiver's order. Never save antibiotics or take leftover antibiotics that were given to you for another illness.

  • Wash your hands: Wash your hands after you urinate or have a BM. Always wash your hands before touching food. Wash your hands before, and after, visiting someone with VRE. Wash your hands even if you were wearing gloves. Use germ-killing soap and water, or you may use alcohol-based hand cleaner. Always wash your hands when they are dirty.

  • Keep wounds covered: Keep any wounds that you have clean and covered with a bandage until they are healed. Ask your caregiver how to keep your wound clean and covered.

  • Do not share items with others: Do not share items, such as forks, spoons, or knives, with other people.

  • Clean surfaces well: Use germ-killing cleaner when cleaning surfaces, such as tables, which are shared and touched often. Keep doorknobs, faucet handles, and furniture clean. Ask your caregiver what cleaner is best to kill VRE germs.

  • Be careful when caring for someone with VRE: You are at greater risk of getting VRE when caring for an infected person. You and your family may need to wear gloves and a gown when having contact with the infected person. You will need to bag and wash the dirty clothes from the infected person separately. Healthy adults and children may be able to hug or touch a person with VRE. Ask caregivers how to care for someone with VRE.

Where can I find more information?

Contact the following:

  • Centers for Disease Control and Prevention (CDC)
    1600 Clifton Road
    Atlanta , GA 30333
    Phone: 1- 800 - 232-4636
    Web Address: http://www.cdc.gov/
  • National Institute of Allergy and Infectious Diseases
    NIAID Office of Communications & Government Relations
    6610 Rockledge Drive, MSC 6612
    Bethesda , MD 20892-6612
    Phone: 1- 301 - 496-5717
    Phone: 1- 866 - 284-4107
    Web Address: www3.niaid.nih.gov

When should I call my caregiver?

Call your caregiver if:

  • You are urinating more than usual, cannot empty your bladder, or have pain when you urinate.

  • You have a fever.

  • You have a rash that is itchy, or spreading over your body.

  • You have muscle pain or weakness.

  • You have skin areas that are red, swollen, and feel warm. These areas may also be painful.

  • You have pus draining from a wound or infected area of your skin.

When should I seek immediate help?

Seek care immediately or call 911 if:

  • Your throat is swelling, and you are having trouble breathing.

  • You have new chest or back pain.

  • You have a headache with a stiff neck, and you feel weak or confused.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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