Vancomycin resistant enterococci healthcare associated infections

Ann Ig. Nov-Dec 2013;25(6):485-92. doi: 10.7416/ai.2013.1948.

Abstract

Background: Vancomycin-resistant enterococci (VRE) are among the most common healthcare associated multidrug-resistant organisms. Purpose of the article was to review recent data regarding the epidemiology, clinical issues and infection control of this organisms.

Methods: A PubMed-MEDLINE search was carried out.

Results: The European Antimicrobial Resistance Surveillance System (EARSS) highlights a large variability between the various european countries, with VRE ranging from <2% (Finland, Holland) to >20% (Ireland, Greece, Portugal). Italy shows a low rate level (4.2%). In USA according to the National Healthcare Safety Network (NHSN) in 2006-2007 overall 33% of enterococci were resistant to vancomycin, whereas in Canada VRE prevalence showed to be much lower <10%. Although with some methodological limits, several studies showed that infections caused by VRE are more serious and associated to a higher mortality rate and economic burden compared to those caused by vancomycin susceptible enterococci (VSE). The average increased associated mortality was over two-fold. Resistance to newer antimicrobial agents as daptomycin and linezolid has been described, complicating treatment options for infections caused by these organisms.

Conclusion: Control measures aimed at reducing the incidence of VRE colonization and infection in healthcare settings should include: hand washing with an antiseptic or a waterless antiseptic agent, routine screening for vancomycin resistance among clinical isolates, rectal surveillance cultures, contact isolation for patients with VRE and antimicrobial stewardship.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Canada / epidemiology
  • Cross Infection / epidemiology
  • Cross Infection / microbiology*
  • Cross Infection / prevention & control*
  • Enterococcus / drug effects
  • Enterococcus / isolation & purification*
  • European Union / statistics & numerical data
  • Gram-Positive Bacterial Infections / epidemiology
  • Gram-Positive Bacterial Infections / microbiology*
  • Gram-Positive Bacterial Infections / prevention & control*
  • Hand Disinfection
  • Humans
  • Incidence
  • Italy / epidemiology
  • Microbial Sensitivity Tests
  • Prevalence
  • Risk Factors
  • United States / epidemiology
  • Vancomycin / pharmacology
  • Vancomycin Resistance*

Substances

  • Anti-Bacterial Agents
  • Vancomycin