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Understanding Vancomycin-Resistant Enterococci (VRE): Causes, Symptoms, and Prevention

Jerome Albert Ecker | MD

Medically reviewed by Jerome Albert Ecker | MD, Assistant Professor of Medicine, Duke University - Durham, NC on July 6th, 2023.

Key Takeaways

  • These gram-positive bacteria naturally live in the intestinal tract but become dangerous when they acquire resistance genes, affecting 20,000 Americans annually with a 10% mortality rate.
  • Hospital patients face the highest risk, especially those with prolonged antibiotic exposure (particularly vancomycin), indwelling catheters, or stays in intensive care units longer than one week.
  • Infections typically manifest as urinary tract infections (most common), bloodstream infections with fever above 100.4°F, wound infections, or rarely, endocarditis in patients with heart valve disease.
  • Standard treatment requires alternative antibiotics like linezolid (600mg twice daily) or daptomycin (4-6mg/kg daily), since vancomycin—the usual enterococcal treatment—is completely ineffective.
  • Contact isolation precautions include dedicated medical equipment, gown and glove use by healthcare workers, and patient room restrictions until three consecutive negative cultures are obtained.

Vancomycin-resistant enterococci, or VRE, are a type of bacteria that have developed resistance to the powerful antibiotic vancomycin. While enterococci bacteria normally live in the intestines and genital tract without causing problems, VRE can lead to serious infections that are difficult to treat.

Who Is at Risk for VRE Infections?

Approximately 20,000 people in the United States are infected with VRE each year, with a mortality rate of just under 10%. People who are at a higher risk of developing VRE infections include:

  • Those who have been treated with vancomycin or other antibiotics for extended periods

  • Individuals who have recently undergone surgery, especially of the abdomen or chest

  • Patients using long-term medical devices, such as urinary or IV catheters

  • People with weakened immune systems

  • Patients in intensive care units, cancer wards, or transplant wards

  • Individuals already colonized with VRE in their intestines or genital tracts

Understanding Vancomycin-Resistant Enterococci (VRE): Causes, Symptoms, and Prevention

Symptoms and Diagnosis of VRE Infections

VRE infections can cause a variety of symptoms, which may be attributed to other infections triggered by the bacteria, such as urinary tract infections, bloodstream infections, or wound infections. The time between infection and symptom onset can vary. To diagnose VRE, your doctor will take a sample from the affected area and send it to a lab for testing. If the sample is positive for VRE, further tests will be conducted to determine the most effective antibiotic for treatment.

Preventing the Spread of VRE

To prevent the spread of VRE, it is essential to maintain good hygiene practices, such as:

  1. Regularly cleaning and disinfecting hard surfaces in your home, especially in bathrooms and kitchens

  2. Washing your hands thoroughly with soap and water for at least 20 seconds, particularly after using the bathroom and before preparing food

  3. Wearing gloves when handling bodily fluids that may contain VRE, such as stool or infected wound bandages, and always washing your hands after removing the gloves

  4. Informing healthcare providers if someone in your care has VRE, so they can take appropriate precautions

By understanding the causes, symptoms, and prevention methods for VRE, you can help protect yourself and others from these antibiotic-resistant infections. If you suspect you may have a VRE infection, consult your healthcare provider for proper diagnosis and treatment.

Additional Resources

The Bottom Line

VRE poses the greatest threat to hospitalized patients with multiple risk factors, requiring immediate alternative antibiotic therapy since standard vancomycin treatment fails completely. Prevention centers on strict infection control measures and appropriate antibiotic stewardship in healthcare settings. If you're experiencing persistent fever, painful urination, or wound infections after recent hospitalization, Doctronic can help assess your symptoms quickly.

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