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vancomycin resistant enterococcus (VRS)

Etiology: 1) nosocomial infection 2) enterococci a) Streptococcus faecalis b) Streptococcus faecium (most common) c) Enterococcus gallinarium 3) use of broad-spectrum antibiotics is a risk factor Epidemiology: 1) carriage time tends to be several months 2) low patient to patient transmission rate 3) low infection rate 4) vancomycin-resistant Enterococcus faecium spreads within & between hospital wards & between hospitals [4] Pathology: - abnormal cell wall ligase confers resistance Laboratory: - vancomycin-resistance gene - vancomycin-resistant enterococcus DNA - vancomycin-resistant enterococcus culture - high level resistance: (MIC > 128 ug/mL) - moderate level resistance: (MIC 16-64 ug/mL) - save isolates for epidemiological investigation Management: 1) isolation - isolation precautions for visitors not needed in communities where VRE is endemic [4] 2) hospital monitoring of vancomycin use 3) health department may require reporting 4) routine infection control measures [2]; contact precautions [7] a) basic hygiene measures b) personal hygiene equipment for patients c) maintain contact precautions until 1-3 negative cultures obtained; cultures should be 1 week apart [6] d) daily cleaning of environmental surfaces reduces VRE colonization of patients & of healthcare workers' hands [3] 5) pharmaceutical agents a) Synercid b) linezolid (Zyvox) 600 mg every 12 hours for 14-28 days c) fosfomycin has activity against VRE (not for pyelonephritis)

Related

vancomycin (Vancocin)

General

Enterococcus

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 19. American College of Physicians, Philadelphia 1998. 2021
  2. Norman, D, In: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  3. Hayden MK, Bonten MJ, Blom DW, Lyle EA, van de Vijver DA, Weinstein RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis. 2006 Jun 1;42(11):1552-60. Epub 2006 Apr 27. PMID: 16652312
  4. Orciari Herman A, Sadough S, Sofair A Guidelines Issued on Isolation Precautions for Hospital Visitors; Utility of Face Masks Reviewed Physician's First Watch, April 13, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Munoz-Price LS et al Isolation Precautions for Visitors. Infection Control & Hospital Epidemiology. April 10, 2015 PMID: 26017347 http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9641478&fileId=S0899823X15000677
  5. Raven KE, Gouliouris T, Brodrick H et al. Complex routes of nosocomial vancomycin-resistant Enterococcus faecium transmission revealed by genome sequencing. Clin Infect Dis 2017 Apr 1; 64:886 PMID: 28362945 https://academic.oup.com/cid/article/3051757/Complex
  6. Banach DB, Bearman G, Barnden M et al Duration of Contact Precautions for Acute-Care Settings. Infection Control & Hospital Epidemiology. Jan 11, 2018 PMID: 29321078 https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/duration-of-contact-precautions-for-acutecare-settings/94E38FDCE6E1823BD613ABE4E8CB5E56
  7. Rubin MA, Samore MH, Harris AD. The Importance of Contact Precautions for Endemic Methicillin- Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci. JAMA. Published online Feb 12, 2018 PMID: 29435582 https://jamanetwork.com/journals/jama/fullarticle/2672842