Vancomycin-Resistant Enterococci (VRE) (cont.)
Mary D. Nettleman, MD, MS, MACP
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Vancomycin-resistant enterococci (VRE) facts
- What are vancomycin-resistant enterococci (VRE)?
- What causes a vancomycin-resistant enterococcal (VRE) infection?
- What are risk factors for vancomycin-resistant enterococci (VRE) infections?
- How are vancomycin-resistant enterococci (VRE) transmitted?
- What are the symptoms and signs of a vancomycin-resistant enterococcal (VRE) infection?
- How do physicians diagnose vancomycin-resistant enterococcal (VRE) infections?
- What is the treatment for a vancomycin-resistant enterococcal (VRE) infection?
- What is the prognosis of a vancomycin-resistant enterococcal (VRE) infection?
- What are the complications of VRE infections?
- Is it possible to prevent vancomycin-resistant enterococci (VRE) infections?
- What precautions should people take when tending to someone with a vancomycin-resistant enterococcal infection?
- What research is being done on vancomycin-resistant enterococci (VRE)?
- Where can people find more information on vancomycin-resistant enterococci (VRE) infections?
What is the treatment for a vancomycin-resistant enterococci (VRE) infection?
VRE are resistant to a wide array of antibiotics. Fortunately, newer antibiotics have been developed to bridge this gap, but sometimes they must be used in combination with other antibiotics. Most microbiological laboratories will supply the physician treating the patient with a list of antibiotics the VRE are resistant and susceptible to. If the laboratory does not or cannot provide an alternative antibiotic for VRE treatment, the state lab or the CDC should be notified as they may be able to provide additional help and suggestions for treatment. Currently, clinicians have had some success in treating VRE with combinations of teicoplanin (Teichomycin) and amoxicillin (Amoxil, Dispermox, Trimox) or a combination of ampicillin (Omnipen, Polycillin, Principen), imipenem, and vancomycin (Vancocin). Linezolid, daptomycin, tigecycline and teicoplanin are additional antimicrobials that have been used with some success against various VRE strains. However, VRE antibiotic susceptibility tests done for each infection should help guide the selection of treatment protocols. In addition, consultation with an infectious-disease expert is usually done.
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Other procedures can augment the antimicrobial treatment of VRE-infected patients. If there is a collection of pus, such as an abscess, it is important that it be drained. If the infection is associated with an intravenous line, the line should be removed if at all possible. Similarly, it is desirable to remove urinary catheters to facilitate treatment of the urinary tract. Patients who are colonized but not infected do not require treatment. There is no established way to eradicate colonization of the stool once it occurs.
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