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Vancomycin-resistant enterococci: the clinical effect of a common nosocomial pathogen
1Division of Critical Care Medicine, University of Pittsburgh, Pennsylvania, USA.
Diagnostic Microbiology and Infectious Disease
|March 26, 1999
Summary
Vancomycin-resistant enterococci (VRE) are a growing threat in hospitals, often linked to antibiotic use and patient factors. Strategies to control VRE include judicious antibiotic stewardship and improved infection control measures.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Resistance
Background:
- Enterococcus species are a significant cause of nosocomial infections, with Enterococcus faecalis and Enterococcus faecium being the most common isolates.
- Enterococcus faecium exhibits high resistance rates to common antibiotics like penicillins and aminoglycosides, posing treatment challenges.
- Vancomycin-resistant enterococci (VRE) are increasingly prevalent, accounting for a substantial portion of hospital-acquired infections.
Purpose of the Study:
- To review risk factors associated with vancomycin-resistant enterococci (VRE) acquisition.
- To evaluate the effectiveness of various interventions aimed at reducing VRE transmission and colonization.
- To discuss current and future therapeutic strategies for managing VRE infections.
Main Methods:
- Review of identified risk factors for VRE, including patient characteristics and prior antibiotic exposure.
- Analysis of studies evaluating infection control interventions, such as contact precautions (gowns and gloves).
- Examination of the impact of antibiotic stewardship, particularly vancomycin usage, on VRE rates.
- Assessment of the efficacy of enteral agents and non-antimicrobial interventions in VRE management.
Main Results:
- Identified risk factors for VRE include prolonged hospitalization, ICU stay, immunosuppression, and prior exposure to specific antibiotics.
- Inappropriate vancomycin use is common (>60%), and its control alone has variable effects on VRE colonization.
- Interventions like gowns and gloves showed mixed results in reducing VRE transmission.
- Enteral agents for VRE eradication have shown only transient effects, while non-antimicrobial measures like catheter removal may be beneficial.
Conclusions:
- Controlling VRE requires a multifaceted approach, including antibiotic stewardship, optimized infection control, and potentially new antimicrobial agents.
- Judicious use of broad-spectrum antibiotics and reducing immunosuppression are important adjuncts to VRE control.
- Development of novel antimicrobial agents is crucial for addressing the growing challenge of VRE morbidity.