[What is to be done with vancomycin-resistant enterococcal infections?]

Area of Science:

• Infectious Diseases
• Microbiology
• Hospital Epidemiology

Context:

• Three recent vancomycin-resistant enterococci (VRE) epidemics in Dutch hospitals highlight challenges in infection control.
• VRE, though relatively avirulent, pose treatment difficulties due to limited antibiotic options and potential for resistance gene transfer.
• Methicillin-resistant Staphylococcus aureus (MRSA) control in the Netherlands contrasts with VRE, as MRSA colonization is preventable, unlike VRE.

Purpose:

• To discuss the challenges and propose a differentiated approach for managing vancomycin-resistant enterococci (VRE) in healthcare settings.
• To address the limitations of traditional 'search and destroy' policies for VRE compared to MRSA control strategies.
• To advocate for a new strategy for VRE, emphasizing targeted infection control based on genotypic evidence and centralized laboratory support.

Summary:

• VRE colonization occurs broadly in the open population, making risk stratification and eradication difficult, unlike MRSA.
• Extensive infection control measures for VRE should be reserved for confirmed spread of a single genotype.
• A centralized reference laboratory for uniform VRE genotyping is recommended to guide control efforts.

Impact:

• The proposed differentiated approach aims to optimize resource allocation for VRE control, focusing on evidence-based interventions.
• Implementing uniform genotyping will improve surveillance and understanding of VRE transmission dynamics.
• This strategy may prevent widespread VRE colonization and infection, safeguarding public health in the Netherlands and beyond.