What Are VRE? Symptoms, Causes, Diagnosis, Treatment, and Prevention

VRE stands for vancomycin-resistant enterococci.

Vancomycin is an antibiotic that is commonly used to treat these infections, but as with a number of other bacteria that have developed antibiotic resistance — the ability of certain germs to fight off the drugs that have been formulated to kill them — enterococci has learned to adapt and prevail against the drug. These hard-to-kill bacteria are called vancomycin-resistant enterococci (VRE).

Enterococcus infections, including VRE infections, cause a range of different symptoms depending on the location of the infection.

Bloodstream infections can cause:

• Fever
• Chills
• Body aches
• Rapid pulse and breathing
• Nausea and vomiting
• Diarrhea
• Decreased urination

  

• Frequent or intense urge to urinate
• Pain or burning sensation while urinating
• Cloudy, dark, bloody, or foul-smelling urine
• Lower back, flank, or abdominal pain

Wound infections can cause:

• Soreness and swelling at wound site
• Red, warm skin around wound
• Pus or fluid leakage from the wound

To understand how antibiotic-resistant bacteria like VRE emerges, it helps to first understand how bacteria and fungi change in response to medicines designed to kill them. According to the CDC, germs naturally evolve constantly, and can develop new ways to avoid the effects of antibiotics. Once that happens, the resistant germ survives and multiplies, and the surviving germs, which now have resistance traits in their DNA, pass on this genetic information to subsequent generations. These resistant germs can continue to spread and pose an increasing threat to people’s health.

VRE are most commonly found in healthcare settings, such as nursing homes or hospitals, particularly in areas where there are people with weakened immune systems, such as intensive care units or cancer or transplant wards. VRE can cause infections in patients and then spread to others when the patient is transferred to another facility or goes home.

If you are healthy, your chances of getting sick from VRE are very low, even if you have been exposed to the bacteria. But if you have a weakened immune system, that can be a very different story.

People who are more likely to have VRE include:

• Those who have been treated with antibiotics, including vancomycin (particularly for long periods of time)
• Individuals who have been hospitalized (particularly if you had surgery or have had medical devices such as catheters inserted into your body)
• People who have weakened immune systems, such as those who have a long-term illness or are in intensive care units or cancer or transplant wards of a hospital

Prognosis of VRE

How long you have a VRE infection can depend on how serious it is and how well it responds to treatment.

Medication Options

Some vancomycin-alternative medications that may be used include:

• ampicillin (Omnipen) (a penicillin antibiotic)
• linezolid (Zyvox)
• daptomycin (Cubicin)
• tigecycline (Tygacil)
• chloramphenicol

  

Prevention of VRE

In the hospital setting, good basic hand hygiene by healthcare providers and use of gowns and gloves can also help decrease transmission, as can isolating patients who are identified as being high-risk for contracting VRE.

If you or someone in your household has VRE, the following measures can help prevent the spread of infection:

• Wash your hands thoroughly and frequently, especially after using the bathroom, before and after handling medical devices or caring for wounds, and before preparing food.
• Clean common areas of the home, such as bathrooms, frequently.
• Wear gloves when caring for wounds (such as changing bandages) or doing other caregiving duties that may involve coming into contact with bodily fluids, and always wash your hands after removing your gloves.

• Bacteremia (bacterial infection that has spread to the bloodstream)
• Urinary tract infection
• Endocarditis (infection of a heart valve)
• Meningitis
• Wound infection
• Pneumonia
• Intra-abdominal infections (such as peritonitis)
• Pelvic infections
• Skin and soft tissue infections

It’s important to note that these complications can also be caused by something unrelated to VRE infections.

Some other statistics that illustrate the scope of the problem and our need for continued mitigation:

• VRE caused an estimated 54,500 infections among hospitalized patients in 2017.
• That same year, 5,400 people died from VRE.
• More than 2.8 million antibiotic-resistant infections occur in the United States each year; more than 35,000 people die as a result of these infections.

• Bacterial sepsis
• Other hospital-acquired infections
• Endocarditis
• Peritonitis and abdominal sepsis
• Septic arthritis
• UTI
• Wound infection

Centers for Disease Control and Prevention (CDC)

The CDC is leading the charge against antibiotic-resistant pathogens such as VRE. This page details important information about what VRE is and how we can protect ourselves from this and other antibiotic-resistant germs that threaten our health. It also links to the latest threats report, which lays out useful and important information about VRE and other dangerous bacteria that should be on everyone’s radar.

MedlinePlus

This site from the U.S. National Library of Medicine offers essential information about who is at risk for VRE and how to prevent the spread of this potentially dangerous, even deadly bacteria.

Michigan Medicine

University of Michigan’s Michigan Medicine explains in simple, jargon-free language exactly why VRE is a problem; what we need to know about basics like how it’s spread, diagnosed, and treated; and, most importantly, how to prevent it.

Additional reporting by Joseph Bennington-Castro.