Enterococci are bacteria present in the normal intestinal flora in humans. These bacteria generally do not cause infections in healthy people; but when certain conditions combine, they may cause infections that require antibiotics.
Enterococci are intrinsically resistant to many antibiotics. Those said to be resistant to vancomycin are called VRE (vancomycin-resistant enterococci). Vancomycin therefore is not effective for treating infections caused by this type of enterococcus.
VRE infections are mostly seen in healthcare facilities, especially hospitals.
People at risk
Healthy people have a low risk of developing a VRE infection.
People who are most at risk of being colonized or infected with VREs are:
- hospitalized individuals who have had surgery or who are using or have used a medical device (e.g., intravenous catheter, urinary catheter)
- people with weakened immune systems
- people with surgical wounds
- people recently treated with antibiotics for another infection
- people sharing their care area with someone who is a VRE carrier or infected with VRE.
Taking antibiotics, although necessary to treat an infection, ultimately disrupts all the microbes in the body, the good ones as well as the bad ones. Given that this natural barrier is weakened, it is easier for a micro-organism such as VRE to colonize or infect the person. In the event of a VRE infection, the doctor will choose antibiotics that are effective against the bacteria.
Someone can be a VRE carrier without being sick or showing signs or symptoms of infection. People who are colonized with, or carriers of, VRE do not require treatment. The carrier’s state can be detected only with a rectal smear or stool specimen.
VRE may nevertheless cause an infection in some people. At that time, signs of infection will appear, based on the body site with VRE (e.g., if VRE is found in a wound, symptoms of a skin infection will appear, such as redness, warmth, swelling, pus drainage, etc.). In the presence of these infections, a laboratory specimen or sample will be taken to determine if VRE is the cause.
A VRE infection is treated with antibiotics other than vancomycin. The doctor will determine the best treament to use. Most people recover from this infection.
Depending on its nature, a VRE infection can lead to serious complications, such as a bloodstream, heart or abdominal infection. Some may even be life threatening for infected people.
VRE are spread through contact with a surface touched by contaminated hands. Toilet seats, bed rails and door handles are surfaces that are liable to be contaminated.
The risk that a carrier or an infected person may transmit VRE bacteria to household members, including pregnant women and children, is low if they are healthy.
VRE can stay in the intestines for many weeks, and even many months.
Protection and prevention
To prevent the spread of VRE, adopt the following hygiene practices:
- Wash your hands often with water and soap or an antiseptic. This is the easiest and most effective way to protect yourself against these bacteria. This practice must be applied not only by carriers or infected people but also by members of their household.
- Frequently clean the room and bathroom with a household cleaning product or disinfectant. Pay special attention to surfaces and objects that are often touched by the carrier or infected person: toilet, grab bar, toilet flush handle, door handles, light switches, bedside table and telephone.
- Wash the carrier’s or infected person’s clothes and bed linen in the washing machine with warm or hot water and household laundry detergent.
- Keep wounds clean and covered, as instructed by your healthcare professional, and dispose of the dressings soiled with the carrier’s or infected person’s secretions in a sealed plastic bag, and then wash your hands.
- Make sure that the carrier or infected person maintains good personal hygiene by bathing with water and soap or by having them take a shower.
If you receive home care or have an appointment with a healthcare professional in a healthcare facility or medical clinic, tell the staff that the person you are accompanying or you yourself are carriers or infected with VRE. When treating that person, staff may need to wear gloves and a protective gown to avoid spreading the bacteria to other people.
You will find additional hygiene measures on the page Steps for limiting the spread of respiratory infectious diseases.
Measures in healthcare facilities
Any hospital that admits or identifies a carrier or a person infected with VRE must put in place different measures:
- Isolate the person in a private room or in a room with other patients who are VRE carriers or infected with VRE, depending on the facility and the patient’s condition.
- Clean and disinfect the carrier’s or infected person's room and bathroom more frequently.
- Clean and disinfect all healthcare equipment not reserved for the person, and clean and disinfect any item that will be taken out of the room (e.g., wheelchair, walker).
- Require staff and visitors to wear gloves and long-sleeved gowns, depending on the situation.
- Post a sign on the door of the carrier’s or infected person’s room to remind staff and visitors to wash their hands and follow the measures put in place.
These measures must be maintained until laboratory test results show that the person is no longer a carrier or infected with VRE.
In long-term care or rehabilitation centres, measures are adapted to the facility and the person's condition
Information about VRE should be given to carriers or infected people, including the measures to follow when they return home. Before leaving the healthcare facility, patients must inform their doctor or the healthcare professional if another person at home is ill or has a weakened immune system. Additional measures may be needed at home to protect that person.
The surveillance of VRE cases (carriers and infected people) has been mandatory in Québec hospitals since 2007. This surveillance program, introduced by the Ministère de la Santé et des Services sociaux, is part of the provincial program for the surveillance of healthcare-associated infections. These infections are acquired during episodes of care provided by a healthcare professional, regardless of the facility that administered the care.
In addition, VRE outbreaks in Québec healthcare facilities must be reported to public health authorities.
Last update: October 16, 2023