VANCOMYCIN-Resistant Enterococci

(GROUP 9 )

Authors- TASHAN ASANKA PERERA(TEAM LEADER),N.D.KODIKARA,M.D.P.S. WEERASINGHE,P.S.CHANDRASEKERA,ISURU RABODAN,ISHARA FERNANDO 1 OVERVIEW- Enterococci are a group of gram-negative, round-shaped bacteria that commonly live in the gut, although they can cause infection anywhere in the body. They are resistant to several antibiotics, but in the past, physicians could rely on the drug vancomycin to effectively treat enterococcal infections. In recent decades, however, some enterococci have become resistant to vancomycin. The two main species that cause problems are vancomycin-resistant Enterococcus faecium and vancomycin-resistant Enterococcus faecalis, with E. faecium being the most common. Vancomycin resistance is acquired when a sensitive Enterococcus acquires a special piece of DNA called a plasmid. The new strain is called vancomycin-resistant enterococci (VRE). One concern is that VRE appears able to transfer vancomycin resistance to unrelated bacteria such as MRSA (methicillin-resistant Staphylococcus aureus). In addition, VRE organisms are usually resistant to more than one antibiotic. VRE can also be spread from person to person and are an increasing problem in hospitals and chronic-care facilities. Approximately 30% of all enterococcal infections are now caused by vancomycin-resistant strains (VRE). 2 CAUSE- VRE can exist in the body without causing infection, in which case a patient is said to be colonized with VRE. Colonization usually occurs in the bowel. If the number of VRE bacteria increases, they can invade the bloodstream or spread locally to cause an abdominal abscess or urinary infection. Once in the bloodstream, VRE can cause meningitis, pneumonia, or infection of a heart valve (endocarditis). VRE may also be introduced directly into an open sore or wound, causing a wound infection. The bacteria produce several substances, including proteases that help them break down the normal barriers between the gut tissue and the bloodstream. 3 TREATMENTS- 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). However, VRE antibiotic susceptibilities done for each infection should help guide the selection of treatment protocols. In addition, consultation with an infectious-disease expert is usually done. 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. 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. 4 PREVENTIONS- The best way to prevent infection is to prevent transmission. This means that hospitals and care facilities must pay meticulous attention to infection-control guidelines to reduce the spread of VRE from patient to patient. Individuals can reduce their risk by washing hands after using the bathroom and before and after touching the mouth or nose. Minimizing the use of intravenous catheters, especially central lines, reduces the risk of VRE sepsis. Similarly, the use of urinary catheters should be minimized and catheters should be removed promptly when no longer needed. Finally, antibiotics should be used only for appropriate indications. Antibiotics are ineffective against viruses and the common cold.