Page 194 - policy and procedure infection control

Policies and Procedures on Infection Control

13.3 Vancomycin Resistant Enterococci

13.3.1Introduction

Enterococci are the second most common cause of HCAI in the United States. The
emergence of vancomycin-resistant enterococci (VRE) as an important nosocomial
pathogen in susceptible populations represents a significant challenge to infection control
personnel. In Malaysia, the prevalence rate of VRE is 0.8% in 2007

13.3.2Enterococcus
Enterococci are gram-positive cocci usually arranged in short chain, which forms part of
the normal flora of the gastrointestinal in 95% of individuals. It is a non-pathogenic organism,
which may colonise the flora in the female genital tract, oral cavity, perineal area,
hepatobiliary tract, and upper respiratory tract.

The two most common species causing human infection are Enterococcus faecalis, which
causes 80% to 90% of all enterococcal infections, and Enterococcus faecium, which
causes 5% to 15%. Virtually all VRE are E. faecium. Mechanism of resistance in VRE is
due to the presence of van gene (van A,B,C,D,E,G).

13.3.3Clinical Manifestation
• Enterococci are relatively poor pathogens, usually causing colonization rather than infection.
• Most enterococcal infections are endogenous, but cross-infection between
hospitalized patients does occur mainly on hands contaminated by contact with
colonised or infected patients, contaminated surfaces or formites.
• They can also cause urinary tract infections, bacteraemia, meningitis and wound
infections. In most patients, colonisation with VRE precedes infection.
•· These organisms were traditionally susceptible to ampicillin, vancomycin,
aminoglycosides and quinolones.

13.3.4Epidemiology of VRE
Populations found to be at increased risk for VRE include:
• Those who have received vancomycin or cephalosporins and/or multi-antimicrobial
therapy;
• Those with severe underlying disease or immunosuppression;

• Those who have had intra-abdominal or cardiothoracic surgical procedures;
• Those who have an indwelling urinary catheter or central venous catheter.
• Patients who have undergone sigmoidoscopy or colonoscopy.
• Patients in ICU/renal /oncology/haematology units.
• Patients in long stay institutions

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