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Vancomycin resistant Enterococcus (VRE) emerged internationally through the 1990s. Prevalence today varies widely, with between 0 percent and 45 percent of E. faecium isolates demonstrating glycopeptide resistance in European countries. In the United States, 3 percent of hospital acquired infections were due to VRE. The risk of invasive disease in VRE colonized patients is 4 percent but can be up to 14 percent in immune-suppressed patients, highlighting the importance of infection control measures especially in countries with a high prevalence.
In the last 10 years, however, uncertainty has increased regarding the infection control prioritisation of this organism. Initially there were concerns over horizontal gene transfer and the possible emergence of Vancomycin Resistant S. aureus but this situation has not been realized. The treatment paradigm for VRE improved with the advent of linezolid and daptomycin in 2000 and 2003.
Now, in the era of carbapenemase producers and polymixin resistance, many question where as a priority VRE control should sit. The optimal approach to screening, isolation and surveillance is unclear, reflected by the paucity of international guidelines for VRE screening and infection control, with the most recent published in the United Kingdom and by the Centers for Disease Control and Prevention (CDC) in 2006. Inevitably, individual institutions have had to develop their own infection control approaches for VRE.
Isenman, et al. (2016) sought to determine the approach to VRE control in different centers internationally. An electronic survey was disseminated amongst infection control practitioners to investigate the variation in practices toward vancomycin resistant enterococci. There were 235 responses, mostly from doctors, in 48 countries. The survey considered active surveillance, in-hospital precautions and tagging and un-tagging processes. There was a great variation in responses between and within countries highlighting a gap in guidance for practitioners on which to base institutional policy.
Reference: Isenman H, Michaels J and Fisher D. Global variances in infection control practices for vancomycin resistant Enterococcus – results of an electronic survey. Antimicrobial Resistance & Infection Control. 2016;5:41