vancomycin resistant enterococcus (VRS)
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Etiology
- nosocomial infection
- enterococci
- Streptococcus faecalis
- Streptococcus faecium (most common)
- Enterococcus gallinarium
- use of broad-spectrum antibiotics is a risk factor
Epidemiology
- carriage time tends to be several months
- low patient to patient transmission rate
- low infection rate
- vancomycin-resistant Enterococcus faecium spreads within & between hospital wards & between hospitals[4]
Pathology
Laboratory
- vancomycin-resistance gene
- vancomycin-resistant enterococcus DNA
- vancomycin-resistant enterococcus culture
- high level resistance: (MIC > 128 ug/mL)
- moderate level resistance: (MIC 16-64 ug/mL)
- save isolates for epidemiological investigation
Management
- isolation
- hospital monitoring of vancomycin use
- health department may require reporting
- routine infection control measures[2]; contact precautions[7]
- basic hygiene measures
- personal hygiene equipment for patients
- maintain contact precautions until 1-3 negative cultures obtained; cultures should be 1 week apart[6]
- daily cleaning of environmental surfaces reduces VRE colonization of patients & of healthcare workers' hands[3]
- pharmaceutical agents
- Synercid
- linezolid (Zyvox) 600 mg every 12 hours for 14-28 days
- fosfomycin has activity against VRE (not for pyelonephritis)
More general terms
Additional terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 19. American College of Physicians, Philadelphia 1998. 2021
- ↑ 2.0 2.1 Norman, D, In: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 3.0 3.1 Hayden MK, Bonten MJ, Blom DW, Lyle EA, van de Vijver DA, Weinstein RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis. 2006 Jun 1;42(11):1552-60. Epub 2006 Apr 27. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16652312
- ↑ 4.0 4.1 4.2 Orciari Herman A, Sadough S, Sofair A Guidelines Issued on Isolation Precautions for Hospital Visitors; Utility of Face Masks Reviewed Physician's First Watch, April 13, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
Munoz-Price LS et al Isolation Precautions for Visitors. Infection Control & Hospital Epidemiology. April 10, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26017347 <Internet> http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9641478&fileId=S0899823X15000677 - ↑ Raven KE, Gouliouris T, Brodrick H et al. Complex routes of nosocomial vancomycin-resistant Enterococcus faecium transmission revealed by genome sequencing. Clin Infect Dis 2017 Apr 1; 64:886 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28362945 https://academic.oup.com/cid/article/3051757/Complex
- ↑ 6.0 6.1 Banach DB, Bearman G, Barnden M et al Duration of Contact Precautions for Acute-Care Settings. Infection Control & Hospital Epidemiology. Jan 11, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29321078 https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/duration-of-contact-precautions-for-acutecare-settings/94E38FDCE6E1823BD613ABE4E8CB5E56
- ↑ 7.0 7.1 Rubin MA, Samore MH, Harris AD. The Importance of Contact Precautions for Endemic Methicillin- Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci. JAMA. Published online Feb 12, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29435582 https://jamanetwork.com/journals/jama/fullarticle/2672842