Tokushukai Medical Group

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Infection Disease: VRE (Vancomycin Resistant Enterococci) Infection Disease

Having the vancomycin resistance characteristics and rapidly increased in the United States of America.

Enterococci primary exists in enteric canal, but VRE, for which vancomycin had lost its effectiveness, appeared in Europe in 1980s. It is called into question that VRE relates to the usage of antibacterial drug used for enticement more than 20 years ago as the growth accelerators for feed additives for barn animal. That antibacterial drug has cross-resistance (drug has lost its effectiveness) with vancomycin so that it becomes banning the use. In the USA VRE in 1989 takes only 0.4% out of entire enterococci, but in 1995, it takes 10% of them and is increasing rapidly. In Japan since 2006, it is in uprising tendency with about 80 cases a year.

Ratio of enterococci changes.

There are enterococcus faecalis (70 – 80%) and enterococcus faecium (15 – 20%) in enterococci bacteria group and most of them are former one. But for Vancomycin Resistant Enterococci (VRE), the latter ratio is increased.

Be careful about the patients who detains Urethra/Blood Vessel Catheter.

Although pathogenicity is low, for compromised immune system or post-surgery patients or person who detains urethra/ blood vessel catheter, infection of the urinary tract, bacteremia, endocardial inflammation or inflammation of meninges are produced. When vancomycin resistance enterococci (VRE) is detected from normally aseptic specimen material like, blood, ascites fluid, pleural effusion, spinal fluid and others, Doctors has to give notice to Public Health Center. In case VRE is detected from normally non-aseptic specimen material like, coughed-up sputum, pus, urine, or others, judgement that isolated microbial is the causative microorganism for infection disease is the condition for the notification requirement. Notification to Public Health Center is not necessary for bacterial carrier.

Selectively use antibacterial drug depend on the type of VRE.

VRE is, most of the case, kept as asymptomatic bacteria carrier so that it is not recommended to treat or administrate preventively for those patients. In case of Complex infections, when leading player of infection is the other strong bacteria, treatment is performed targeting that bacteria.

In case VRE is faecalis type, it is treated using ampicillin. There is a case where gentamicin is combined.
In case VRE is faecium type, most of the cases, it is resistant to antibacterial drug like ampicillin or aminoglycoside. Linezolid or Daptomycin is the first choice.

Infection prevention measure is important to hospital inpatient.

VRE is commonly kept in bacterial carrier, so that it is not enough to perform preventive measure for only VRE infected patients. It is important to perform standard preventive measure for all hospital inpatients. It is mainly propagated from patient to patient via hands of medical profession, so that appropriate washing hands is necessary.

Or when bacterial carrier or onset (infected) patient has appeared from hospital inpatient, contact precaution is performed. Wearing gown and gloves and appropriately teared them off not to be contaminated own clothes or hand and finger, when leaving from patient room.

Reference
  • Kunio Yano; Drug Resistant strain knowingly prevent 2, Van Medical 2015
  • Today’s Treatment Guideline 2017, NAKODO

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