What can you tell me about the treatment and recovery from VRE? How easily is it passed to another person? What is the new antibiotic that is stronger than vancomycin that was approved recently?

Mr. B.

VRE stands for vancomycin-resistant Enterococcus. Enterococcus is a group of bacteria that causes infections in humans and animals and is related to Streptococcus. Most human infections are due to Enterococcus faecalis and Enterococcus faecium. I will use the term "enterococci" to describe these bacteria.

In most people, enterococci live in the colon without causing infection or disease. Enterococci are not very virulent, which means that they are not usually capable of causing serious infections in normally healthy people. The most common infections caused by enterococci are urinary tract infections. The bacteria can also occasionally get into the blood and infect the valves of the heart. This infection, called endocarditis, is the most serious of the more common enterococcal infections, and it can be fatal. In addition to urinary and cardiac infections, enterococci can sometimes infect wounds, cause intra-abdominal infections after bowel perforations and cause bloodstream infections in hospitalized patients.

Enterococci are innately resistant to many common antibiotics. The most useful antibiotics for killing these bacteria are penicillin, ampicillin (Omnipen) and vancomycin (Vancocin). For many years, most, if not all strains (varieties) of enterococci could be controlled by these antibiotics. Several years ago, some strains became resistant to penicillin and its derivatives. More recently, an increasing number of strains have become resistant to vancomycin. Most of these are also resistant to penicillin and ampicillin. These strains were dubbed VRE.

A strain of enterococci generally does not become resistant to vancomycin and other antibiotics during a person's treatment. The way someone develops an infection with VRE is by acquiring the resistant organism from someone else. This usually occurs in the hospital, when a patient acquires a small amount of VRE and it gets into the patient's colon. Then, the patient is treated with multiple antibiotics for an infection with another bacterium, and in the process, much of the bacteria in the gut are destroyed. Because the VRE is resistant to these antibiotics, it multiplies rapidly as competing organisms are killed. Soon, a large proportion of the bacteria in the gut will be VRE. Then the patient is at risk of developing a true infection with VRE.

VRE causes the same types of infections as the usual enterococci. They are just much more difficult to treat. Patients with serious medical problems are more likely than healthy people to develop an infection with VRE in the first place. That is at least partly because the sickest patients are more likely to have been on many antibiotics.

It is quite easy for VRE to spread from one person to another, and the bacteria survive on inanimate objects for a considerable length of time. Since most important infections and almost all outbreaks of VRE infections occur in the hospital, strict measures are used to prevent the spread. Typically, health-care workers caring for a patient with VRE are required to wear gloves and gowns at all times while in the patient's room.

There is no need to treat every patient with a positive stool or skin culture for VRE, but significant illnesses such as urinary, bloodstream and cardiac infections definitely do require therapy. A new antibiotic called quinupristin/dalfopristin (Synercid) has activity against most strains of vancomycin-resistant Enterococcus faecium. Several studies in animals and humans have demonstrated the effectiveness of Synercid against VRE, and it is now considered the drug of choice for such infections. Some other antibiotics can also be used to treat VRE, but their effectiveness may be less well studied.