Vancomycin-resistant Enterococci (VRE)

What is VRE?

Enterococci are a family of bacteria that live in our gastrointestinal tract or bowels. Vancomycin-resistant Enterococci (VRE) are types of bacteria that develop resistance to many antibiotics, especially vancomycin. Vancomycin is often used to treat serious infections. As a result, an infection caused by VRE can be difficult to treat.

Does VRE go away?

Most people who carry VRE and have no symptoms of infection are said to be colonized. The main site of colonization of VRE is the bowel. People who have VRE in their bowel will likely carry it for a long time. If VRE causes an infection for your child, they will be treated with antibiotics other than vancomycin.

Who is at risk for VRE?

Children with weakened immune systems are most commonly affected by VRE infections.

Children who have been treated with vancomycin or other antibiotics for long periods of time are also more at risk for VRE infections.

Having indwelling devices, such as urinary catheters, increases the risk of becoming infected with VRE.

How are VRE spread?

VRE is not spread through the air but may survive on equipment and surfaces, such as bedrails, tables, chairs, countertops and door handles. VRE can spread from one person to another by contact with unwashed hands or soiled equipment and surfaces. Infections can occur if VRE enters a person’s body through entry points such as their eyes, nose, mouth and open or broken areas of skin such as cuts, incisions and wounds.

How is VRE diagnosed?

Your child’s health-care provider may test them for VRE by taking samples of their stool or by performing a rectal swab. The samples would then be sent to the laboratory for VRE testing. Your child’s health-care provider may test for VRE if your child lived or received health care outside of Canada within the past year. Some health-care facilities test all admitted patients for VRE.

VRE infections are treated with antibiotics

Most people who carry VRE and have no symptoms of infection are said to be colonized. They will not need treatment. If your child develops an infection caused by VRE, they will be treated with antibiotics other than vancomycin.

What special precautions are required for VRE while your child is in the hospital?

Your child’s health-care team will continue to provide the same level of patient care. They will use additional precautions to prevent the spread of the bacteria.

• Your child will be moved to a single patient room.
• Your child will not be able to visit the playroom or other family spaces.
• A Contact Precautions sign will be placed on your child’s door to remind staff who enter the room about the special precautions.
• You will notice staff wearing a gown and gloves when they enter your child’s room.
• Everyone who enters and leaves your child’s room must clean their hands.
• Your child’s hospital record will indicate they are VRE positive so that health-care workers are aware your child has VRE if your child visits the hospital again.
• You may notice more frequent cleaning of your child’s room.

What are the possible complications of VRE?

VRE can cause infections in any part of the body (e.g., lungs, bloodstream, abdomen, urinary tract and central venous catheters). These infections can be difficult to treat since VRE is resistant to many antibiotics, especially vancomycin, an antibiotic used to treat serious infections.

What will happen at home?

• It is important to wash hands often at home for at least 15 seconds, especially after using the bathroom and before preparing food.
• No special cleaning of items in your home is required.
• You can wash clothing the same way as usual, along with the rest of the household laundry.
• If you go to another health-care facility, visit another health-care provider or have home care services, you should tell them your child has VRE. They may use additional precautions when providing care, which will help prevent spread to others and help your child’s health-care provider choose the correct antibiotic treatment if needed.

Resources

Public Health Ontario: Vancomycin-resistant enterococci (VRE)
https://www.publichealthontario.ca/en/Diseases-and-Conditions/Health-Care-Associated-Infections/VRE