Vancomycin-resistant enterococci (VRE): a reason to isolate?

Abstract

In recent years, an increase in invasive VRE infections has been reported worldwide, including Germany. The most common gene encoding resistance to glycopeptides is VanA, but predominant VanB clones are emerging. Although neither the incidence rates nor the exact routes of nosocomial transmission of VRE are well established, screening and strict infection control measures, e.g. single room contact isolation, use of personal protective clothing by hospital staff and intensified surface disinfection for colonized individuals, are implemented in many hospitals. At the same time, the impact of VRE infection on mortality remains unclear, with current evidence being weak and contradictory. In this short review, we aim to give an overview on the current basis of evidence on the clinical effectiveness of infection control measures intended to prevent transmission of VRE and to put these findings into a larger perspective that takes further factors, e.g. VRE-associated mortality and impact on patient care, into account.

Genomic interrogation of the burden and transmission of multidrug-resistant pathogens within and across hospital networks

“…vanA VRE exhibits several important differences compared to the other study MDROs; it was more likely to be responsible for colonization than to cause infection, more likely to be detected later in admission (suggesting hospital acquisition), more likely to cause infections in patients in high-risk wards, and had much higher rates of in-hospital transmission by both genomics and epidemiological classification (76.7%). Whilst there is ongoing debate about the pathogenicity of this MDRO [34], in our setting it is clearly a healthcare-acquired pathogen, especially in high-risk wards, and provides an opportunity for intervention, where genomics can be used to accurately target infection control interventions to wards with demonstrated transmission. Importantly, genomics can untangle complex transmission networks, identifying transmission in wards where patients were previously admitted (including general and subacute care wards, which together comprised over 60% of wards with probable vanA VRE transmission), rather than the ward on which the VRE was identified (often high-risk wards with routine screening, only comprised 12.5% of wards with probable transmission).…”

Comprehensive integrated NGS-based surveillance and contact-network modeling unravels transmission dynamics of vancomycin-resistant enterococci in a high-risk population within a tertiary care hospital

“…Furthermore, strict control and, possibly, further broadening of surface cleaning and disinfection procedures need to be considered. The appropriateness of single room placement of VRE-patients itself is a matter of debate for economic and patient safety issues, especially in Germany [57]. The relative economic burden imposed by single room isolation in the hematological-oncological setting is very high if the number of…”

Multidrug Resistance (MDR) and Collateral Sensitivity in Bacteria, with Special Attention to Genetic and Evolutionary Aspects and to the Perspectives of Antimicrobial Peptides—A Review

“…Since the appearance of vancomycin-resistant enterococci strains in the late 1980s, the number of resistances has been steadily rising, both in Enterococci [ 14 , 271 , 335 ], and Staphylococci [ 336 , 337 ]. Many resistance isolates appeared, often with life-threatening consequences [ 337 , 338 , 339 , 340 ]. As an alternative to the generation of completely new substances, novel approaches have focused on structural modifications of vancomycin to overcome these resistances and to restore its efficacy against vancomycin-resistant enterococci [ 334 , 340 ].…”

“…Many resistance isolates appeared, often with life-threatening consequences [ 337 , 338 , 339 , 340 ]. As an alternative to the generation of completely new substances, novel approaches have focused on structural modifications of vancomycin to overcome these resistances and to restore its efficacy against vancomycin-resistant enterococci [ 334 , 340 ]. The most recent knowledge about the mechanism of vancomycin resistance has been summarized [ 341 ].…”