Vancomycin-resistant enterococci (VRE): colonisation, infection and what it means

Enterococci are a group of bacteria that normally live in the bowel. GOV.UK, in guidance from what was then Public Health England, explains that there are many species but only a few can cause infections in humans, including urinary tract infections, bloodstream infections (bacteraemia) and wound infections. Glycopeptide-resistant enterococci (GRE) are those resistant to vancomycin and teicoplanin, and are sometimes called VRE. The two most common species are Enterococcus faecalis and Enterococcus faecium.

The resistance means that a standard antibiotic stops working, so options for treating an infection are narrower. UCLH puts it simply: VRE has become resistant to vancomycin and some other antibiotics, which can make infections more difficult to treat, but other antibiotics can be used.

Being colonised means having the bacteria in the gut, on the skin or in wounds without causing illness. UCLH says most people with VRE are in this group and do not need antibiotics. The bacteria can stay in the body for months. Infection, which is less common, may cause urinary tract, wound or bloodstream infection, and is treated with antibiotics that are active against the particular strain.

GOV.UK adds that GRE are sometimes found in the faeces of people who have never been in hospital or have not recently been given antibiotics, so a positive swab does not necessarily mean someone has picked it up in hospital.

UCLH lists an increased risk of infection for patients who have been in hospital for a long time, have weakened immune systems or are in intensive care, have open wounds or surgical incisions, have medical devices such as catheters or cannulas, or have been treated with antibiotics such as vancomycin before, which can allow resistant bacteria to grow. It adds that people receiving many different antibiotics are more likely to develop resistant strains.

GOV.UK names previous treatment with certain other antibiotics, particularly cephalosporins and glycopeptides, a prolonged hospital stay, immunocompromise and specialist units such as intensive care and renal units.

UCLH describes the usual precautions: you may be cared for in a single room with an en-suite toilet, staff wear aprons and gloves and clean their hands, and if a single room is not available you may be nursed in a bay with similar precautions depending on a risk assessment. The bacteria spread more easily when someone has diarrhoea, so tell staff if you develop it. VRE can enter the body through open wounds and devices, so avoid touching catheters, cannulas and wounds.

UCLH advises patients to wash hands with soap and water, particularly after the toilet and before eating, or to use alcohol hand sanitiser when hands are visibly clean, and says staff will help if you need it. Unless you develop an infection, you do not necessarily need to stay in hospital longer.

Not everyone with VRE needs treatment. UCLH says that antibiotics are only prescribed for an infection, because careful use of antibiotics is essential in reducing the chance of resistance. If treatment is needed, other antibiotics are available, and some are given by injection, so you might need to remain in hospital while the infection is treated. Choice is guided by the laboratory results and the hospital's antibiotic guidelines.

UCLH says that VRE is not usually a problem for healthy people and that visitors should clean their hands on entering and leaving your room. At home, good hand hygiene is important and normal household cleaning and laundry are enough. It advises telling healthcare workers that you are colonised with VRE when you see new doctors, attend a different hospital or are readmitted, and telling your GP.

Infection prevention and control teams in NHS and private hospitals follow similar national principles. Screening swabs and treatment are arranged by the hospital caring for you. Ask the ward staff or the infection prevention and control team if you have questions about your status.