Move Over MRSA, Hello Vancomycin Resistant Enterococcus (VRE)

MRSA, commonly known as "Staph" to the average lay person and as Methicillin Resistant Staphylococcus Aureus to the Health Care Provider, has caused a public scare in the past year. There have been numerous cases of skin infections, bone infections (Osteomyelitis), urinary tract infections, and blood stream infections due to this organism. Deaths of young healthy individuals have been attributed to this "Superbug". The mainline treatment for this infection has been Vancomycin administered intravenously over a course of several weeks. But have you ever heard of Vancomycin Resistant Enterococcus?

VRE or Vancomycin Resistant Enterococcus is an organism that is gaining attention fast. Because Vancomycin has been the wonder drug of choice for several years, is it unusual that we are now seeing organisms become resistant to it? In the past, an individual would come down with symptoms of the common cold. They would go to their family Physician, and they would get a shot of Penicillin. They would feel better in just a few days. Later, they would go, and instead of a shot, they would get a prescription for Amoxicillin, take the medication for a few days, and then feel better. But instead of completing the entire bottle of medication, they would save it to use later. Perhaps another family member would be ill, and they would take it for a few days, etc...

What was actually happening, is that the majority of the bacteria would be killed out, the patient would feel better and stop the medication. However, there still lurked a few surviving bacteria. Over time, the bacteria "adapted" and became resistant to the antibiotic. Penicillin was no longer the wonder drug that it once was, and new medications had to be developed to kill off the bacteria that had "adapted". It's a continuous cycle. New medications are developed, and bacteria become resistant. Then along came Vancomycin and oh what a wonderful antibiotic this was. It could knock out just about anything. MRSA was the "big one" that health care providers were afraid of. The patients were isolated and anyone caring for that patient had to gown and glove just to enter the room to care for them. But now, health care providers are calling the "big one" VRE, or Vancomycin Resistant Enterococcus.

VRE is an Enterococcal Infection that is resistant to Vancomycin. Hence, the name. Enterococci are bacteria that normally inhabit the bowel. They are hardy, thrive in a wide variety of conditions, and are resistant to many antibiotics. Urinary tract infections are the most frequently occurring of the enterococci infections. This is due primarily to the close proximity of the rectum to the female urethra. Elderly patients who require a catheter and also have bowel incontinence are also at risk. Enterococci can also inhabit wounds causing wound infections and can enter the blood stream and cause sepsis. Enterococci that are resistant to Vancomycin treatment are growing and researchers are working diligently to determine the best method of treating this infection. How the infection is transmitted is not clear but it is felt that it is spread between patients on the hands of health care providers or on medical devices that are used between patients. Risk factors for the development of VRE include prior treatment with multiple antibiotics, open abdominal surgery, prolonged hospitalization, and tube feedings.

Now that you know what VRE is, what can you do to protect yourself from this new Superbug..
*First and foremost, stay healthy. VRE infection is most dangerous to those who have weakened immune systems such as the very young, the elderly, individuals with chronic disease processes, and those with compromised immune systems such as cancer patients and patients with HIV.

*Avoid hospitals unless you are the patient and need to be there. VRE can live on surfaces and objects for an extended period of time. This includes hospital bed side rails, equipment such as thermometers, door knobs, etc. So, don't utilize the ER as a physicians office for minor illnesses or for problems that can wait until you can get an appointment. Utilize an urgent care center when able. But if you truly have an emergency, then by all means, utilize the ER. If you are visiting someone in the hospital then make sure to wash your hands with soap and warm water for a minimum of 15 seconds, cleaning in between the fingers and under the nails.

Count it out, 15 seconds is longer than it sounds when you are washing your hands. If you are a patient in the hospital, make sure that your health care provider uses an antibacterial hand sanitizer or soap and water before providing your care. It's "OK" to remind them. Most hospital rooms have hand sanitizer mounted on the wall in patient rooms.

*If you don't need an antibiotic, then don't take one. Many individuals run to their physician's office with a cough or congestion and automatically expect their physician to prescribe an antibiotic. If you do not have a BACTERIAL infection, then you do not need an antibiotic. A viral illness cannot be cured with an antibiotic. Most common "colds" are viral infections. Again, you do not need an antibiotic for a viral infection. If you have an underlying respiratory disease such as COPD or are immunocompromised, your physician may prescribe an antibiotic for you if you have symptoms of congestion or the common cold to prevent an acute exacerbation of your disease process. But, if your physician does not think you need an antibiotic, then don't pressure him/her and don't get mad at him/her.

They are acting in your best interest, whether you believe it or not. If your symptoms do not improve in 5-7 days, then call your physician for further recommendations. The only way to know if you have a bacterial infection is by having a complete blood count done, or a culture done. Respect the fact that your physician knows more about medication than you do, even if you have done a lot of research on it. In an era of bacteria that are becoming resistant to antibiotics, why would you want to take one if it was not truly needed. If you are healthy, your body is equipped to handle most minor infections on its own. When you have a fever, your body is fighting to kill off unwanted invaders.

*If you are prescribed an antibiotic, take it exactly as you have been instructed by your physician and pharmacist. If it is ordered every 8 hours, take it every 8 hours, give or take 1 hour either way. If you feel better after a few days, don't stop taking the medication. Continue to take it as prescribed until you have completed the full course of the antibiotic.

While we are so very fortunate to live in a world where new drugs have eased so much suffering and have increased longevity, we must be aware that medications must be used appropriately. More medication is not always the best answer. Learn to live a healthy life, eat well, exercise, and rest. Then, when problems arise, leave them to your physician or health care provider. And realize that we all have some things that we just "have to learn to deal with". A pill for this and a pill for that is not always the best answer.

This article is not intended to frighten you or cause undue worry. It is just to inform you that there are things that you need to be aware of and to know how to protect yourself. The guidelines presented above can go a very long way to protect you from a wide array of infectious processes. Hand washing has long been proven to be the number one way to prevent the spread of infection.

As always, this article is not meant to be used as a diagnostic tool and does not substitute for any information or recommendations that you receive from your physician or health care provider.