Vancomycin-resistant enterococci: 15 years and counting

• Published in: Journal of Hospital Infection Vol. 53; no. 3; pp. 159 - 171
• Main Authors: Chavers, L.S, Moser, S.A, Benjamin, W.H, Banks, S.E, Steinhauer, J.R, Smith, A.M, Johnson, C.N, Funkhouser, E, Chavers, L.P, Stamm, A.M, Waites, K.B
• Format: Book Review Journal Article
• Language: English
• Published: Kent Elsevier Ltd 01.03.2003; Elsevier
• Subjects: Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Carrier State - epidemiology; Carrier State - microbiology; Carrier State - prevention & control; Causality; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - prevention & control; Cross Infection - transmission; Disease Outbreaks - prevention & control; Disease Outbreaks - statistics & numerical data; Disease Reservoirs; DNA, Bacterial - analysis; DNA, Bacterial - genetics; Electrophoresis, Gel, Pulsed-Field; Enterococcus - classification; Enterococcus - genetics; Enterococcus - pathogenicity; Gram-Positive Bacterial Infections - epidemiology; Gram-Positive Bacterial Infections - microbiology; Gram-Positive Bacterial Infections - prevention & control; Gram-Positive Bacterial Infections - transmission; Humans; Incidence; Medical sciences; Pharmacology. Drug treatments; Phylogeny; Population Surveillance - methods; Serotyping; Vancomycin Resistance; vancomycin, antimicrobials, resistance, enterococci; vancomycin, antimicrobials, resistance, enterococci; Enterococcus; Nosocomial infection; Methodology; Peptides; Transmission; Reservoir; Review; Vancomycin; antimicrobials; Case history; Antimicrobial agent; Prevention; Resistance; Streptococcaceae; Antibiotic; Surveillance; Glycopeptide; Risk factor; Bacteria; Micrococcales; Hospital; Antibacterial agent; enterococci
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1053/jhin.2002.1375

We review the history of vancomycin-resistant enterococci (VRE) and propose a causal model illustrating the roles of exposure to VRE reservoirs, patient characteristics, antimicrobial exposure, and prevalence of VRE in the progression from potential VRE reservoirs to active disease in hospitalized patients. Differences in VRE colonization and VRE infection are discussed with respect to hospital surveillance methodology and implications for interventions. We further document clonal transmission of VRE in a large, urban, teaching hospital and demonstrate VRE susceptibility to a wide array of antimicrobial agents. This model can guide the identification of mutable factors that are focal points for intervention.