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Unit Code 84406:
Vancomycin-Resistant Enterococcus (VRE) Detection by Rapid PCR

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Useful For

Identifying VRE carriers

Clinical Information

Over the past decade, vancomycin-resistant enterococci (VRE)

have emerged as  major nosocomial pathogens. Patients who

are particularly vulnerable to fatal disease from VRE include

those with hematologic malignancies or liver transplants. A

recent report from a large United States multicenter study showed

that 37% of enterococcal isolates responsible for 398 episodes

of enterococcal bacteremia showed resistance to vancomycin.

In the same study, vancomycin resistance was an independent

predictor of death from enterococcal bacteremia and when

effective antimicrobial therapy was provided sooner, the outcome

was significantly better. Nosocomial spread of VRE occurs as

the result of fecal carriage. Risks for both colonization and

infections include prolonged hospitalization, intensive care,

transplantation, hematologic malignancies, and prolonged

exposure to antibiotics, including vancomycin.

 

The Centers for Disease Control and Prevention (CDC) provides

recommendations to prevent the spread of VRE in institutional

settings. These recommendations include isolation of patients

experiencing active VRE infection, screening of patients by

perianal swab or fecal surveillance cultures to identify carriers

of VRE, and subsequent isolation or cohorting of VRE carriers.

Identification and isolation of VRE carriers decreases morbidity

and mortality associated with VRE infection and is cost-effective.(1)

 

In Enterococcus faecalis or Enterococcus faecium, vancomycin resistance

is conferred by the vanA or vanB genes. The presence of these genes

can be detected by molecular (DNA) methods.

Reference Values

Negative (reported as positive or negative)

Interpretation

Positive test results indicate the presence of either the vanA

or vanB gene, which confers vancomycin resistance in

Enterococcus faecalis and Enterococcus faecium. Patients with

a positive screen for VRE should be placed in isolation or cohorted

with other VRE carriers according to the institution's infection control

practices.

Cautions

A positive result does not imply the presence of VRE disease;

the presence of vanA or vanB genes correlates with 

colonization by VRE. Clinical correlation is required to

determine VRE disease.

Clinical Reference

1. Muto CA, Jernigan JA, Ostrowsky BE, et al:  SHEA Guideline for

    preventing nosocomial transmission of multidrug-resistant strains

    of Staphylococcus aureus and enterococcus. Infect Control Hosp

    Epidemiol 2003;24(5):362-386

    

2. Vergis EN, Hayden MK, Chow JW, et al: Determinants of vancomycin

    resistance and mortality rates in enterococcal bacteremia: a

    prospective multicenter study. Ann Intern Med 2001;135:484-492

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