NEW ORLEANS-Vancomycin-resistant enterococci have spread across the nation and crossed the border into Canada.
“It’s all over the place,” said CDC’s Dr. William Jarvis. At the Interscience Conference on Antimicrobial Agents and Chemotherapy here, 48 vancomycin-resistance studies were presented.
So far Staphylococcus aureus hasn’t acquired vanA or vanB genes, but it seems inevitable. Some coagulase-negative staph have become resistant. “It’s inching up,” says Dr. Jarvis.
Though vancomycin is given IV, some seeps into the gut, giving vancomycin-resistant enterococci a chance to develop. Seven microbial genes are involved in enterococci’s resistance to vancomycin, and the genes can be transferred from one type of bacteria to another in a plasmid, says Dr. David Pegues of Mass General.
In an Emory VRE outbreak, 13 severely neutropenic patients became infected and seven were bacteremic until death, says Dr. John Jernigan. Emory decreased use of vancomycin as prophylaxis for oncology and hematology patients last year.
Control efforts should target VRE carriers as well as infected patients, says New York Medical College’s Dr. Marisa Montecalvo. In carriers’ stools, she’s found significantly more resistant than susceptible enterococci.
At Chicago’s Cook County Hospital, 11 of 43 patients colonized with VRE on admission to the MICU had not been hospitalized in the prior two months, says Dr. Marc Bonten. In the Netherlands VRE has been detected in 5% of healthy people, he adds.
VRE can be carried for years and be picked up from hard surfaces on which it survives. Since VRE was detected in Canada last year, it’s been cultured from bed rails, bathroom areas, and even patients’ call bells, says Dr. Lee Lior of Health Canada. -Elsie Rosner
NEW ORLEANS-Vancomycin-resistant enterococci have spread across the nation and crossed the border into Canada.
