Vancomycin-resistant enterococci (VRE): transmission and control

Transmission of vancomycin-resistant enterococci (VRE) can occur through direct contact with colonised or infected patients or through indirect contact via the hands of health-care workers (HCWs), or via contaminated patient care equipment or environmental surfaces. Antibiotic exposure plays an important role in the transmission dynamic of VRE. Until now, the control measures aimed at reducing the incidence of VRE colonisation and infection in hospitals have included: education of HCWs with implementation of hand-washing practices and compliance; wide and targeted surveillance cultures; isolation of VRE-positive patients; pre-emptive isolation of high-risk patients; and restriction of antibiotic use. However, despite these, VRE is still endemic in many hospitals. The causes of this could be non-compliance with infection control interventions, overuse of antibiotics, and insensitive microbiological methods for detecting VRE in stool. A scoring system using point values has been demonstrated to be useful in reducing rates of nosocomial VRE colonisation. Future prospective comparative studies of infection control approaches in different epidemiological situations might be useful.