Deterrence/Prevention

See the list below:

A unified effort by all physicians is necessary to slow increasing morbidity and mortality rates associated with vancomycin-resistant Enterococcus (VRE). The Hospital Infection Control Advisory Committee has published the following policies to limit the spread of VRE:
- Routine screening for vancomycin resistance among clinical isolates
- Contact isolation of colonized or infected persons (ie, gown, gloves, hand washing)
- Restriction of instruments used in patient care to an infected or colonized patient's room only (including electronic thermometers with probe sheaths)
- Thorough decontamination of environmental surfaces
- Vancomycin not recommended for routine surgical prophylaxis, primary treatment of antibiotic-associated colitis, prophylaxis of low birth weight infants, and dialysis prophylaxis
- Active surveillance for VRE in ICU
An epidemiologic surveillance study performed in a large neonatal ICU (NICU) over 3 years has shown that combining routine contact precautions, active screening cultures, and rep-polymerase chain reaction (PCR) aids in the detection and reduction of the clonal spread of VRE. An electronic thermometer was identified as a source in one of the clonal outbreaks. This is also supported by applying a mathematical model using simulators, which suggests that VRE colonization in a 10-bed ICU can be reduced by more than 60% by isolating patients upon admission until the surveillance cultures obtained at admission are negative for VRE.
Standard and contact precautions are indicated in children with VRE infection or colonization. These precautions should continue until the patient is no longer receiving antibiotics and culture results from multiple body sites and indwelling urinary catheter or colostomy sites, if present, are negative on at least 3 separate occasions (>1 wk apart).
Refer to Endocarditis, Bacterial for further details and recommendations issued by the American Heart Association (AHA) for prevention of bacterial endocarditis.
Oral bacitracin had been shown to eradicate enterococci from stool better than vancomycin. However, recurrences have been noted after about 1-3 weeks after completion of treatment.
In a large study of 5939 ICU patients, oropharyngeal or digestive decontamination resulted in a reduction in mortality of 3% at 4 weeks of hospitalization compared with standard care.^[19]

van Vliet MJ, Tissing WJ, Dun CA, et al. Chemotherapy treatment in pediatric patients with acute myeloid leukemia receiving antimicrobial prophylaxis leads to a relative increase of colonization with potentially pathogenic bacteria in the gut. Clin Infect Dis. 2009 Jul 15. 49(2):262-70. [QxMD MEDLINE Link]. [Full Text].
CDC. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004 Dec. 32(8):470-85. [QxMD MEDLINE Link]. [Full Text].
Kawecki D, Chmura A, Pacholczyk M, et al. Bacteria isolated from bile samples of liver recipients in the early period after transplantation: epidemiology and susceptibility of the bacterial strains. Transplant Proc. 2007 Nov. 39(9):2807-11. [QxMD MEDLINE Link].
Carmona F, Prado SI, Silva MF, Gaspar GG, Bellissimo-Rodrigues F, Martinez R, et al. Vancomycin-resistant enterococcus outbreak in a pediatric intensive care unit: report of successful interventions for control and prevention. Braz J Med Biol Res. 2012 Feb. 45(2):158-62. [QxMD MEDLINE Link].
Biedenbach DJ, Moet GJ, Jones RN. Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997-2002). Diagn Microbiol Infect Dis. 2004 Sep. 50(1):59-69. [QxMD MEDLINE Link]. [Full Text].
Humphreys H, Dolan V, Sexton T, et al. Implications of colonization of vancomycin-resistant enterococci (VRE) in renal dialysis patients. Learning to live with it?. J Hosp Infect. 2004 Sep. 58(1):28-33. [QxMD MEDLINE Link]. [Full Text].
Drees M, Snydman DR, Schmid CH, et al. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis. 2008 Mar 1. 46(5):678-85. [QxMD MEDLINE Link].
Papadimitriou-Olivgeris M, Drougka E, Fligou F, Kolonitsiou F, Liakopoulos A, Dodou V, et al. Risk factors for enterococcal infection and colonization by vancomycin-resistant enterococci in critically ill patients. Infection. 2014 Dec. 42(6):1013-22. [QxMD MEDLINE Link].
Bitsori M, Maraki S, Raissaki M, Bakantaki A, Galanakis E. Community-acquired enterococcal urinary tract infections. Pediatr Nephrol. 2005 Nov. 20(11):1583-6. [QxMD MEDLINE Link]. [Full Text].
Sava IG, Heikens E, Kropec A, Theilacker C, Willems R, Huebner J. Enterococcal surface protein contributes to persistence in the host but is not a target of opsonic and protective antibodies in Enterococcus faecium infection. J Med Microbiol. 2010 Sep. 59:1001-4. [QxMD MEDLINE Link].
Christie C, Hammond J, Reising S, Evans-Patterson J. Clinical and molecular epidemiology of enterococcal bacteremia in a pediatric teaching hospital. J Pediatr. 1994 Sep. 125(3):392-9. [QxMD MEDLINE Link].
Matar MJ, Safdar A, Rolston KV. Relationship of colonization with vancomycin-resistant enterococci and risk of systemic infection in patients with cancer. Clin Infect Dis. 2006 May 15. 42(10):1506-7. [QxMD MEDLINE Link]. [Full Text].
Bonadio WA. Group D streptococcal bacteremia in children. A review of 72 cases in 12 years. Clin Pediatr (Phila). 1993 Jan. 32(1):20-4. [QxMD MEDLINE Link].
Tebruegge M, Pantazidou A, Clifford V, Gonis G, Ritz N, Connell T, et al. The age-related risk of co-existing meningitis in children with urinary tract infection. PLoS One. 2011. 6(11):e26576. [QxMD MEDLINE Link]. [Full Text].
Lubell TR, Schnadower D, Freedman SB, Macias CG, Agrawal D, Kuppermann N, et al. Comparison of Febrile Infants With Enterococcal and Gram-negative Urinary Tract Infections. Pediatr Infect Dis J. 2016 Sep. 35 (9):943-8. [QxMD MEDLINE Link].
[Guideline] Solomkin JS, Mazuski JE, Baron EJ, et al. Guidelines for the Selection of Anti-infective Agents for Complicated Intra-abdominal Infections. Clinical Infectious Diseases. 2003. 37:997-1005. [QxMD MEDLINE Link]. [Full Text].
Mave V, Garcia-Diaz J, Islam T, Hasbun R. Vancomycin-resistant enterococcal bacteraemia: is daptomycin as effective as linezolid?. J Antimicrob Chemother. 2009 Jul. 64(1):175-80. [QxMD MEDLINE Link].
Santos BA, Oliveira JS, Cardoso NT, Barbosa AV, Superti SV, Teixeira LM, et al. Major globally disseminated clonal complexes of antimicrobial resistant enterococci associated with infections in cancer patients in Brazil. Infect Genet Evol. 2017 Sep 1. 55:56-62. [QxMD MEDLINE Link].
de Smet AM, Kluytmans JA, Cooper BS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med. 2009 Jan 1. 360(1):20-31. [QxMD MEDLINE Link].
Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals. Circulation. 2005 Jun 14. 111(23):e394-434. [QxMD MEDLINE Link]. [Full Text].
Bell EA. Quinupristin/dalfopristin: An interesting new antibiotics period. Infect Dis Child. 2000. 13(3):53.
DiazGranados CA, Jernigan JA. Impact of vancomycin resistance on mortality among patients with neutropenia and enterococcal bloodstream infection. J Infect Dis. 2005. 191:588-595. [QxMD MEDLINE Link]. [Full Text].
Furuno JP, Perencevich EN, Johnson JA, et al. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci co-colonization. Emerg Infect Dis. 2005 Oct. 11(10):1539-44. [QxMD MEDLINE Link].
Graham PL, Ampofo K, Saiman L. Linezolid treatment of vancomycin-resistant enterococcus faecium ventriculitis. Pediatr Infect Dis J. 2002. 21:798. [QxMD MEDLINE Link].
Green M. Vancomycin resistant enterococci: impact and management in pediatrics. Adv Pediatr Infect Dis. 1997. 13:257-77. [QxMD MEDLINE Link].
Hardie JM, Whiley RA. Classification and overview of the genera Streptococcus and Enterococcus. Soc Appl Bacteriol Symp Ser. 1997. 26:1S-11S. [QxMD MEDLINE Link].
Hospital Infection Control Practices Advisory Committee. Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol. 1995 Feb. 16(2):105-13. [QxMD MEDLINE Link].
Kawecki D, Chmura A, Pacholczyk M, et al. Surgical site infections in liver recipients in the early posttransplantation period: etiological agents and susceptibility profiles. Transplant Proc. 2007 Nov. 39(9):2800-6. [QxMD MEDLINE Link].
Med Lett Drugs Ther. Linezolid (Zyvox). Med Lett Drugs Ther. 2000 May 29. 42(1079):45-6. [QxMD MEDLINE Link].
Morrison D, Woodford N, Cookson B. Enterococci as emerging pathogens of humans. Soc Appl Bacteriol Symp Ser. 1997. 26:89S-99S. [QxMD MEDLINE Link].
Murray BE. Vancomycin-resistant enterococcal infections. N Engl J Med. 2000 Mar 9. 342(10):710-21. [QxMD MEDLINE Link].
Murray BE, Weinstock GM. Enterococci: new aspects of an old organism. Proc Assoc Am Physicians. 1999 Jul-Aug. 111(4):328-34. [QxMD MEDLINE Link].
O'Donovan CA, Fan-Havard P, Tecson-Tumang FT, Smith SM, Eng RH. Enteric eradication of vancomycin-resistant Enterococcus faecium with oral bacitracin. Diagn Microbiol Infect Dis. 1994 Feb. 18(2):105-9. [QxMD MEDLINE Link].
Perencevich EN, Fisman DN, Lipsitch M, et al. Projected benefits of active surveillance for vancomycin-resistant enterococci in intensive care units. Clin Infect Dis. 2004 Apr 15. 38(8):1108-15. [QxMD MEDLINE Link]. [Full Text].
Singh N, Léger MM, Campbell J, Short B, Campos JM. Control of vancomycin-resistant enterococci in the neonatal intensive care unit. Infect Control Hosp Epidemiol. 2005 Jul. 26(7):646-9. [QxMD MEDLINE Link]. [Full Text].
Suara RO, Dermody TS. Enterococcal meningitis in an infant complicating congenital cutis aplasia. Pediatric Infectious Disease Journal. 2000. 19:668. [QxMD MEDLINE Link].

Media Gallery

This photomicrograph reveals cocci-shaped Enterococcus species bacteria taken from a patient with pneumonia.

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Author

Meera Varman, MD Associate Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University Medical Center

Meera Varman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Healthcare Epidemiology of America

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Pfizer, Sanofi<br/>Received research grant from: Merck; MedImmune; Regenron; Pfizer;Novartis; Sanof; GSK<br/>Received honoraria from phamaceutical companies for speaking and teaching; Received grant/research funds from phamaceutical companies for clinical trials research.

Coauthor(s)

Archana Chatterjee, MD, PhD Professor and Chair, Department of Pediatrics, Senior Associate Dean for Faculty Development, Sanford School of Medicine, The University of South Dakota

Archana Chatterjee, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, International Society for Infectious Diseases, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Walid Abuhammour, MD, MBA, CIC, FAAP, FIDSA Professor of Pediatrics, Michigan State University College of Human Medicine; Adjunct Professor, Department of Pediatrics, Hashemite University, Jordan; Head of Pediatric Infectious Diseases, Department of Pediatrics, Al Jalila Children's Hospital, UAE

Walid Abuhammour, MD, MBA, CIC, FAAP, FIDSA is a member of the following medical societies: American Academy of Pediatrics, International Society for Infectious Diseases, International Society for Infectious Diseases, Jordan Medical Association, Jordan Pediatric Society, Michigan Infectious Disease Society, Michigan State Medical Society, National Arab American Medical Association, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD, FACP Editor-in-Chief, ID Cases; Moderator, Program for Monitoring Emerging Diseases; Adjunct Professor of Medicine, State University of New York Downstate College of Medicine

Larry I Lutwick, MD, FACP is a member of the following medical societies: American Association for the Advancement of Science, American Association for the Study of Liver Diseases, American College of Physicians, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, Infectious Diseases Society of New York, International Society for Infectious Diseases, New York Academy of Sciences, Veterans Affairs Society of Practitioners in Infectious Diseases

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

José Rafael Romero, MD Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center

José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Warren C Johnson III, MD, to the development and writing of this article.

Sections Pediatric Enterococcal Infection
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