Focus on VRE
There are two types of vancomycin resistance in enterococci. The first type is intrinsic resistance (mostly vanC type but also vanD, vanE, vanF etc) found in E. gallinarum and E. casseliflavus/E. flavescens and demonstrates a low-level resistance to vancomycin. The second type of vancomycin resistance in enterococci is acquired resistance (vanA & vanB types), mostly seen in E. faecium and E. faecalis.
Therefore, to avoid the spread of this resistance to more virulent pathogens (S.aureus, for instance) it is crucial to promptly detect the presence of any of these two species in the patient, and accurately differentiate them from other Enterococci.
VRE Epidemiologic Issues
Vancomycin-resistant Enterococcus (VRE) infections are especially aggressive and have been associated with mortaliity rates approaching 60% to 70%.
“Knowledge of the type of resistance is critical for infection control purposes. vanA and vanB genes are transferable and can spread from organism to organism. In contrast, vanC genes are not transferable, have been associated less commonly with serious infections, and have not been associated with outbreaks” – from CDC guidelines