Should Vancomycin-Resistant Enterococci in Stool Be Treated?
Both VRE and vancomycin-sensitive enterococci are considered normal flora in the human intestine.
Advances in environmental sanitation, immunizations, antimicrobial therapy, and medical research have greatly reduced the impact of infectious diseases (IDs) on our communities. Nonetheless, infections and the cost of treating them remain a burden to the health care system.
In primary care practice, we may spend more time making referrals for suspected ID than actually treating infected patients. Here, as a brush up, is the eighth in our series of 10 practical ID pearls.
8. Should vancomycin-resistant enterococci (VRE) in the stool be treated?
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Answer: It is not necessary to treat when vancomycin-resistant enterococci (VRE) is found in stool.
Both VRE and vancomycin-sensitive enterococci (VSE) are considered normal flora in the human intestine. The presence of enterococci in the stool is not responsible for diarrhea, regardless of whether it is VRE or VSE. Exposing VSE to glycopeptides such as vancomycin is the main risk factor for converting VSE to VRE-the process known as selective pressure.1VRE usually resolves within several weeks after the selective pressure of vancomycin is removed.
1. Kolar M, Vagnerova I, Urbanek K. The impact of antibiotic selective pressure on vancomycin-resistant enterococci occurrence. Biologia. 2001;56:31-35. (Full text)
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