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Vancomycin-resistant enterococci - hospital

Super-bugs; VRE; Gastroenteritis - VRE; Colitis - VRE; Hospital acquired infection - VRE

Enterococcus is a germ (bacteria). It normally lives in the intestines and in the female genital tract.

Most of the time, it does not cause problems. But enterococcus can cause an infection if it gets into the urinary tract, bloodstream, or skin wounds or other sterile sites.

Vancomycin is an antibiotic that is often used to treat these infections. Antibiotics are medicines that are used to kill bacteria.

Enterococcus germs can become resistant to vancomycin and therefore are not killed. These resistant bacteria are called vancomycin-resistant enterococci (VRE). VRE can be hard to treat because there are fewer antibiotics that can fight the bacteria. Most VRE infections occur in hospitals.

Who is Most at Risk for VRE?

VRE infections are more common in people who:

  • Are in the hospital and they are taking antibiotics for a long time
  • Are older
  • Have long-term illnesses or weak immune systems
  • Have been treated before with vancomycin, or other antibiotics for a long time
  • Have been in intensive care units (ICUs)
  • Have been in cancer or transplant units
  • Have had major surgery
  • Have catheters to drain urine or intravenous (IV) catheters that stay in for a long time

Preventing the Spread of VRE in the Hospital

VRE can get onto the hands by touching a person who has VRE or by touching a surface that is contaminated with VRE. The bacteria then spread from one person to another by touch.

The best way to prevent the spread of VRE is for everyone to keep their hands clean.

  • Hospital staff and health care providers must wash their hands with soap and water or use an alcohol-based hand sanitizer before and after caring for every patient.
  • Patients should wash their hands if they move around the room or the hospital.
  • Visitors also need to take steps to prevent spreading germs.

Urinary catheters or IV tubing are changed on a regular basis to minimize the risk of VRE infections.

Patients infected with VRE may be placed in a single room or be in a semi-private room with another patient with VRE. This prevents the spread of germs among hospital staff, other patients, and visitors. Staff and providers may need to:

  • Use proper garments, such as gowns and gloves when entering an infected patient's room
  • Wear a mask when there is a chance of splashing bodily fluids

Treating VRE Infections

Often, other antibiotics besides vancomycin can be used to treat most VRE infections. Lab tests will tell which antibiotics will kill the germ.

Patients with the enterococcus germ who do not have symptoms of an infection do not need treatment.


Miller WR, Arias CA, Murray BE. Enterococcus species, Streptococcus gallolyticus group, and leuconostoc species. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 200.

Savard P, Perl TM. Enterococcal infections. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 275.

  • Bacteria

    Bacteria - illustration

    Bacterial infections can lead to the formation of pus, or to the spread of the bacteria in the blood.



    • Bacteria

      Bacteria - illustration

      Bacterial infections can lead to the formation of pus, or to the spread of the bacteria in the blood.




    Review Date: 3/10/2022

    Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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