Vancomycin-resistant enterococci (VRE)
Prevention and control of VRE is an important patient safety issue for Australian healthcare.
VRE in Australia
The occurrence of VRE in Australia is monitored by the Antimicrobial Use and Resistance in Australia (AURA) Surveillance System through the Australian Group on Antimicrobial Resistance (AGAR) and Australian Passive AMR Surveillance (APAS). The first APAS report found that vancomycin non-susceptible Enterococcus faecium strains are now very common across Australia.
AGAR Sepsis Outcome Program reports show that overall rates of vancomycin resistance in Enterococcus faecium are declining nationally. However, Australia has one of the highest rates of resistance to vancomycin in E. faecium compared with almost all European countries.
Australian Guidelines for the Prevention and Control of Infection in Health Care: Core strategies
The Australian Guidelines for the Prevention and Control of Infection in Healthcare 2019 (AICGs) outline strategies for identification and management of VRE in healthcare settings. The guidelines indicate that, where a patient is known to be either colonised or infected with a multidrug-resistant organism (MRO) including VRE, contact precautions should be used in addition to standard precautions.
The AICGs recommend two approaches for the prevention and control of MROs:
- Core strategies, for prevention and control in any situation where MRO infection or colonisation is suspected or identified
- Organism-based or resistance mechanism-based approaches if incidence or prevalence of MROs is not decreasing after implementation of the core strategies
Successful control of VRE is based on a combination of core strategies in infection control. These strategies include continued adherence to hand hygiene, appropriate use of personal protective equipment (PPE) and implementation of specific contact-based precautions, for example, increased environmental cleaning. See below for further information on core strategies for VRE prevention and control.
The AICGs acknowledge the current lack of consensus regarding the most appropriate way to screen for MROs including VRE. For development of screening protocols for VRE, the AICGs suggest consideration of the following factors:
- Local prevalence of VRE
- The reason for admission of the patient
- The risk status of the unit to which they are admitted
- The likelihood that the patient is carrying VRE.
The following state and territory health department websites also include information about VRE prevention and control: