Outline the causes, consequences and management of Vancomycin Resistant Enterococcus in the critically ill patient.

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College Answer

Causes:

1)  previous treatment with anti-microbials (especially vancomycin, cephalosporins, and broad-spectrum antibiotics),
2)  increased length of stay, renal insufficiency,
3)  enteral tube feeding,
4)  prevalence ofVRE colonised patients in the unit, and
5)  residents of long-term care facilities.

Consequences:

1)   potential transmission of resistance to Staph aureus
2)  are determined by the presence of infection (UTI, bloodstream includfug endocarditis, and rarely respiratory infection),
3)  or just colonisation (main consequence being requirement for isolation and associated factors

Management

Involves specific antibiotics if infected rather than colonised (depend on sensitivities: regimens may include one or more of ampicillin, tetracyclines, teicoplanin, quinolones, and quinupristin-dalfopristin),  infection control related to the patient (isolation [avoiding direct contact], aggressive infection control, limiting broad spectrum antibiotics if possible, surveillance of patient until clear).

Discussion

VRE is a much-beloved organism of the college examiners.

This question closely resembles Question 2 from the second paper of 2012.