 | Dr. Aruna Subramanian answers some frequently asked questions about infectious diseases. In this issue, she addresses "VRE" and "MRSA." |
What are VRE and MRSA?
The bacteria known as "entrococcus" and "staphylococcus aureus" are natural in our bodies. Enterococcus is generally found among the bacteria that live in our gastro-intestinal tract and our stools. Staphylococcus aureus is found in the bacteria on our skin, typically inside our noses.
Each of these bacteria can be worrisome when they become resistant to antibiotics. Entrococcus transforms into "vancomycin resistant enterococcus (VRE)" only when it becomes resistant to the antibiotic known as vancomycin (but it can also become resistant to other antibiotics). Likewise, staphylococcus aureus transforms into "methicillin resistant staphylococcus aureus (MRSA)" when it becomes resistant to the form of penicillin known as "methicillin" (but it, too, can become resistant to other forms of penicillin).
You should also be aware that there is a difference between "health-care-associated" MRSA and "community-associated" MRSA. This column discusses "health-care-associated" MRSA.
If you would like to learn more about "community-associated" MRSA, please visit the Department of Health and Human Services Centers for Disease Control and Prevention website at: http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html or contact them for more information at telephone number: 800-CDC-INFO.
What is the difference between VRE and MRSA colonization and infection?
VRE and MRSA can colonize (live on) peoples hands or objects in a hospital room. These resistant bacteria can be easily transferred from person to person unless precautions are taken. When someone is carrying (colonized with) VRE or MRSA, that person will not feel sick or show any symptoms of being sick. The Hopkins team can identify whether a person is carrying colonized VRE or MRSA by conducting one of the many regular tests that we do for our in-patient transplant recipients.
In addition to carrying VRE and MRSA as a colonized form of the bacteria, patients can also become infected by VRE and MRSA. Infection means that the VRE or MRSA has gotten into the bloodstream, or other part of the body where it should not be. Patients will recognize that they have an infection by the traditional signs and symptoms: fever, high white blood cell count, sometimes low blood pressure, or pain that is local to the site of the infection. If the patient is in the hospital at the time, the team will already be conducting regular testing to screen for VRE and MRSA and will know quickly so that they can treat the patient promptly.
What are the concerns about VRE and MRSA infection?
Not every entrococcus develops into the VRE form of bacteria and not all staphylococcus aureus develops into the MRSA form of bacteria. Many different factors are involved, including the patient’s use of antibiotics and the state of his or her general health, particularly if the patient is on immunosuppression medication. Some patients have a higher risk of developing VRE infection, but the bottom line is that it can affect all patients because of its ability to be transmitted from patient to patient. Your medical team is always concerned about the spread of VRE and MRSA because these bacteria are resistant to many forms of antibiotics. When the team treats for VRE or MRSA, many of the antibiotics that have to be used are accompanied by uncomfortable side effects. Furthermore, health professionals are always concerned that VRE and MRSA may become resistant to even more antibiotics. In the long-term, this can diminish the variety of antibiotics that may be used to treat this infection.
What are the concerns about VRE and MRSA colonization for transplant patients?
Transplant patients who carry colonized VRE or MRSA are able to leave the hospital because their health is not compromised by the colonized bacteria. However, the team does monitor the patient so that: (1) VRE or MRSA does not spread to other patients; and (2) we can identify if it develops into an infection and treat it promptly. When patients’ health is otherwise stable and they leave the hospital, their bodies can naturally rid themselves of the colonized VRE or MRSA over time. The transplant team does, however, want to make sure that this cleansing process happens. Once a patient has been identified as having colonized VRE or MRSA, the transplant team has the patient undergo screening for signs of colonized VRE or MRSA at later times. When the team sees that patient is clear, the team will note that in the patients’ record and remove any special in-hospital precautions for that patient.
What are the concerns about VRE and MRSA colonization for family members or visitors?
Usually family members and visitors are in healthy condition and do not become infected by their contact with VRE or MRSA. Hopkins asks them to take precautions when they are in the hospital to prevent infection and transfer of the bacteria to other patients who are on immunosuppression. If they do carry VRE or MRSA, it is usually for a short time, and eventually their bodies will rid the resistant bacteria by themselves.
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Tammy and Robert Taylor photographed right before Robert’s discharge from the lung transplant floor. As a visitor, Tammy had had to wear the gown and gloves at earlier times as a precaution against VRE and MRSA. |
What are the precautions against VRE and MRSA?
When patients have resistant bacteria in their systems, VRE and MRSA can be transmitted from them to objects and items around them. When other people come to visit the patient, they can pick up the VRE or MRSA and carry it to other patients, or other objects in the hospital. Family members and visitors play an important role in halting the spread of VRE and MRSA by wearing gloves, gowns, and washing their hands. Precautions against developing resistant bacteria can include reducing inappropriate use of antibiotics.
