Vancomycin-resistant Enterococcus (VRE) Agent Information Sheet
Boston University
Research Occupational Health Program (ROHP)
617-358-7647
Agent
Enterococcus spp. is facultatively anaerobic, catalase-negative Gram-positive cocci bacterium that are arranged individually, in pairs, or short chains. Vancomycin-resistant Enterococci VRE are those enterococci that are resistant to the antibiotic vancomycin. E. faecalis is the most frequent species isolated from human intestine samples (80-90%), E. faecium accounts for 5-10% of isolates.
Disease/Infection
Enterococci can cause urinary tract, wound, and soft tissue infections. They are also associated with bacteremia which can lead to endocarditis in previously damaged cardiac valves.
Pathogenicity
Enterococci are opportunistic pathogens which affect elderly patients with underlying disease and other immunocompromised patients who have been hospitalized for long periods, treated with invasive devices, or received broad-spectrum Enterococci are common nosocomial pathogens, accounting for 10% of hospital- acquired infections in the USA.
No laboratory acquired cases have been reported; however, 78 cases with 4 deaths associated with Streptococcus spp. were reported before E. faecalis and E. faecium were placed in the Enterococcus genus.
Biosafety Information
Risk Group/BSL
Risk Group 2
Biosafety Level 2
Modes of Transmission
| Transmission | |
| Skin Exposure (Needlestick, bite, or scratch): | Yes |
| Mucous Membrane Splash to Eye(s), Nose or Mouth: | Yes |
| Inhalation: | No |
| Ingestion: | Yes |
Host Range/Reservoir
Host Range – Humans, pets and livestock
Reservoir – Gastrointestinal tract of humans and animals including mammals, birds, insects, and reptiles
Symptoms
Symptoms related to VRE are specific to the site of infection and are identical to vancomycin sensitive enterococcus infections. In general, urinary tract infections will present as dysuria, increased frequency of urinary, abdominal discomfort. Skin and soft tissues infections may occur. Systemic disease may present as fever, hypotension, malaise.
Incubation period
As VRE can be a colonizer, disease may not manifest until infection is caused during an opportunistic setting.
Viability
Susceptible to 70% isopropyl alcohol, 70% ethanol, 5.25% sodium hypochlorite, phenolic and quaternary ammonia compounds, and glutaraldehyde. Resistant to 3% hydrogen peroxide
Survival Outside Host
Enterococci can grow and survive in harsh environments, and can persist almost anywhere including soil, plants, water, and food. Enterococcus spp can survive 5 days to 4 months on dry inanimate surfaces.
Information for Lab Workers
Laboratory PPE
Lab coat, gloves and eye protection but not limited to when direct skin contact with infected materials or working with infected animals.
Containment
BSL-2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures. Procedures that are likely to generate aerosols should be conducted in a biosafety cabinet. Practices may be enhanced based on risk assessment.
In Case of Exposure/Disease
- For injuries in the lab which are major medical emergencies (heart attacks, seizures, etc…):
Medical Campus: call or have a coworker call the Control Center at 617-414–4144.
Charles River Campus: call or have a coworker call campus security at 617-353-2121.
You will be referred to or transported to the appropriate health care location by the emergency response - For lab exposures (needle sticks, bite, cut, scratch, splash, etc…) involving animals or infectious agents, or for unexplained symptoms or illness call the ROHP 24/7 hour number (1-617-358-ROHP (7647); or, 8-ROHP (7647) if calling from an on-campus location) to be connected with the BU Research Occupational Health Program (ROHP) medical ROHP will refer you to the appropriate health care location.
- Under any of these scenarios, always inform the physician of your work in the laboratory and the agent(s) that you work with.
- Provide the wallet-size agent ID card to the physician.
Vaccination
No vaccine available
Information for First Responders/Medical Personnel
Public Health Issues
Nosocomial and person-to-person transmission; can also be transmitted on food products. Contact precautions should be used. The goal of raising awareness of this agent as a laboratory hazard is to inform clinical personnel regarding possible exposure to agent and hence impacting the choice of empiric antibiotics, which are active against VRE.
Diagnosis/ Surveillance
Monitor for symptoms, diagnosis is via isolation of enterococci from culture of clinical specimens.
First Aid/Post Exposure Prophylaxis
Perform one of the following actions:
| Skin Exposure (Needlestick or scratch): | Immediately go to the sink and thoroughly wash the wound with soap and water for 15 minutes. Decontaminate any exposed skin surfaces with an antiseptic scrub solution. |
| Mucous Membrane Splash to Eye(s), Nose or Mouth: | Exposure should be irrigated vigorously. |
| Splash Affecting Garments: | Remove garments that may have become soiled or contaminated and place them in a double red plastic bag. |
Treatment
People with colonized VRE (bacteria are present, but have no symptoms of an infection) do not need treatment. Most VRE infections can be treated with antibiotics other than vancomycin. Laboratory testing of the VRE can determine antibiotics sensitivity.
References
Health Canada – http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/enterococcus-eng.php
CDC – http://www.cdc.gov/HAI/organisms/vre/vre.html#a1
Rev. 8/23/12