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Enterococcus Print E-mail
by Ron Kennedy, M.D., Santa Rosa, CA

Dr. Kennedy Enterococci are bacteria normally found in the feces of people and many animals. There are two types of enterococci - Enterococcus faecalis and Enterococcus faecium - occasionally cause human disease, most commonly wound infections and urinary tract infections. Other infections, including those of the blood stream (bacteremia), heart valves (endocarditis) and the brain (meningitis) can occur in severely ill patients in hospitals. Enterococci also often colonize open wounds and skin ulcers.

Enterococci are among the most common antibiotic-resistant bacteria. The first vancomycin-resistant enterococcus (VRE) was found in 1986. Since that time, VRE has become a growing problem. Bacteria resistant to vancomycin are commonly also resistant to a similar antibiotic called teicoplanin, and vice versa.

Enterococcus is not dangerous in healthy people with strong immune systems where the balance of healthy flora in their digestive tract helps keep VRE from getting out of control. VRE is dangerous because it cannot be controlled with antibiotics, and it causes life-threatening infections in people with compromised immune systems: the very young, very old, and very ill. It is especially dangerous because it can easily transmit the resistance genes to other, more dangerous bacteria, such as staph and strep.

Although VRE generally doesn't affect healthy people, anyone who comes in contact with the bacteria can become a carrier. If you become a chronic carrier of VRE you can become infected when you are older or in declining health. Also, it is easy to infect people you are in contact with who are vulnerable. Estimates are that around 4% of the population in Europe are be carriers of VRE. VRE first appeared in the U.S. on the East Coast and has since spread to the West Coast. It is likely that carrier rates in those areas will catch up to the European carrier rates.

The most likely place to pick up VRE is in hospitals. VRE has been cultured from hospital equipment, doorknobs, and bedrails. It has also been cultured on the hands of hospital personnel. Anyone who frequents hospitals should be considered at risk for carrying VRE. People who work in hospitals, even administrative personnel, are at much higher risk for being exposed and becoming a carrier.

Careful hygiene is the best way to avoid becoming a carrier. VRE is highly adherent and has been found on hospital personnel's hands after five seconds of hand washing. It is recommended that you wash your hands for twenty seconds with an antibacterial soap every time before you eat. (Note that this means right before you eat. If you are eat in a restaurant and handle the menu, you can pick up VRE. The most likely place to pick up VRE is the door handle of the rest room. Consider using the towel you dried your hands with when you open the door. Avoid hospitals, as this is the only documented source of VRE in the U.S. If you do go to a hospital to visit someone, maintain fastidious hygiene throughout your visit. Avoid eating while at the hospital, and especially avoid eating hospital food. When possible, avoid taking antibiotics and thus avoid becoming a breeding ground for an antibiotic-resistant infection.



The information in this article is not meant to be medical advice.�Treatment for a medical condition should come at the recommendation of your personal physician.

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