title: Vancomycin resistant enterococci healthcare associated infections.
abstract: BACKGROUND
  Vancomycin-resistant enterococci (VRE) are among the most common healthcare associated multidrug-resistant organisms. Purpose of the article was to review recent data regarding the epidemiology, clinical issues and infection control of this organisms.
  
  
  METHODS
  A PubMed-MEDLINE search was carried out.
  
  
  RESULTS
  The European Antimicrobial Resistance Surveillance System (EARSS) highlights a large variability between the various european countries, with VRE ranging from <2% (Finland, Holland) to >20% (Ireland, Greece, Portugal). Italy shows a low rate level (4.2%). In USA according to the National Healthcare Safety Network (NHSN) in 2006-2007 overall 33% of enterococci were resistant to vancomycin, whereas in Canada VRE prevalence showed to be much lower <10%. Although with some methodological limits, several studies showed that infections caused by VRE are more serious and associated to a higher mortality rate and economic burden compared to those caused by vancomycin susceptible enterococci (VSE). The average increased associated mortality was over two-fold. Resistance to newer antimicrobial agents as daptomycin and linezolid has been described, complicating treatment options for infections caused by these organisms.
  
  
  CONCLUSIONS
  Control measures aimed at reducing the incidence of VRE colonization and infection in healthcare settings should include: hand washing with an antiseptic or a waterless antiseptic agent, routine screening for vancomycin resistance among clinical isolates, rectal surveillance cultures, contact isolation for patients with VRE and antimicrobial stewardship.
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
authors.forename: G B
authors.initials: GB
authors.lastname: Orsi
authors.forename: V
authors.initials: V
authors.lastname: Ciorba
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002170:Canada / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control*; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification*; D005062:European Union / Q000706:statistics & numerical data; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control*; D006235:Hand Disinfection; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014640:Vancomycin / Q000494:pharmacology; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin