Vancomycin-Resistant Enterococcus: Symptoms & Treatment

Instructor: Alexandra Unfried

Alexandra earned her master's degree in nursing education and is currently a hospital supervisor/administrator.

Vancomycin resistant enterococcus is a bacteria that is resistant to the medication known as vancomycin. The bacteria can infect different parts of the body and be difficult to treat. This lesson will discuss symptoms and treatment of vancomycin resistant enterococcus.


Sarah is a seventy-year-old woman who had knee surgery several weeks ago. She had to stay in the hospital for several days to recover and received antibiotics to prevent an infection of her surgical sight. However, she is now back at the hospital because the incision in her knee has not healed well and is red and tender to touch. The doctor tells Sarah that her incision looks infected and that the nurse will get a culture of the wound to determine the best treatment.

What is Vancomycin Resistant Enterococcus?

Vancomycin resistant enterococcus (VRE) is a bacteria that is resistant to many different types of antibiotics. The enterococcus bacteria become especially resistant to vancomycin, a common antibiotic used to treat infections. Enterococci bacteria are present in the body already, but when they become resistant to treatments, they can cause severe infections. VRE is more common in those who are weak and sick, and more likely to occur in the hospital setting.

Vancomycin resistant enterococcus bacteria
Vancomycin resistant enterococcus bacteria

Sarah's wound culture is positive for VRE. That means that the enterococci bacteria in her body have become resistant to several antibiotics including vancomycin, and have caused an infection. The infection is most likely from her recent knee surgery and that is why it is showing symptoms of an infection.

Symptoms of Vancomycin Resistant Enterococcus

Symptoms of VRE are not the same for every person. Since it is a bacterial infection, it will affect the area of the body that is infected. Examples of sites of infection and symptoms include:

  • VRE in the blood can cause sepsis which is a severe infection that can result in organ damage, loss of limb, or death if not treated. Symptoms consist of decreased blood pressure, fever, and a fast heart rate.
  • VRE can occur as a urinary tract infection. Symptoms will be painful urination, back pain, fever, and urinary frequency.
  • Meningitis with VRE is not common, but show symptoms of fever, a stiff neck, confusion, and a headache.
  • Endocarditis is an infection of a heart valve and occurs more often in those with an artificial or damaged valve. Symptoms are fatigue, weight loss, dry cough, mild fever, body aches, and night sweats. This can lead to sepsis or a leak or failure of the heart valve.
  • Wounds infected with VRE will appear red, tender to touch, swollen, warm, and may have drainage or pus.
  • VRE related to pneumonia can cause difficulty breathing, fever, and coughing.

These infections are diagnosed by testing samples of body fluid such as blood, urine, phlegm, spinal fluid, wounds, and other various secretions.

Sarah is diagnosed with VRE by having a wound culture done. The nurse rubs a swab over her incision site. The culture is now being tested to determine what type of antibiotic will be effective in treating her infection.

Treatment of Vancomycin Resistant Enterococcus

Antibiotics must be used to treat VRE since it is a bacterial infection. Results from the body fluid and secretion samples help identify which antibiotics are resistant to the bacteria and which antibiotics will be effective in treating the infection. Often times a combination of antibiotics will be best to treat the VRE contamination. Medication works best when given intravenously (IV) or through the vein in the bloodstream. Once initial treatment is started, a pill can be just as effective to finish the course of treatment. Therefore, treatment can start in the hospital and then be completed at home as long as the infection is showing signs of improvement.

Intravenous medication to treat VRE
Intravenous medication to treat VRE

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