Vancomycin-resistant enterococcal infections in Korea

Abstract

Enterococci recently became the second-to-third most commonly isolated organism from nosocomial infections. Enterococci are intrinsically more resistant to many antimicrobial agents and often show acquired resistance to many antimicrobial agents including high-level aminoglycosides. With the increased use of vancomycin, vancomycin-resistant enterococci (VRE) has become an important nosocomial pathogen. In Korea, the proportion of VRE among all enterococcal isolates in most tertiary care hospitals has remained around 1% or less, but the rate of carriage of VRE is no longer low in some settings and recent observations of a sudden increase of VRE isolation in several hospitals in Korea suggests that VRE infection may become a serious problem in the near future. The most important considerations are that vancomycin-resistant genes may spread to other highly virulent genera, such as MRSA, and that there are no approved and convincingly effective antibiotics for the treatment of VRE. Therefore, current efforts have concentrated on limiting the spread of these organisms within the hospital environment. Prudent use of antimicrobial agents and strict adherence to preventive measures such as aggressive communication, education, and infection control practices are essential to control the spread of this organism. However, hospital infection control protocols and the laboratory support they require are costly in terms of space and supplies, as well as in personnel resources. These factors add further pressure to already stretched hospital budgets. Nevertheless, policies or programs defining and managing VRE infection or colonization should be established and now is the time to enforce an overall management strategy against VRE.