Med-Surg: Chapter 21: Vancomycin-Resistant Enterococci

Question 1

Where does Enterococci normally live?

Answer 1

• gastrointestinal tract
• female genital tract
• soil, water, and food

Question 2

Enterococci is Facultatively anaerobic

Answer 2

organisms that use aerobic metabolism if oxygen is present but can switch to anaerobic metabolism if oxygen is absent

Question 3

Risk Factors for Vancomycin-resistant Enterococci (VRE)

Answer 3

• prolonged hospitalizations
• weakened immune system
• prolonged antibiotic exposure (to vancomycin and cephalosporins)
• invasive procedures/medical devices
• comorbid conditions

Question 4

Where do VRE infections mostly occur?

Answer 4

• in hospitals

- patients who are critically ill in the ICU

Question 5

Pathophysiology of VRE

Answer 5

hardy organisms

• can remain viable on environmental surfaces for 7 days to 2 months
• patient can remain colonized with VRE ranging from 7 weeks to 3 years
• less virulent than MRSA, but can cause many therapeutic problems b/c of resistance to many antibiotics

Question 6

How is VRE spread?

Answer 6

• direct patient-to-patient contact

- indirectly on the hands of healthcare personnel or on unclean patient care equipment

Question 7

Clinical Manifestations of VRE

Answer 7

enterococci cause
-UTIs
-Peritonitis (intra-abdominal and pelvic wound infections)
-Bacteremias
>manifestations vary depending on site of infection

Question 8

Classic Signs of UTI

Answer 8

• back pain
• pain on urination
• sensation of needing to urinate
• fever

Question 9

Signs of Wound Infections

Answer 9

• red
• hot
• purulent drainage

Question 10

Signs of Bacteremia

Answer 10

signs of sepsis

• tachycardia
• hypotension
• fever

Question 11

Complications of VRE

Answer 11

• resistance to antimicrobial agents
• prolonged hospital stays
• prolonged antimicrobial therapy
• higher mortality rates
• increased cost of hospitalization
• endocarditis

Question 12

Medications used to treat VRE

Answer 12

Quinupristin- dalfopristin (Synercid)

Question 13

Medication to treat VRE: Quinupristin-dalfopristin (Synercid)

Answer 13

antimicrobial

• given IV
• can be caustic to veins; peripherally inserted central catheter (PICC) is recommended if long-term use required
• dosages adjusted with liver insufficiency or cirrhosis
• may cause joint pain, mild diarrhea, nausea, vomiting, and muscle pain