Vancomycin-resistant enterococci (VRE) are gaining much attention in the West, chiefly because of the lack of available antimicrobial therapy for VRE infections, as most VRE are also resistant to drugs previously used to treat such infections (e.g. aminoglycosides and ampicillin), the possibility that the vancomycin-resistance genes present in VRE can be transferred to methicillin-resistant Staphylococcus aureus (MRSA), and increasing reports of VRE with a trend towards endemicity in North America.
There are three case reports and one study showing stool carriage rates of more than 10% from Singapore. One of the case reports is notable because the VRE isolated from the urinary tract was community-acquired. In Europe, there is a strong association between the use of avoparcin (a glycopeptide) in animal feed and the emergence of VRE. Clonal dissemination resulting in nosocomial transmission has also been demonstrated. Prior vancomycin use is a risk factor for the subsequent development of VRE bacteraemia.
The laboratory plays an important role in: (a) the detection of VRE; and (b) the determination of antimicrobial susceptibilities, whereby possible therapeutic options may be instituted when antimicrobial intervention is indicated. There is a need to evaluate existing infection control measures against VRE to prevent it from becoming endemic in Singapore, as had happened in North America.
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The author(s) declare there are no affiliations with or involvement in any organisation or entity with any financial interest in the subject matter or materials discussed in this manuscript.
