Vancomycin-resistant enterococci (VRE) infection or colonisation

Statutory notification

• Vancomycin-resistant enterococci (VRE) colonisation or infection is notifiable in Western Australia.
• Case definition: See notifiable disease case definitions (Word 1.29MB).
• Notification: Private and public laboratories that identify VRE cases are required to forward the isolate with patient details to the PathWest Laboratory Medicine WA Gram-positive Reference Laboratory located at Fiona Stanley Hospital.
• See also description of statutory medical notifications in Western Australia.

Public health summary

• Infectious agent: enterococci are part of the normal flora of the gastrointestinal tract and are inherently resistant to most antibiotics. Although not highly pathogenic, VRE can cause serious infection in immunocompromised patients. There are several different enterococci but those of importance in the context of vancomycin resistance are Enterococcus faecium and Enterococcus faecalis.
• Transmission: Person-to-person through direct contact with an infected or colonised person or the contaminated hands of a healthcare worker, or indirectly from contact with contaminated environmental surfaces or medical equipment. Enterococci are capable of prolonged survival on environmental surfaces for several months.
• Incubation period: Variable.
• Infectious period: As long as VRE is shed from the colonised or infected person.
• Case exclusion: Do not exclude. Healthcare facility patients colonised or infected with a VRE should be managed in a single room with dedicated bathroom facilities as per the Guidelines for the Screening and Management of Multi-resistant Organisms in Healthcare Facilities.
• Contact exclusion: Do not exclude.
• Treatment: Antibiotic treatment for clinical infections as recommended by the doctor.
• Immunisation: None available.
• Case follow-up: Is conducted by hospitals, and the Communicable Disease Control Directorate, as required.

Information and resources for health providers 

• Vancomycin-resistant enterococci – information for consumers (Healthy WA)
• Guidelines for the Screening and Management of Multi-resistant Organisms in Healthcare Facilities

Notifiable disease data and reports

VRE infection or colonisation is a notifiable condition via laboratory notification in WA. Private and public laboratories that identify VRE cases are required to forward the VRE isolate with patient details for molecular testing at the PathWest Laboratory Medicine WA Gram-positive Reference Laboratory located at Fiona Stanley Hospital. The PathWest Gram-positive Reference Laboratory works in collaboration with the Antimicrobial Resistance Infectious Diseases Research (AMR-ID) Laboratory at Murdoch University. VRE surveillance data are reported separately to other notifiable infectious disease data.