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Broad Street Solutions
James Marx, RN, MS, CIC Editor
P.O. Box 16557
San Diego, CA 92176
(619)563-0274 Voice/FAX
jmarx@concentric.net
Due to the increasing demands for newsletter subscriptions, a fee for this newsletter will begin in January 1998. This fee will only apply to subscribers who are not currently clients of Broad Street Solutions. The annual subscription fee of $24.00 will begin with January 1998 issue. Participants of the Infection Control School for Long Term Care Nurses can receive the first year's subsciption for half the annual fee if they subscribe during the class. A subscription form will be available beginning in October 1997.
Enterococcus is a bacteria that normally lives in the intestines and female genital tract, this is called colonization. With advances in medical technology over the past twenty years, infection with this bacteria has become more common. An infection with enterococcus is ususally treated with ampicillin (an enhanced penicillin). With the widespread use of antibiotics, including cephalosporins, enterococcus has become resistant to the antibiotics usually used to treat it. This resistance includes vancomycin, the drug of choice used to treat Staphylococcus aureus infection resistant to "enhanced penicillins," or also known as Methicillin Resisant Staphylococcus aureus (MRSA).
Because bacteria commonly share genetic material, the fear is that enterococcus with tranfer it's vancomycin resistant gene to Staphylococcus aureus, thus creating another potential pathogen resistant to antibiotics.
In response to this perceived threat, the Centers for Disease Control and Prevention (CDC), published an guideline in September 1995. This guideline includes isolation protocols for patients infected and colonized with VRE. These guidelines have been questioned by many infection control professionals, largely because of the lack of well controlled scientific studies on VRE. The guidelines are also not practically applied in the long term care setting.
Several State Departments of Health have published guidelines for control and prevention of antibiotic resistant bacteria: California, New York and North Carolina. They contain practical information and for treating residents in long term care facilities with VRE. These guidlines are available directly from the respective Department of Health or through our website.
The cornerstone to preventing antibiotic resistant bacteria is control of antibiotic use. Antibiotic review should be part of the facility's infection control or pharmacy committee. Purdent of antibiotics use in the most effective way to prevent antibiotic resistance.