Enterococci are bacteria (germs) that are normally present in the human

intestines and in the female genital tract, and are often found in the environment,
like in soil and water. These bacteria can cause infections.

See CDC’s report

Antibiotic Resistance Threats in the United States, 2019
Enterococci bacteria are constantly finding new ways to avoid the effects of the
antibiotics used to treat the infections they cause. Antibiotic resistance occurs
when the germs no longer respond to the antibiotics designed to kill them. If
these germs develop resistance to vancomycin, an antibiotic that is used to treat
some drug-resistant infections, they become vancomycin-resistant enterococci
(VRE).

How common are these infections?

In 2017, VRE caused an estimated 54,500 infections among hospitalized patients
and 5,400 estimated deaths in the United States [Source: 2019 AR Threats
Report].

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Who is at risk?
Those most likely to be infected include:

 people who have been previously treated with antibiotics, including

vancomycin, for long periods of time
 people who are hospitalized, have undergone surgical procedures, or have
medical devices inserted in their bodies (such as catheters)
 people with weakened immune systems, such as patients in intensive care
units, or in cancer or transplant wards
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How is it spread?
VRE can spread from one person to another through contact with contaminated
surfaces or equipment or through person to person spread, often via
contaminated hands. It is not spread through the air by coughing or sneezing.

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How can you avoid getting an infection?
If you or someone in your household has VRE, you can protect yourself by:

 keeping your hands clean to avoid getting sick and spreading germs that
can cause infections
o patients and their caregivers should wash their hands with soap and
water or use alcohol-based hand sanitizer, particularly:
 after using the bathroom
 before and after handling medical devices or caring for
wounds
 before preparing food
 frequently cleaning areas of the home, such as bathrooms, that may
become contaminated with VRE
 wearing gloves if hands may come in contact with body fluids that may
contain VRE, such as stool (poop) or bandages from infected wounds
o Always wash your hands after removing gloves.
 informing healthcare providers if you or someone you care for has VRE so
that appropriate precautions can be taken to prevent spread
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How are these infections treated?
When VRE infections do develop, they are generally treated with antibiotics other
than vancomycin. In order to identify the best antibiotic to treat a specific
infection, healthcare providers will send a specimen (often called a culture) to the
laboratory and test any bacteria that grow against a set of antibiotics to
determine which are active against the germ. The provider will then select an
antibiotic based on the activity of the antibiotic and other factors like potential
side effects or interactions with other drugs.

Some people will carry VRE on their body without it causing symptoms, which is
called being colonized. People who are colonized do not require antibiotics.

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What is CDC doing to address VRE infections?
CDC tracks VRE infections using data from several sources, including the National
Healthcare Safety Network Patient Safety Component. This surveillance system
collects reports of VRE from device-associated infections, such as central-line
associated bloodstream infections.

CDC works with healthcare facilities and state and local health departments to
control outbreaks of resistant germs like VRE and to help devise and implement
prevention strategies for facilities with high numbers of VRE infections.