CDC's Hospital Infection Control Practices Advisory Committee (HICPAC) has published "Recommendations for Preventing the Spread of Vancomycin Resistance." The recommendations focus on vancomycin-resistant enterococci (VRE).

The reported incidence of infection and colonization with VRE in U.S. hospitals has increased rapidly in the last 5 years. This increase has compounded the need for antimicrobial drugs to treat VRE infections. Most VRE are also resistant to multiple other drugs (e.g., aminoglycoside and ampicillin), which have been used for treating VRE infections. In addition, the possibility that the vancomycin-resistance genes present in VRE may be transferred to other gram-positive microorganisms, especially Staphylococcus aureus, is a serious public health concern.

Although the epidemiology of VRE has not been fully elucidated, and most enterococcal infections have been attributed to the patient's endogenous flora, recent studies have demonstrated that enterococci, including VRE, can be spread directly from patient to patient or indirectly by transient carriage on the hands of personnel or contaminated environmental surfaces and patient-care equipment.

In its recommendations, HICPAC stresses that the prevention and control of vancomycin resistance will require a coordinated, concerted effort from various departments of a hospital. Because the recommendations were developed with limited data and further research is needed to find cost-effective ways to control the spread of vancomycin resistance, HICPAC strongly encourages hospitals to develop their own institution-specific plans, which should stress the following elements: 1) prudent vancomycin use by clinicians, 2) education of hospital staff regarding vancomycin resistance, 3) early detection and prompt reporting of vancomycin resistance in enterococci and other gram-positive microorganisms by the hospital microbiology laboratory, and 4) immediate implementation of appropriate infection-control measures to prevent person-to-person transmission of VRE.

The recommendations were developed by HICPAC's Subcommittee on the Prevention and Control of Antimicrobial-Resistant Microorganisms in Hospitals and subject-matter experts and representatives of the American Hospital Association, American Society for Microbiology, Association for Professionals in Infection Control and Epidemiology, Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, and Surgical Infection Society. The recommendations were published in February in Infection Control and Hospital Epidemiology 1995;16:105-13 and will also be published in the April 1995 issue of the American Journal for Infection Control.

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