Health protection – guidance

Enterococcus species and glycopeptide-resistant enterococci (GRE)

The characteristics, diagnosis, management, surveillance and epidemiology Enterococcus species and Glycopeptide Resistant Enterococci (GRE).

Enterococci bacteria are frequently found in the bowel of normal healthy individuals. There are many different species of enterococci, but only a few have the potential to cause infections in humans. They can cause a range of illnesses including urinary tract infections, bacteraemia (blood stream infections) and wound infections.

Glycopeptide-resistant Enterococci (GRE) are enterococci that are resistant to glycopeptide antibiotics (vancomycin and teicoplanin). GRE are sometimes also referred to as VRE (Vancomycin-Resistant Enterococci).

The 2 most common species of GRE are E. faecalis and E. faecium. In rare instances, infections may also be caused by other GRE such as Enterococcus casseliflavus or Enterococcus gallinarum.

Infections caused by GRE mainly occur in hospital patients, particularly those who:

  • are immuno-compromised
  • have had previous treatment with certain other antibiotics (particularly cephalosporins and glycopeptides)
  • are on a prolonged hospital stay
  • are in specialist units such as intensive care or renal units

However, GRE are sometimes found in the faeces of people who have never been in hospital or have not recently been given antibiotics.

Diagnosis

Antimicrobial resistance and healthcare associated infections (AMRHAI) reference unit.

Clinical management

Public Health England (PHE) monitors the spread of antibiotic resistant infections and advises healthcare professionals about controlling antimicrobial resistance. See information on the management of healthcare associated infections (HCAI).

Specific guidance on the management of GRE is provided by the Hospital Infection Society.

Epidemiology

Voluntary surveillance

PHE collects data on a range of organisms, including bacteria detected in blood samples through the voluntary surveillance scheme. Data is mainly collected using electronic reporting to SGSS. Records of bacteria received by this system may include:

  • patient details such as age and sex
  • details of detection methods used
  • some antibiotic susceptibility results

Voluntary surveillance of Enterococcus spp. causing bacteraemia in England, Wales and Northern Ireland: 2014

Enterococcus faecalis bacteraemia voluntary reports and vancomycin susceptibility in England from 1990 to 2005

Mandatory surveillance

The Department of Health advised that from 1 April 2013, glycopeptide-resistant enterococci (GRE) bacteraemias is no longer the subject of mandatory surveillance. Trusts are still encouraged to report these data voluntarily.

See the last annual results of the mandatory GRE bacteraemia enhanced surveillance scheme.