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Year : 2015  |  Volume : 33  |  Issue : 5  |  Page : 166--167

Vancomycin-resistant enterococcus (VRE) vs Methicillin-resistant Staphylococcus Aureus (MRSA)

KS Ashwin, NP Muralidharan 
 Department of Microbiology, Saveetha Dental College, Chennai, Tamil Nadu, India

Correspondence Address:
K S Ashwin
Department of Microbiology, Saveetha Dental College, Chennai, Tamil Nadu

How to cite this article:
Ashwin K S, Muralidharan N P. Vancomycin-resistant enterococcus (VRE) vs Methicillin-resistant Staphylococcus Aureus (MRSA).Indian J Med Microbiol 2015;33:166-167

How to cite this URL:
Ashwin K S, Muralidharan N P. Vancomycin-resistant enterococcus (VRE) vs Methicillin-resistant Staphylococcus Aureus (MRSA). Indian J Med Microbiol [serial online] 2015 [cited 2020 Apr 5 ];33:166-167
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Dear Editor,

Antimicrobial resistance is a major concern in a clinical set-up. Newer pathogens are emerging day by day which pose a major threat in treating hospitalised patients. This correspondence highlights the bacteria which so far considered as a commensal has reached the status of highly virulent pathogen. The vancomycin-resistant enterococcus (VRE) is attaining virulence as Methicillin-resistant Staphylococcus aureus (MRSA). The incidence is more compared to MRSA. The key message is to highlight the importance of VRE strains that is increasingly seen in wound infections. Enterococcus was normally ignored by many clinicians in clinical samples as it is normal flora. But now it stands individually in most of the recurrent infections and interferes with the healing of wound. The source is always noted to be the faecal flora.

The recent studies show that VRE is emerging as a major threat in postoperative sepsis, which delays the process of wound healing. It is of utmost concern because it is a part of the normal flora in our body and in most sepsis, its occurrence is from an endogenous source only. This is evident in cases which show recurrence of sepsis with the bacterial strains with almost same sensitivity patterns. A comparison of the incidence rates of VRE and MRSA were analysed based on four categories from previous studies and the results were attained. Based on percentage of resistant strains isolated in the study by National Nosocomial Infections Surveillance (NNIS) System, USA, VRE-resistant Enterococi among intensive care unit (ICU) patients, 1995-2004, the percent of S. aureus infections caused by methicillin-resistant strains increased from approximately 40-60% and similarly when we compare the VRE percentage rates, it also showed an increase from approximately 24.9-28.5% which is quiet significant when compared individually. [1] Based on number of bacteremias in a study by Ontario Medical Association, MRSA and VRE Bacteremias in Ontario, 1992-2004, Canada, the MRSA and VRE incidence rates based on number of bacteremias between the years 2003-2004 were analysed. It revealed a slight increase in the number of MRSA bacteremias, whereas the VRE bacteremia incidents increased many folds compared to MRSA. [2] Similarly based on rate of infection incidences in a study by Dr. Elizabeth Bryce et al., Vancover Coastal Health Infection Control Annual Report 2010-2011, the 2009 National Canadian Nosocomial Infection Surveillance Program (CNISP) rate for MRSA is 5.89 per 10,000 inpatient days, whereas the 2009 national CNISP rate for VRE is 5.44 per 10,000 inpatient days [3] and finally according to the Blood Stream Infection (BSI) incidence rates by hospital category in the study by California Department of Public Health Technical Report, from overall among 361 reporting hospitals, reporting at least 10 months of data, there were 908 MRSA and 788 VRE BSIs during 16,207,201 patient days. The pooled mean incidence rate of MRSA BSIs and VRE BSIs per 10,000 patient days was 0.6 and 0.5, respectively. [4] The cumulative data from the various studies analysed are tabulated in [Table 1].{Table 1}

From the analysis of various reports, we see that in most of the cases reported earlier, the MRSA incident were higher and was considered seriously whereas the VRE incidences were neglected. But in the recent reports and reviews, we find out that the VRE incidents have risen up at alarming rates and are almost equal to the MRSA incidence rates. If this rate is continued we will finally have no antibiotics at all to protect us at all. Preventive measures like washing the hands, dressing of wound, etc., if followed properly the incidence of MRSA and VRE rates can definitely be reduced.

So the probable sustainable solution is to stop uncontrolled and unwarranted use of antibiotics and use antibiotics with justification!!


1Erika D′Agata, Modelling Outbreaks of Antibiotic Resistance in Hospitals [Power Point slides]. Available from: [Last accessed on 2014 Jun 30].
2Data from Quality Management Program - Laboratory Services (QMP-LS) [Graph]. Available from: [Last accessed on 2014 Jun 30].
3Elizabeth Bryce, Patrick O′Connor, Linda Dempster, Dermot Kelly , Claire O′Quinn , Dr. Kellé Payne, et al. Vancover Coastal Health Infection Control Annual Report 2010-2011. Available from: 4California Department of Public Health. Technical Report: Healthcare-Associated MRSA and VRE Bloodstream Infections in California Hospitals, April 2010 through March 2011.