Vancomycin-resistant Enterococcus (VRE) is a mutation of a very common bacterium that spreads easily from person to person by direct contact. Health care facilities in more than 40 states have reported VRE, with rates as high as 14% in oncology units of large teaching facilities.

Patients most at risk for VRE include immunosuppressed patients and those with severe underlying disease. Patients who are VRE colonized pretransplant have been found to develop bacteremia and prolonged neutropenia and have a high risk of death when undergoing allogeneic blood and marrow transplant. Patients with a history of taking vancomycin, third-generation cephalosporins, or antibiotics targeted at anaerobic bacteria (such as Clostridium difficile) are at risk. Patients with wounds with an opening to the pelvic or intra-abdominal area, including surgical wounds, burns, and pressure ulcers, are at risk. Patients with enterococcal bacteremia, which is commonly associated with endocarditis, are at risk as well as those exposed to contaminated equipment or to a VRE-positive patient. Elderly patients, especially those with prolonged or repeated facility admissions, and individuals with malignancies or chronic renal failure are also at risk. Patients with indwelling urinary or central venous catheters and those undergoing cardiothoracic or intra-abdominal surgery or organ transplants are susceptible.