Recently, a combination of vancomycin and third-generation cephalosporins has been shown to be successful. Other alternatives include clindamycin, macrolides, and quinolones. In cases of pneumonia or bacteremia, high doses of penicillin, up to 16 million units per day, may be effective against the strains with intermediate resistance. Group D streptococcus or enterococcus are inherently resistant to many antibiotics and vancomycin has been one of the few drugs effective in treating these infections. Enterococcal infections are usually associated with nosocomial infections in intensive care units and oncology units.
Transmission is thought to be via stools.
Often a drain catheter can be a source of contamination. Dr. Harrington stressed that it is crucial that clinicians use vancomycin judiciously. For prophylaxis in surgery, it should only be used in cases where the patient is allergic to penicillin. Treatment of VRE is a difficult problem. Even so, the success rate is very poor.