MRSA and CDIFF= VRE???

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Specializes in ER (new), Respitory/Med Surg floor.

A new nurse told me she heard that if a pt has MRSA and CDIFF it creates VRE. Is this true? I'm trying to find info online and can't find a connection that 2 would equal the other. I don't know if MRSA has to be present in one area with cdiff to qualify but I've never heard it and have had pts with Cdiff and MRSA sharing rooms with similar pts but if one has MRSA and then the other has MRSA and CDIFF and if that means that one has VRE then they shouldn't be together. Right? Can anyone direct me to any books or online sites that might confirm this? Thanks!

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Specializes in ER (new), Respitory/Med Surg floor.

Thanks I was looking at that and nice information but I don't see that in there! She confirmed it with another nurse on a surgical floor. I'll ask infection control at work but I like to see the info myself.

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Specializes in cardiac/critical care/ informatics.

I have never heard of that. they are separate 'bugs'. IT is not like yellow and blue make green.

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I have never heard of that. they are separate 'bugs'. IT is not like yellow and blue make green.

Exactly. They are three entirely separate microbes.

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Thanks I was looking at that and nice information but I don't see that in there! She confirmed it with another nurse on a surgical floor. I'll ask infection control at work but I like to see the info myself.

Your co-workers are misinformed. They are different organisms and you won't find the info documented because it is not possible. Also, good for you for not believing everything that you are told. I am a firm believer in researching the topic myself or speakng to an expert. Do you think they were pulling your leg or did they actually believe what they told you?

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There is a relationship/commonality between these infectious diseases which may be the source of the confusion: Vancomycin.

Vancomycin used to be the only drug which could handle most MRSA strains; And in general it became over prescribed to the point that many facilities were forced to develop institutional review processes to make sure Vancomycin was most appropriate for any given case. The concern was that high vanco use results in increasing vanco resistance.

So the treatment for MRSA was Vanco. And the treatment for C-diff is stopping antibiotics and then starting Flagyl ....or Vanco.

High Vanco use promotes increased resistance and there is a direct relationship to VRE as suggested by the name.

Going full circle a major concern with VRE (besides that it can be life threatening in certain populations) is that in folks with VRE and MRSA a gene swapping can occur resulting in a vancomycin resistant staph aureas. That's significant because in general staph is regarded as relatively stronger/more serious than enterococcus.

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Specializes in ICU-CVICU.

while the terminology used to describe this is false, the development of a vre infection makes sense if you're being treated with mega antibiotics to first treat a mrsa infection which then causes c.diff which then allows a vre because of treatment for c.diff. i wouldn't discount the nurse's information outright.

here is some more information.

standard therapy consists of (1) discontinuation of the inciting antibiotic, (2) avoidance of such antimotility agents as loperamide hydrochloride and diphenoxylate hydrochloride with atropine sulfate, and (3) oral administration of metronidazole (flagyl) or vancomycin for 10 to 14 days (table 1). metronidazole is first-line therapy for reasons of cost as well as concern about antibiotic resistance. the cost differential between similar courses of metronidazole and oral vancomycin can be several hundred dollars. both metronidazole and oral vancomycin have high in vivo activity against c difficile. however, development of vancomycin-resistant enterococcus faecium infection is a concern (10). for patients with severe c difficile colitis, oral vancomycin or intravenous metronidazole is used.

http://www.postgradmed.com/issues/2002/11_02/joyce3.htm

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Specializes in Geriatrics.
I have never heard of that. they are separate 'bugs'. IT is not like yellow and blue make green.

I totally agree!

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Specializes in ICU-CVICU.

rstewart,

I did not see you reply before I posted mine. Thank you for the explanation.

May

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Specializes in ER (new), Respitory/Med Surg floor.
While the terminology used to describe this is false, the development of a VRE infection makes sense if you're being treated with mega antibiotics to first treat a MRSA infection which then causes C.Diff which then allows a VRE because of treatment for C.diff. I wouldn't discount the nurse's information outright.

http://www.postgradmed.com/issues/2002/11_02/joyce3.htm

Thanks so much! So then should'nt they test for VRE if you have mrsa then cdiff especially if it's severe and on vanco??? I'm going to talk to infection control too. I allways like to find out why something is myself or if I didn't know something research it. Thanks for all the replies. I thought they were seperate things but sounded maybe could lead to one another but I had no info to go on.

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