Vancomycin-resistant enterococci (VRE) and ESBL and multi-resistant bacteria Please rate this page (bottom of page)

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Vancomycin is an antibioticand enterococci are common intestinal bacteria. These do not normally cause disease. After using antibiotics, especially cephalosporins against infections, enterococci can become resistant, so that the treatment no longer works. Vancomycin is an effective antibiotic for many life-threatening infections, but some enterococci have become resistant. Vancomycin-resistant enterococci are called VRE.

People with impaired immune system, such as during immunosuppression antirheumatic drugs can be seriously ill by VRE.


All persons who have been admitted to health institutions / hospitals outside the Nordic countries in the last 12 months are examined for vancomycin-resistant enterococci. In addition, the following is relevant:



  • Microbiological laboratory and attending physician report proven vancomycin resistant enterococci to MSIS at the National Institute of Public Health
  • The doctor also reports to the patient's local authority
  • More information here (NIPH)


  • Insulation
  • Infection control routines are carried out
  • Information is provided when transferring to another ward or hospital
  • More information here (NIPH)


ESBL and multiresistant bacteria


The definition of multi-resistant bacteria varies. Methicillin-resistant yellow staphylococci (MRSA), vancomycin resistant enterococci (VRE), multiresistant tubercle bacteria (MDRTB) and gram-negative rod bacteria that form broad-spectrum beta lactamases (ESBL / MBL) are the most common. Infections with these bacteria cannot be treated with standard antibiotics. The problem then is that the infections can spread to the individual and also pose a significant infection problem.

  • People with weakened immune systems are particularly at risk. This applies to other people with immunosuppressive rheumatic medication for rheumatic disease


ESBL ("Extended Spectrum Beta-Lactamase") has been found in

  • Klebsiella species
  • E. coli bacteria
  • Gramnegative bowel bacteria that can produce ESBL
  • Different salmonella herb
  • Proteus mirabilis
  • Other Enterobacteriaceae
  • Pseudomonas aeruginosa.

Bacteria that produce ESBL have a significantly higher incidence in some countries, especially in southern Europe (Italy, Greece), Africa and Asia.


The bacteria are transmitted from person to person, usually through hands (contact contagion) or through poorly cleaned equipment and common contact points.


Healthy persons (health professionals) are most often without signs of illness (asymptomatic), while infections can develop as a result of reduced immune defenses, such as immunosuppressive anti-rheumatic treatment or severe other illness.


One takes bacterial samples from wounds or surfaces where bacteria are suspected. Microbiological laboratory conducts resistance determination detects bacteria by culturing or gene-technical methods (PCR).


Prevention is very important. Good hand hygiene and use of alcohol-based disinfectants is necessary. Clean wounds with disinfectant. Food is cooked, fruit is peeled. Infections must be treated based on the results of the resistance studies. The Norwegian Institute of Public Health (in Norway) recommends the following (as per 2016): Before or during hospitalization, it is recommended to take samples for ESBL-containing bacteria of all who:

  • Has been hospitalized outside the Nordic region in the last year
  • The last year has been hospitalized in Norway or another Nordic country where there was an outbreak of ESBL-containing bacteria (during the current stay).
  • Have lived together with a person who has detected ESBL-containing bacteria the last year
  • Previously, ESBL-containing bacteria have been detected
  • For all hospital admissions in wards that, according to local assessment, are characterized as wards with particularly susceptible patients and / or a high risk of spread, (eg burns ward, intensive care unit, haematological ward, neonatal intensive care unit and the like)

Antibiotics: There are currently only a few groups of beta-lactam antibiotics (the group carbapenems and combination preparations with beta-lactam and betelectamase inhibitor, for example piperacillin-tazobactam), to which ESBL-producing bacteria are sensitive.

Measures in case of individual cases or outbreaks

  • Infected persons should be isolated against contact infection in single rooms with their own toilet
  • No special measures or restrictions are recommended for healthcare professionals who are ESBL-resistant carriers
  • In the event of an outbreak in a health institution, a local working group should be set up to investigate the outbreak and evaluate infection prevention measures. These measures may include: training of staff, patients and relatives, infection detection, isolation of contacts and screening of selected patient groups (but not of staff).

Requirements to report infection

Infectious carriers and infections with microbes with special resistance patterns are reportable disease group A to MSIS. Notification criteria are the detection of

  • Enterobacteriaceae with reduced sensitivity to meropenem and proven ESBLKARBA January
  • Pseudomonas aeruginosa with reduced sensitivity to meropenem and proven ESBLKARBA genes.
  • Acinetobacter spp. With reduced sensitivity to meropenem and proven ESBLKARBA January
  • Enterobacteriaceae, P. aeruginosa, Acinetobacter spp. Isolates with reduced susceptibility to meropenem combined with other phenotypic findings compatible with carbapenemase production, but negative for known ESBLsKARBA genes should be biochemically investigated for carbapenemase production. The finding must be reported to MSIS (Norway) if carbapenemase production is verified in a validated biochemical assay.

Notification to the municipal council, the Norwegian Institute of Public Health and other instances of outbreak or transmission of infected patient between health institutions


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