Vancomycin-resistant Enterococcus spp. (VRE)

Reportable by Providers and Laboratories

About this Reportable Disease

Infectious agent: Enterococcus spp., most frequently Enterococcus faecalis or Enterococcus faecium. These organisms are normally present in the human intestinal tract and the female genital tract and are often found in the environment. Some Enterococcus strains are resistant to vancomycin, leaving few treatment options available.

Description of illness: VRE can live in the human intestines and female genital tract without causing disease (often called colonization). Signs and symptoms vary based on which system is infected. Enterococcus can cause intraabdominal infections, urinary tract infections, bacteremia, endocarditis, or wound infections associated with catheters or surgical procedures. The following persons are at increased risk of becoming infected with VRE:

  • People who have been previously treated with the antibiotic vancomycin or other antibiotics for long periods of time.
  • People who are hospitalized, particularly when they receive antibiotic treatment for long periods of time.
  • People with weakened immune systems, such as patients in intensive care units, or in cancer or transplant wards.
  • People who have undergone surgical procedures such as abdominal or chest surgery.
  • People with medical devices that stay in for some time, such as urinary catheters or central intravenous (IV) catheters.
  • People who are colonized with VRE.

Interactive Disease Data


Laboratory Reporting for this Disease

Reporting requirements apply to all laboratories located within Tennessee, as well as laboratories outside of Tennessee that test residents of Tennessee, including laboratories located within healthcare facilities. Healthcare providers and laboratories in the same healthcare facility both have a duty to report. The type of organisms and analytes laboratories must report to TDH for 2026 are indicated, and there are several ways laboratories can report results to TDH.

Information about this Reportable Disease for Healthcare Providers

Clinical Summary

  • Definition: Vancomycin-resistant Enterococcus (VRE) refers to Enterococcus faecalis or Enterococcus faecium strains resistant to vancomycin.
  • Reservoir: Commonly colonizes the gastrointestinal tract; may be present without causing disease.
  • Colonization vs. Infection:
    • Colonization = asymptomatic carriage (no treatment indicated).
    • Infection = clinical illness requiring targeted antimicrobial therapy.
  • Transmission:
    • Primarily, contact spread via contaminated hands, surfaces, or medical equipment.
    • Most often healthcare-associated.
  • Clinical Manifestations:
    • Urinary tract infections
    • Bloodstream infections
    • Intra-abdominal infections
    • Wound and surgical site infections
    • Device-associated infections
    • Less commonly, endocarditis
  • Risk Factors:
    • Prolonged hospitalization or ICU stay
    • Indwelling devices (e.g., urinary catheters, central lines)
    • Recent or prolonged antibiotic exposure (especially vancomycin or broad-spectrum agents)
    • Immunocompromised state
    • Severe underlying illness
  • Infection Prevention (Healthcare Settings):
    • Strict hand hygiene
    • Contact precautions (gloves and gowns)
    • Environmental cleaning and disinfection
    • Antimicrobial stewardship
    • Appropriate device management

Healthcare Provider Reporting

Healthcare reporting requirements apply to all providers located within Tennessee, as well as providers whose patients reside in Tennessee.

Providers must report cases of all diseases and conditions listed through one of these methods:

• Mail or fax a completed PH-1600 form to your local health department or fax to the state health office at (615) 741-3857

• Send automatically via electronic case reporting (eCR). See this TDH webpage for more information on eCR, register at the Trader Partner Registration website, or contact MU.Health@tn.gov for assistance.

• Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting. 

• Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link. 

Information about this Reportable Disease for the Public

What Is It

Vancomycin-resistant Enterococcus (VRE) are bacteria that no longer responds to the antibiotic vancomycin. Enterococcus bacteria normally live in the intestines and usually do not cause harm. When they become resistant and enter other parts of the body, they can cause infection. VRE infections most often occur in hospitals and other healthcare settings.

How It Spreads

VRE spreads mainly through direct contact. Germs can move from person to person on unclean hands or from contaminated surfaces and medical equipment. Good hand hygiene is the most important way to prevent the spread.

Symptoms

Symptoms depend on the type of infection and may include:

  • Fever or chills
  • Pain or burning with urination
  • Redness, swelling, or drainage from a wound
  • Feeling weak or very ill

Seek medical care if you develop symptoms, especially after a recent hospital stay.

Who Is at Higher Risk

People at greater risk for VRE infection include those who:

  • Have been hospitalized for a long time
  • Are in intensive care units (ICUs)
  • Have medical devices such as urinary catheters or central lines
  • Have taken antibiotics for long periods
  • Have weakened immune systems or serious medical conditions

Some people carry VRE without feeling sick. This is called colonization.

Prevention

You can help prevent VRE by:

  • Washing hands often with soap and water or using alcohol-based hand sanitizer
  • Taking antibiotics exactly as prescribed
  • Avoiding unnecessary antibiotic use
  • Following healthcare facility instructions if you or a loved one is placed on contact precautions

Healthcare facilities use special infection-control practices, including gloves, gowns, and enhanced cleaning, to reduce spread.

This Page Last Updated: March 25, 2026 at 8:53 PM