Debate-guidelines for control of glycopeptide-resistant enterococci (GRE) have not yet worked

Abstract

Glycopeptide-resistant enterococci (GRE) have become a focus of concern in many countries because options for antimicrobial therapy of GRE infection are limited. Several guidelines for the control and prevention of GRE colonization and infection have been developed for healthcare settings, and occasional journal articles now report "control" (usually relative reduction of incidence or prevalence rate rather than elimination) of GRE infections. Yet, rates of infection and colonization with GREcontinue to climb in many parts of the world, showing that true control has not been achieved. Programmes to control GRE will be effective only when they (1) are less expensive to implement; (2) are shown to be cost-effective despite the fact that they merely reduce prevalence levels rather than eradicating the problem; (3) do not require almost perfect implementation to be effective; (4) are shown to be sustainable; (5) are shown to work in acute-care settings other than selected academic centres; and (6) are shown to work in non-acute care settings. Until then, it is clear that guidelines for control of GRE have not worked. New guidelines that truly control GRE must be developed, and this must be done quickly.