Lab Test

Culture, VRE

Vancomycin Resistant Enterococcus (VRE) Culture, faecalis, faecium, nosocomial, enterococci, vanA, vanB, vanC, vancomycin-resistant Enterococcus

Test Codes

EPIC: LAB0912

Department

Microbiology

Specimen Collection Criteria

Collect: One of the following specimens:

  • Stool: Random stool specimen, about the size of a walnut, placed in a Cary-Blair transport medium. Specimens not in Cary-Blair transport medium must be placed in a sterile collection container, immediately refrigerated and sent to the Laboratory.
  • Rectal Swab: Rectal swab submitted in E-Swab/Amies transport medium. Fecal material must be visible on the swab.
  • Urine: Approximately 15 mL urine specimen in a sterile collection container (clean-catch, catheter, cystoscopic, random or suprapubic needle aspiration).

For Urine Specimens: For optimal recovery of pathogenic microorganisms, transfer 4-5 mL of the urine specimen to a Gray-top Boric Acid urine transport tube immediately after collection. For specimens with less than 3 mL of urine (i.e. pediatric, patients with oliguria/anuria):

  • Do NOT transfer urine to the Gray-top Boric Acid urine transport tube.
  • Maintain the urine in the collection cup and keep refrigerated (2-8°C or 36-46°F).
  • Send immediately to the Microbiology Laboratory.

Physician Office/Draw Specimen Preparation

  • Stool specimens in Cary-Blair transport medium can be maintained at room temperature (20-26°C or 68-78.8°F). Stool specimens not in Cary-Blair must be refrigerated (2-8°C or 36-46°F) and transported to the Laboratory immediately.
  • Rectal swab specimens in E-Swab/Amies transport medium can be maintained at room temperature (20-26°C or 68-78.8°F) prior to transport.
  • Urine specimens in Gray-top transport tubes can be maintained at room temperature (20-26°C or 68-78.8°F). Urine specimens in sterile collection containers must be refrigerated (2-8°C or 36-46°F) and transported to the Laboratory immediately.

Preparation for Courier Transport

Transport: Stool specimen, rectal swab, or urine specimen in the appropriate container, at room temperature (20-26°C or 68-78.8°F) or refrigerated (2-8°C or 36-46°F), as described above.

Rejection Criteria

  • Specimens in non-sterile or leaking containers.
  • Dry swabs, or swabs submitted in an expired collection system.
  • Specimens greater than 24 hours old.
  • 24-hour or pooled urine specimens.
  • Original urine specimens delayed in transport to the lab [greater than 2 hours at room temperature (20-26°C or 68-78.8°F) or greater than 24 hours refrigerated (2-8°C or 36-46°F)].

In-Lab Processing

If a urine specimen is received in a sterile cup (not a Gray-top tube) and is a shared urinalysis specimen, immediately (less than one hour from collection) pour into a separate clean container and send to the Urinalysis Laboratory.

Storage

Specimen Stability for Testing:

Stool Specimens
Room Temperature (20-26°C or 68-78.8°F): 2 hours (Unpreserved)
Room Temperature (20-26°C or 68-78.8°F): 48 hours (Para-Pak)
Refrigerated (2-8°C or 36-46°F): 24 hours (Unpreserved)
Frozen (-20°C/-4°F or below): Unacceptable

Rectal Swabs in Amies Transport Medium
Room Temperature (20-26°C or 68-78.8°F): 24 hours
Refrigerated (2-8°C or 36-46°F): 24 hours
Frozen (-20°C/-4°F or below): Unacceptable

Urine Specimens
Room Temperature (20-26°C or 68-78.8°F): 2 hours (Unpreserved)
Room Temperature (20-26°C or 68-78.8°F): 48 hours (Gray-top tube)
Refrigerated (2-8°C or 36-46°F): 24 hours
Frozen (-20°C/-4°F or below): Unacceptable

Specimen Storage in Department Prior to Disposal:

Refrigerated (2-8°C or 36-46°F): 4 days

Laboratory

Sent to Royal Oak Microbiology Laboratory or the Dearborn Microbiology Laboratory – all locations. 

Performed

Sunday – Saturday, 24 hours a day.
Urine: Final results available within 48 hours.
Stool or Rectal Swabs: Final results available within 24 hours.

Reference Range

No vancomycin resistant Enterococcus (VRE) recovered.

Test Methodology

Culture (Chromogenic Agar).

Clinical Utility

This test identifies individuals colonized with vancomycin-resistant Enterococcus (VRE).

Clinical Disease

Vancomycin-resistant Enterococcus (VRE) are a major concern in the healthcare setting. VRE are increasing in prevalence and their ability to transfer vancomycin resistance to other bacteria makes them a formidable opponent. Individuals may be colonized or infected with VRE. Sites of infection commonly include urinary tract, blood, GI, wound, and tissue.

Epidemiology

Enterococci are part of the normal gut flora of humans, but can also be found in soil, food, water, and other animals. There are at least 12 species of Enterococcus, but E. faecalis and E. faecium comprise the vast majority of isolates recovered clinically. Vancomycin-resistant enterococci are a major problem within healthcare systems as they are able to survive in the environment for prolonged periods (>1 week). As such they can contaminate almost any surface, and can easily be passed from patient to patient by health care workers.

Transmission

Hands, fomites.

Reference

  1. Moellering Jr. RC. 2005. Enterocccus Species, Streptococcus bovis, and Leuconostoc Species, In Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 6th Ed, p. 2411-2421.

CPT Codes

87077
LOINC:  13316-5

Contacts

Last Updated

8/5/2021

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