Laboratory: Clinical Microbiology
Test Name:
VANCOMYCIN-RESISTANT ENTEROCOCCI (VRE), CULTURE, AEROBIC BACTERIA, SURVEILLANCE, RECTAL SWAB (SBH ONLY) - (SWAB)
Test Code: VRE
Clinical Information:
Test Indications:
Vancomycin Resistant Enterococcus (VRE) is a culture-based test to identify carriers of VRE.  The test is used to look for the presence of transferable and high-level vancomycin resistance that may be present in isolates of Enterococcus faecium and Enterococcus faecalis.
Special infection control precautions are no longer required for VRE in Manitoba and therefore, VRE screening on admission for contact management or prevalence screening purposes is no longer performed.
VRE screening may be required for admission of patients in an out-of-province facility, e.g., in the context of dialysis (during travel) or transplant.

Recommendations:
1.  VRE screening cultures must be cleared by a Microbiologist.
2.  VRE screening cultures are performed at SBH only.
3.  Specimens submitted for contact management or prevalence screening purposes will NOT be processed.
4.  Accurate patient identification must be made prior to sample collection.
5.  Sample and requisitions must be labeled/completed in accordance with the Shared Health Specimen Acceptance Policy.

Patient Preparation Instructions:
Not applicable.
Collection Devices:
Preferred Device:
Rectal swab: carefully insert the swab ~1 in. beyond the anal sphincter.  Gently rotate.
Peri-rectal swab: swab the peri-rectal area
Ostomy: swab the stoma site and place it in transport medium.
Specimen Required: Rectal swab
Peri-rectal swab (for pediatric patients or patients in D6 at the Health Sciences Centre)
GI ostomy swab
Swabs should be visibly soiled with fecal material.  Unsoiled swabs are sub-optimal.
Peri-rectal swabs are acceptable for D6 patients at Health Sciences Center only.
Referral:
Requisition:
Reference Values:
Negative for VRE.
For positive samples, a descriptive report will be provided.
Availability:
Daily
See Also:
More Information:
Specimen Handling:
Specimen must be delivered to the laboratory as soon as possible and ideally within 24 hours of collection.  Specimens received beyond 48 hours of collection will be processed but results may be compromised because of the prolonged transit time (a comment to this effect will be added to all negative reports).
Local: ≤2 hours, store at room temperature.
Courier/local storage: ≤48 hours (≤24 hours optimal), store at 4°C.
 
References:
1.  Miller JM., Miller SA. A guide to specimen management in clinical microbiology, 3rd edition, 2017. American Society for Microbiology, Washington, DC.
2.  Manitoba Health, Seniors and Active Living. Guidelines for the Prevention and Control of Antimicrobial-Resistant Organisms. 2016. http://www.gov.mb.ca/health/publichealth/cdc/docs/ipc/aro.pdf
3.  Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual, 2017.