Vancomycin resistance: when failure becomes an opportunity for leadership

OBJECTIVE: To discuss the emergence of the enterococci as significant nosocomial pathogens and reports of glycopeptide resistance as demonstrating the failure of healthcare professionals to limit the clinical impact of these organisms. BACKGROUND: The enterococci have long occupied a peculiar position in medical and surgical patients. A component of the normal gastrointestinal tract, these organisms exhibit little overt pathogenicity in healthy hosts, but are frequently recovered in patients with severe debilitative or immunosuppresive disorders. While the enterococci have always demonstrated intrinsic resistance to a broad range of antiinfective agents, recent findings of moderate to high-level glycopeptide resistance potentially threaten the limited therapeutic options for methicillin-resistant gram-positive cocci. FINDINGS: The emergence and dissemination of vancomycin-resistant enterococci are signs of much greater problems, which include incomplete success of formulary controls, unreliable detection and identification of resistant microorganisms within the hospital environment, and poor fundamental infection control practices by all healthcare professionals. CONCLUSIONS: The Hospital Infection Control Practices. Advisory Committee Recommendations for the Prevention and Spread of Vancomycin Resistance are an important step in resolving these issues through the elements of collegiality and shared leadership.