History High-level vancomycin-resistant E. faecalis and E. faecium are clinical isolates first documented in Europe in 1986 and the United States in 1987. In the United States, vancomycin-resistant E. faecium was associated with 4% of healthcare-associated infections reported to the Centers for Disease Control and Prevention National Healthcare Safety Network from January 2006 to October 2007. VRE can be carried by healthy people who have come into contact with the bacteria, usually in a hospital (nosocomial infection), although it is thought that a significant percentage of intensively farmed chickens also carry VRE. Other regions have noted a similar distribution, but with increased incidence of VRE. For example, a 2006 study of nosocomial VRE revealed a rapid spread of resistance among enterococci along with an emerging shift in VRE distribution in the Middle East region, such as Iran. Treatment failures in enterococcal infections result from inadequate information regarding glycopeptide resistance of endemic enterococci due to factors such as the presence of VanA and VanB. The study from Iran reported the first case of VRE isolates that carried VanB gene in enterococcal strains from Iran. This study also noted the first documented isolation of nosocomial E. raffinosus and E. mundtii in the Middle East region. See also Methicillin-resistant Staphylococcus aureus (MRSA)(Vancomycin intermediate-resistant Staphylococcus aureus redirect) Antibiotic resistance Drug resistance MDR-TB References Further reading External links PubMed Lactobacillales Antibiotic-resistant bacteria Healthcare-associated infections