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VanB vs VanA VRE — SCE Infectious Diseases MCQ

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HardHealthcare-Associated InfectionsVanB vs VanA VRESCE Infectious Diseases

A 50-year-old man with end-stage liver disease develops a transjugular intrahepatic portosystemic shunt (TIPS) infection. Blood cultures grow a vancomycin-resistant Enterococcus (VRE) with VanB phenotype. Sensitivities show: Vancomycin resistant, Teicoplanin susceptible, Ampicillin resistant. What is the significance of the VanB phenotype for treatment?

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Correct answer: D — VanB confers resistance to Vancomycin but NOT Teicoplanin — Teicoplanin can be used for VanB VRE

VanB phenotype VRE confers resistance to Vancomycin but retains susceptibility to Teicoplanin — this is the key distinguishing feature from VanA (which confers resistance to BOTH Vancomycin and Teicoplanin). For VanB VRE infections, Teicoplanin is a viable treatment option. For VanA VRE, Daptomycin or Linezolid must be used. Understanding VanA vs VanB resistance phenotypes is essential for directing glycopeptide therapy. Laboratory confirmation of the phenotype is mandatory before using Teicoplanin for VRE.

Reference: BSAC 2023 – VRE treatment; EUCAST 2024 – Enterococcus breakpoints