Name of the Condition

• Resistance to Vancomycin (ICD-10-CM Code: Z16.21)

Summary

Resistance to vancomycin is a condition wherein certain bacteria, particularly some strains of Enterococcus and Staphylococcus, are not killed or inhibited by the antibiotic vancomycin. This can lead to challenging treatment scenarios, as vancomycin is often used to treat serious infections when other antibiotics fail.

Causes

The primary cause of vancomycin resistance is the genetic mutation in bacteria that alters the cell wall structure, reducing the drug's effectiveness. Such mutations can occur naturally or develop over time due to selective pressure from frequent use of antibiotics.

Risk Factors

• Previous or prolonged use of vancomycin or other antibiotics.
• Hospitalization, particularly in intensive care units.
• Weakened immune system due to medical conditions or treatments.
• Presence of invasive medical devices like catheters.

Symptoms

Resistance itself does not cause symptoms, but infections with vancomycin-resistant bacteria may present typical infection symptoms such as fever, chills, and inflammation at the infection site.

Diagnosis

• Culture and sensitivity tests to determine vancomycin resistance.
• Molecular methods such as PCR to identify resistant genes in bacteria.

Treatment Options

• Alternative antibiotics such as linezolid or daptomycin.
• Combination antibiotic therapy to target resistant bacteria.
• Ensuring infection control measures to prevent the spread.

Prognosis and Follow-Up

• With appropriate alternative treatments, infections can be managed, although they may be challenging.
• Regular follow-up is essential to monitor the effectiveness of treatment and prevent recurrence.

Complications

• Prolonged infections and increased risk of spread to others.
• Potential development of resistance to additional antibiotics.

Lifestyle & Prevention

• Ensuring judicious use of antibiotics as per medical guidance.
• Practicing proper hand hygiene and infection control measures in healthcare settings.

When to Seek Professional Help

• If experiencing persistent symptoms of an infection that do not improve with initial antibiotic treatment.
• If hospitalization occurs, promptly report any subsequent infections to healthcare providers for evaluation.

Additional Resources

• Centers for Disease Control and Prevention (CDC): Antibiotic Resistance Threats
• World Health Organization (WHO): Antimicrobial Resistance

Tips for Medical Coders

• Verify patient's medical history for antibiotic treatments and tests confirming resistance.
• Ensure accurate coding by distinguishing between "resistance" and an active infection with resistant bacteria.
• Watch out for documentation errors distinguishing between vancomycin-resistant Enterococcus (VRE) and vancomycin-resistant Staphylococcus aureus (VRSA).