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Background  Prolonged asymptomatic carriage of vancomycin-resistant enterococci (VRE) in the gastrointestinal tract and the lack of effective decolonization regimen perpetuate the endemicity of VRE in the healthcare settings.    Case presentation  We report a regimen for decolonization of gastrointestinal carriage of VRE by a combination of environmental disinfection, patient isolation, bowel preparation to wash-out the fecal bacterial population using polyethylene glycol, a five-day course of oral absorbable linezolid and non-absorbable daptomycin to suppress any remaining VRE, and subsequent oral  Lactobacillus rhamnosus  GG to maintain the colonization resistance in four patients, including two patients with end-stage liver cirrhosis, one patient with complication post liver transplant, and one patient with complicated infective endocarditis. All patients had clearance of VRE immediately after decolonization, and 3 of them remained VRE-free for 23 to 137 days of hospitalization, despite subsequent use of intravenous broad-spectrum antibiotics without anti-VRE activity.    Conclusion  This strategy should be further studied in settings of low VRE endemicity with limited isolation facilities.    Electronic supplementary material  The online version of this article (doi:10.1186/1471-2334-14-514) contains supplementary material, which is available to authorized users.

Decolonization of gastrointestinal carriage of vancomycin-resistant Enterococcus faecium: case series and review of literature