Summary
Only a few years after the introduction of penicillin, resistant staphylococci were isolated in hospitals. This situation has led to the development of semisyn-thetic penicillins. Today, multiresistant Gram-positive bacteria have become an increasing problem in both hospitals and the community, frequently leaving the glycopeptides as the only therapeutic option. Notable problem pathogens are methicillin-resistant Staphylococcus aureus, coagulase-negative staphylococci and glycopeptide-resistant enterococci in the nosocomial environment, and penicillin-resistant Streptococcuspneumoniae in the community. In the hospital setting, as well as in the community and in animal husbandry, crowding and poor hygiene can facilitate the spread of resistant bacteria selected by antibiotic usage. However, the precise epidemiology and frequency of each drug-resistant pathogen depends on geographical location, the patient group involved and previous antibiotic use. Active measures need to be taken to reduce the spread of these pathogens and thus preserve the efficacy of available antibiotics.
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References
Schaberg DR, Culver DH, Gaynes RP. Major trends in the microbial aetiology of nosocomial infection. Am J Med 1991; 91 Suppl. 3B: 72–5S
Cormican MG, Jones RN. Emerging resistance to antimicrobial agents in Gram-positive bacteria — enterococci, staphylococci and nonpneumococcal streptococci. Drugs 1996; 51 Suppl. 1: 6–12
Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. JAMA 1995; 274: 639–44
Bates J, Jordens Z, Selkon JB. Evidence for an animal origin of vancomycin resistant enterococci. Lancet 1993; 342: 490–1
Noble WC, Virani Z, Cree RG. Co-transfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC 12201 to Staphylococcus aureus. FEMS Microbiol Lett 1992; 72: 195–8
Baquero F, Martinez-Beltran J, Loza E. A review of antibiotic resistance patterns of Streptococcus pneumoniae in Europe. J Antimicrob Chemother 1991; 28 Suppl. C: 31–8
Seppala H, Klaukka T, Lehtonen R, et al. Outpatient use of erythromycin: link to increased erythromycin resistance in group A streptococci. Clin Infect Dis 1995; 21: 1378–85
Hiramatsu K, Hanaki H, Ino T, et al. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother 1997; 40: 135–6
Arason VA, Kristinsson KG, Sigurdsson JA, et al. Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence study. BMJ 1996; 313: 387–91
Baquero F. Trends in antibiotic resistance of respiratory pathogens: an analysis and commentary on a collaborative surveillance study. J Antimicrob Chemother 1996; 38 Suppl. A: 117–32
Haley RW, Cushion NB, Tenover FC, et al. Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995; 171: 614–24
Uhari M, Mottonen M. Infection prevention in child day care centers [abstract K180]. Proceedings of the 35th Interscience Conference on Antimicrobial Agents and Chemotherapy: 1995 Sep 17–20: San Francisco. Washington DC: American Society for Microbiology, 1995
Neu HC. The crisis in antibiotic resistance. Science 1992; 257: 1064–73
Mouthon L, Mainardi J-L. Vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus: the gram-positive challenges. Curr Opin Infect Dis 1996; 9: 256–60
Voss A, Milatovic D, Wallrauch-Schwarz C, et al. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 1994; 13: 50–5
Doebbeling BN. The epidemiology of methicillin-resistant Staphylococcus aureus colonisation and infection. J Chemother 1995; 7 Suppl. 3: 99–103
Cox RA, Mallaghan C, Conquest C, et al. Epidemic methicillin-resistant Staphylococcus aureus: controlling the spread outside hospital. J Hosp Infect 1995; 29: 107–9
Goldstein FW, Pean Y, Gertner J, et al. Resistance to ceftriaxone and other beta-lactams in bacteria isolated in the community. Antimicrob Agents Chemother 1995; 39: 2516–9
Peters G, von Eiff C, Herrmann M. The changing pattern of coagulase-negative staphylococci as infectious pathogens. Curr Opin Infect Dis 1995; 8 Suppl. 1: S12–9
Hedin G, Hambraeus A. Multiply antibiotic-resistant Staphylococcus epidermidis in patients, staff and environment — a one week survey in a bone marrow transplant unit. J Hosp Infect 1991; 17: 95–106
Daschner FD, Kropec A. Glycopeptides in the treatment of staphylococcal infections. Eur J Clin Microbiol Infect Dis 1995; 14 Suppl. 1: S12–7
Leclercq R. Epidemiology and control of multiresistant enterococci. Drugs 1996; 52 Suppl. 2: 47–9
Leclercq R, Courvalin P. Emerging problems with enterococcal infections. Curr Opin Infect Dis 1996; 9: 115–9
Clark NC, Cooksey RC, Hill BC, et al. Characterisation of gly-copeptide-resistant enterococci from US hospitals. Antimicrob Agents Chemother 1993; 37: 2311–7
Morris JG, Shay DK, Hebden JN, et al. Enterococci resistant to multiple antimicrobial agents including vancomycin. Ann Intern Med 1995; 123: 250–9
Gin AS, Zhanel GG. Vancomycin-resistant enterococci. Ann Pharmacother 1996; 30: 615–24
Tornieporth NG, Roberts RB, John J, et al. Risk factors associated with vancomycin-resistant Enterococcus faecium infection or colonisation in 145 matched case patients and control patients. Clin Infect Dis 1996; 23: 767
Edmond MB, Ober JF, Weinbaum DL, et al. Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis 1995; 20: 1126–33
Van der Auwera P, Pensart N, Korten V, et al. Influence of oral glycopeptides on the fecal flora of human volunteers: selection of highly glycopeptide-resistant enterococci. J Infect Dis 1996; 173: 1129–36
Klare I, Heier H, Claus H, et al. Enterococcus faecium strains with vanA mediated high-level glycopeptide resistance isolated from animal foodstuffs and fecal samples of humans in the community. Microb Drug Resist 1995; 1: 265–72
Karanfil LV, Josephson A. A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit. Infect Control Hosp Epidemiol 1992; 13: 195–200
Boyce JM, Opal SM, Chow JW, et al. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994; 32: 1148–53
Appelbaum PC. Antimicrobial resistance in Streptococcus pneumoniae: an overview. Clin Infect Dis 1992; 15: 77–83
Baquero F, Loza E. Antibiotic resistance of microorganisms involved in ear, nose and throat infections. Pediatr Infect Dis J1994; 13 Suppl. 1: 9–14
Marton A. Epidemiology of resistant pneumococci in Hungary. Microb Drug Resist 1995; 1(2): 127–30
Geslin P, Buu-Hoi A, Fremaux A. Antimicrobial resistance in Streptococcus pneumoniae: an epidemiological survey in France, 1970–1979. Clin Infect Dis 1992; 15: 95–8
Baquero T. Epidemiology and management of penicillin-resistant pneumococci. Curr Opinion Infect Dis 1996; 9: 372–9
Block SL, Harrison CJ, Hedrick JA, et al. Penicillin-resistant Streptococcus pneumoniae in acute otitis media: risk factors, susceptibility patterns and antimicrobial management. Pediatr Infect Dis J 1995; 14: 751–9
Soares S, Kristinsson KG, Musser JM. Evidence for the introduction of a multiresistant clone of serotype 6B Streptococcus pneumoniae from Spain to Iceland in the late 1980s. J Infect Dis 1993; 168: 158–63
Arnold KE, Leggiadro RJ, Breiman RF, et al. Risk factors for carriage of drug-resistant Streptococcus pneumoniae among children in Memphis, Tennessee. J Pediatr 1996; 128: 757–64
Nava JM, Bella F, Garau J, et al. Predictive factors for invasive disease due to penicillin-resistant Streptococcus pneumoniae: a population-based study. Clin Infect Dis 1994; 19: 884–90
Moreno F, Crisp C, Jorgensen HJ, et al. The clinical and molecular epidemiology of bacteremias at a university hospital caused by pneumococci not susceptible to penicillin. J Infect Dis 1995; 172: 427–32
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Cars, O. Colonisation and Infection with Resistant Gram-Positive Cocci. Drugs 54 (Suppl 6), 4–10 (1997). https://doi.org/10.2165/00003495-199700546-00004
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DOI: https://doi.org/10.2165/00003495-199700546-00004