Management of Gram-positive bacteraemia

Abstract

Gram-positive bacteraemic infections are frequent and associated with high morbidity and mortality. This paper reviews publications focusing exclusively on new findings related to Gram-positive bacteraemia in the published literature from July 2006 to June 2007. Ninety-eight articles have been reviewed. Of the 66 incorporated in this review, 21 focused on epidemiology or prevention. Thirty-two concerned staphylococcal bacteraemia, while 11 addressed other Gram-positive pathogens. There were seven articles on daptomycin, nine on endocarditis, seven on diagnostic issues, five on haemodialysis-related bacteraemia, and four on antibiotic lock techniques. In contrast to the large amount of articles dealing with epidemiological issues, the past year did not reveal any new fundamental insights into the treatment of Gram-positive bacteraemia. The rise in the minimal inhibitory concentrations of Staphylococcus aureus to vancomycin may become a threat. Several publications underlined the in-vivo efficacy of daptomycin, the new kid on the block against Gram-positive bacteraemia and endocarditis. The antibiotic lock technique showed some promising potential for secondary prevention or treatment of catheter-related infection, while rapid molecular techniques for early species identification may become a valuable diagnostic tool. Most evidence was not based on large, randomized trials and needs future confirmation.