Streptogramins: an answer to antibiotic resistance in gram-positive bacteria

Abstract

The past 15 years have seen the emergence of grampositive microorganisms as major nosocomial pathogens, and a corresponding increase in their antibiotic resistance. Penicillin-resistant pneumococci, meticillinresistant staphylococci, and vancomycin-resistant enterococci have been reported worldwide. 1 Gold HS Moellering Jr, RC Antimicrobial-drug resistance. N Engl J Med. 1996; 335: 1445-1453 Crossref PubMed Scopus (375) Google Scholar In addition, certain species, such as Enterococcus faecium and glycopeptide-intermediate Staphylococcus aureus (GISA), have become resistant to so many antibiotics that they have been described as “untreatable” pathogens. 2 Leclercq R Courvalin P Resistance to glycopeptides in enterococci. Clin Infect Dis. 1997; 24: 545-554 Crossref PubMed Scopus (198) Google Scholar , 3 Hiramatsu K Hanaki H Ino T Yabuta K Oguri T Tenover FC Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother. 1997; 40: 135-136 Crossref PubMed Scopus (1646) Google Scholar However, the clinical consequences of such resistance should not be exaggerated. Extensive spread of resistant enterococci seems to be limited to the USA or to particular hospital ecosystems, and the number of publications on GISA greatly exceeds that of clinical isolates. Nevertheless, where present, these strains cause infections impossible to treat, and they would pose a substantial threat worldwide if they were to be disseminated.