[Epidemiology of Gram-positive infections in France: changing resistance]

CONTRIBUTION OF CLINICAL EPIDEMIOLOGY: Clinical epidemiology goes beyond simply counting cases of resistance. The goal is to collect clinical data contributing to an explication of epidemiological observations enabling a classification into 4 types of resistance. GRAM POSITIVE BACTERIA: Depending on the specialty, Gram positive bacteria are the cause of a variable percentage of clinical infections. In oncology and hematology, Gram-positive infections appear to be on the rise due to the increase in the number of coagulase-negative staphylococcal infections. The percentage appears to be unchanged in intensive care. Community-acquired streptococcal infections include a growing number caused by Streptococcus viridans, with the development of resistance and an aggravation of Streptococcus pneumoniae resistance. Nosocomial Gram-positive infections show that the increase in the number of meticillin-resistant Staphylococcus aureus infections is slowing down with the emergence of exceptional Staphylococcus aureus strains exhibiting intermediary resistance to glycopeptides. STREPTOCOCCUS VIRIDANS: Isolation of Streptococcus viridans is becoming increasingly frequent, particularly in immunodepressed patients or in patients with surgical conditions such as peritonitis. Several risk factors have been identified. In vitro glycopeptides and linezolide would have 100% activity against S. viridans. METICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA): Infections caused by MRSA strains are rather exceptional compared with simple colonization. All patients with suspected Staphylococcus aureus infections should not be treated as if they had a MRSA infection. STREPTOCOCCUS PNEUMONIA: Beta-lactame resistant pneumococci have shown some progression.