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Epidemiology and clinical relevance of microbial resistance determinants versus anti-Gram-positive agents

Gian Maria Rossolini1, Elisabetta Mantengoli, Francesca Montagnani

  • 1Department of Molecular Biology, Section of Microbiology, University of Siena, Viale Bracci 16, I-53100 Siena, Italy. rossolini@unisi.it

Current Opinion in Microbiology
|September 18, 2010
PubMed

Insights

Gram-positive pathogens like MRSA are developing antibiotic resistance through mutations and gene transfer. Emerging linezolid resistance in Staphylococcus aureus is a growing concern, alongside increased Clostridium difficile infections.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Gram-positive pathogens cause significant community and hospital-acquired infections.
  • Antibiotic resistance in Gram-positive bacteria, including MRSA, GRE, and resistant pneumococci, poses major global health challenges.
  • Mechanisms of resistance involve mutations and horizontal gene transfer via mobile genetic elements.

Purpose of the Study:

  • To review the current landscape of antibiotic resistance in Gram-positive pathogens.
  • To highlight emerging resistance mechanisms and their clinical implications.
  • To discuss the association between antibiotic resistance and Clostridium difficile infections.

Main Methods:

  • Literature review of antibiotic resistance mechanisms in Gram-positive bacteria.
  • Analysis of clinical impact and dissemination of resistant strains.
  • Examination of emerging resistance trends to newer antibiotics.

Main Results:

  • Methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant enterococci (GRE), and multidrug-resistant pneumococci are key resistance challenges.
  • Resistance to glycopeptides in staphylococci is uncommon; resistance to newer agents like linezolid, daptomycin, and tigecycline is rare but emerging.
  • A transferable linezolid resistance mechanism (Cfr protein) in S. aureus is a significant concern, with increasing reports in enterococci and coagulase-negative staphylococci.
  • Antibiotic resistance is linked to the rise of hypervirulent Clostridium difficile infection (CDI) strains.

Conclusions:

  • Gram-positive bacteria possess diverse mechanisms for antibiotic resistance evolution.
  • Emerging resistance to linezolid, particularly transferable mechanisms, requires urgent attention.
  • The interplay between antibiotic resistance and the increasing incidence of CDI warrants further investigation.

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