[The multiresistance of Streptococcus pneumoniae: a global danger]

S. pneumoniae causes several serious and potentially life-threatening community-acquired diseases, and there are 5 million deaths per year globally. In multidrug-resistant clones (those with resistance to erythromycin, tetracycline, chloramphenicol, penicillin, and trimethoprim-sulfamethoxazole), treatment of even relatively localized pneumococcal infection may require hospitalization because of the need to use parenteral vancomycin. Thanks to the tremendous increase in the size of populations at high risk, and to the increased mobility of human populations the problem has been amplified to one of global dimensions: during the last decade multidrug-resistant clones have been clinically isolated in Spain, South Africa, Hungary, USA, Croatia, and South Korea. In Italy, epidemiologic data are unknown. Pneumococci would have developed resistance modifying the PBP genes, probably acquiring foreign DNA from taxonomic related streptococci and became global pathogens because of geographic spread of multidrug-resistant clones during the 1990s. These theses have been demonstrated using a relatively new technique of molecular epidemiology: Pulsed-Field Gel Electrophoresis, able to recognize chromosomal similarity among clinical isolates. About 50% of the pharmaceutical company had either reduced or phased out their natibacterial programs five years ago. There are relatively few new drugs ready for introduction today, and promising agents are still in the development stage and will require more years of testing for clinical efficacy.