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Emerging resistance to antimicrobial agents in gram-positive bacteria. Enterococci, staphylococci and nonpneumococcal
1Department of Pathology, University of Iowa College of Medicine, Iowa City, USA.
Abstract:
Staphylococci (Staphylococcus aureus and coagulase-negative Staphylococcus species) and enterococci are the aetiological organisms in 47 to 52% of nosocomial blood stream infections and approximately 30% of all nosocomial infections in the US. In European intensive care units, almost half of all infections are attributed to staphylococci. The streptococci have also become increasingly important because of the modified virulence of Streptococcus pyogenes strains, and the emerging role of the viridans group streptococci as a cause of potentially fatal bacteraemia in the neutropenic host. Resistance to available antimicrobial agents is increasing and includes, in particular, resistance to the glycopeptides (vancomycin and teicoplanin) amongst enterococci, resistance to penicillinase-resistant penicillins (oxacillin and methicillin) and fluoroquinolones (ciprofloxacin and ofloxacin) amongst staphylococci, and resistance to penicillin and some other beta-lactams amongst viridans group streptococci. New compounds for effective therapy of infection with antimicrobial-resistant Gram-positive species are needed urgently. To this end, the streptogramin combinations [quinupristin/dalfopristin (RP 59500; Synercid)], everninomycin derivatives (SCH 27899), oxazolidinones (U-100572, U-100766) and several newer fluoroquinolones (clinafloxacin, DU 6859a, grepafloxacin, levofloxacin, sparfloxacin, trovafloxacin) are under rapid development and clinical investigation.
Insights
Antimicrobial resistance in Gram-positive bacteria like staphylococci and enterococci is a growing concern, driving the urgent need for new therapies. Several novel antibiotic classes are under development to combat these resistant infections.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Staphylococci and enterococci are major causes of nosocomial infections in the US and Europe.
- Increasing antimicrobial resistance, including to glycopeptides and penicillins, complicates treatment.
- Emerging roles of streptococci in severe infections necessitate new therapeutic strategies.
Purpose of the Study:
- To highlight the urgent need for new antimicrobial agents.
- To review novel compounds under development for resistant Gram-positive infections.
- To discuss the clinical investigation of new antibiotics.
Main Methods:
- Literature review of current antimicrobial resistance trends.
- Identification of novel antimicrobial compounds in development.
- Summary of clinical investigation status for new agents.
Main Results:
- Significant prevalence of staphylococcal and enterococcal nosocomial infections.
- Rising resistance to established antibiotics (glycopeptides, penicillins, fluoroquinolones).
- Development of new drug classes including streptogramins, oxazolidinones, and novel fluoroquinolones.
Conclusions:
- Urgent need for effective therapies against antimicrobial-resistant Gram-positive pathogens.
- Promising new compounds are in advanced stages of development and clinical investigation.
- Continued research is crucial to address the evolving challenge of antibiotic resistance.