Overview of resistant gram-positive pathogens in the surgical patient.
Staphylococci and enterococci are the most common pathogens in surgical-site and bloodstream infections. The emergence of drug resistance among these gram-positive bacteria thus poses a substantial threat to patients with surgical infections. Resistance to methicillin/oxacillin is frequently observed in Staphylococcus aureus isolates and is often accompanied by multidrug resistance. Vancomycin is usually the treatment of choice for infections caused by methicillin-resistant S. aureus (MRSA), so the recent appearance of S. aureus isolated with intermediate sensitivity to vancomycin is cause for concern. Vancomycin resistance has already appeared in most species of enterococci. Infections caused by vancomycin-resistant enterococci (VRE) are associated with increased mortality compared to infections caused by vancomycin-sensitive isolates. Measures for preventing vancomycin resistance include reducing the use of vancomycin and other agents that appear to be associated with VRE, including third-generation cephalosporins and anti-anaerobic drugs. Third-generation cephalosporins have also been implicated in the increased prevalence of MRSA infections. Prudent use of existing antibiotics is an essential strategy for combating the rising tide of drug-resistant gram-positive pathogens.
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Division of Pharmacy Practice and Science, University Hospital, University of Kentucky Medical School, Lexington, KY 40536-0082, USA. rprapp01@pop.uky.edu
D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D024881:Drug Resistance, Bacterial / Q000235:genetics; D013293:Enterococcus faecalis / Q000187:drug effects; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000235:genetics; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D017053:Infection Control; D017410:Practice Guidelines as Topic; D013211:Staphylococcus aureus / Q000187:drug effects; D013514:Surgical Procedures, Operative; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000382:microbiology