title: Quinupristin-dalfopristin resistance in gram-positive bacteria: mechanism of resistance and epidemiology.
abstract: Antimicrobial resistance in gram-positive bacteria is a continuing problem resulting in significant morbidity, mortality, and cost. Because of this resistance, new antimicrobial agents have been needed. Quinupristin-dalfopristin is a recently approved agent for treatment of these infections. Shortly after its introduction into clinical medicine, resistance was reported. Resistance can occur by one or more of several mechanisms, including enzymatic modification, active transport of efflux mediated by an adenosine triphosphate-binding protein, and alteration of the target site. Resistance is rare in isolates of staphylococci and Enterococcus faecium from humans. Resistance is common in isolates recovered from food animals and is related to the use of virginiamicin as a feed additive. Considering the effect antimicrobial resistance has on human health, as well as its economic impact, measures to preserve the usefulness of these agents and delay the development of resistance are urgently needed.
authors.affiliation: William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
authors.forename: Ellie
authors.initials: E
authors.lastname: Hershberger
authors.forename: Susan
authors.initials: S
authors.lastname: Donabedian
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Konstantinou
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Zervos
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D004351:Drug Resistance / Q000502:physiology*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics / Q000502:physiology*; D016984:Enterococcus faecium / Q000187:drug effects*; D005787:Gene Frequency; D006094:Gram-Positive Bacteria / Q000187:drug effects; D017048:Health Care Costs; D006801:Humans; D008826:Microbial Sensitivity Tests; D014769:Virginiamycin / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D014769:Virginiamycin; C062940:quinupristin-dalfopristin