title: New antibiotic agents: problems and prospects.
abstract: BACKGROUND
  Surgical site infections are the third most common healthcare-associated infection, often leading to prolonged hospital stay and excessive expenditures. Management of these infections has become more challenging due to rising rates of multi-drug-resistant organisms and few new antibiotic options.
  
  
  METHODS
  This paper reviews the literature, summarizes the epidemiology of surgical site infections and the threat of antibiotic-resistant bacteria, and provides an insight into new treatment options for this condition.
  
  
  RESULTS
  Patients with surgical site infections are at greater risk of acquiring healthcare-associated antibiotic-resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) sp., and extended-spectrum beta-lactamase-(ESBL)-producing Escherichia coli and Klebsiella pneumoniae. Multi-drug-resistant Pseudomonas aeruginosa and Bacteroides fragilis are also a growing problem. Several useful drugs have recently become available for the management of serious, gram-positive infections (e.g., daptomycin, linezolid, telithromycin). Tigecycline, the first-in-class glycylcycline, has broad-spectrum in vitro activity, including against MRSA, VRE, resistant enteric gram-negative bacilli (e.g., Acinetobacter sp.), "atypical" pathogens, and anaerobes. Phase 3 clinical trials suggest that tigecycline will be an excellent option for antibiotic monotherapy for complicated skin and soft tissue infections (cSSSI) and intra-abdominal infections. Oritavancin and dalbavacin, two novel glycopeptide antibiotics that are also in late-stage clinical development, appear that they, too, will be useful for cSSSI due to resistant, gram-positive bacteria.
  
  
  CONCLUSIONS
  Multi-drug-resistant pathogens are threatening the success of available antibiotic therapy. Many new options are useful for infections due to multi-drug-resistant, gram-positive bacteria. Tigecycline is a promising new agent that provides coverage against a broad spectrum of gram-positive and gram-negative, aerobic, facultative, and anaerobic strains, including resistant isolates, and may make broad-spectrum, single-agent therapy possible.
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7030, USA. dweber@unch.unc.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
authors.forename: William A
authors.initials: WA
authors.lastname: Rutala
mesh_terms: D000081:Acetamides / Q000627:therapeutic use; D000150:Acinetobacter; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003428:Cross Infection / Q000382:microbiology; D017576:Daptomycin / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D048628:Ketolides / Q000627:therapeutic use; D000069349:Linezolid; D055624:Methicillin-Resistant Staphylococcus aureus; D008911:Minocycline / Q000031:analogs & derivatives / Q000627:therapeutic use; D023303:Oxazolidinones / Q000627:therapeutic use; D011550:Pseudomonas aeruginosa; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D000078304:Tigecycline; D020713:Vancomycin Resistance
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D048628:Ketolides; D023303:Oxazolidinones; D000078304:Tigecycline; D008911:Minocycline; D000069349:Linezolid; C106791:telithromycin; D017576:Daptomycin