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Introduction

      The incidence of serious, gram-positive bacterial infections has risen dramatically in recent years, especially among the most vulnerable patient populations. At the same time, many gram-positive species have become increasingly resistant to many classes of antibiotics, leaving the glycopeptide antibiotics as the drugs of last resort. Within the last decade, however, many enterococcal species have acquired high-level resistance to vancomycin or teicoplanin.

      Moellering RC Jr. Vancomycin-resistant enterococci. Clin Infect Dis. 1998 (in press).

      ,
      CDC
      Nosocomial enterococci resistant to vancomycin—United States, 1989-1993.
      In the past several years, there have been disturbing reports of low- and intermediate-level resistance to vancomycin and teicoplanin in strains of both coagulase-negative Staphylococcus and Staphylococcus aureus.
      • Hiramatsu K.
      • Hanaki H.
      • Ino T.
      • Yabuta K.
      • Oguri T.
      • Tenover E.C.
      Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility.
      ,
      CDC
      Staphylococcus aureus with reduced susceptibility to vancomycin—United States, 1997.
      ,
      CDC
      UpdateStaphylococcus aureus with reduced susceptibility to vancomycin—United States, 1997.
      Laboratory studies have demonstrated that S. aureus strains resistant to vancomycin can be produced by a step-pressure procedure.
      • Sieradzki K.
      • Tomasz A.
      A highly vancomycin-resistant laboratory mutant of Staphylococcus aureus.
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