Abstract
Two glycopeptide antibiotics, vancomycin and teicoplanin, are currently available
for clinical use in various parts of the world, whereas a third, avoparcin, is available
for use in agricultural applications and in veterinary medicine in some countries.
Because of their outstanding activity against a broad spectrum of gram-positive bacteria,
vancomycin and teicoplanin have often been considered the drugs of “last resort” for
serious infections due to drug-resistant gram-positive pathogens. Glycopeptides had
been in clinical use for almost 30 years before high-level resistance, first reported
in enterococcal species, emerged. More recently, there have been disturbing reports
of low- and intermediate-level resistance to vancomycin in strains of Staphylococcus aureus. A review of earlier reports reveals, however, that S. aureus strains with reduced susceptibility to glycopeptides were first identified >40 years
ago. Such strains may occur in nature or may have developed low-level mutational resistance
in response to the selection pressure of glycopeptide therapy. Of considerably greater
concern is the possibility that vancomycin resistance genes found in enterococci may
be transferred to more virulent organisms such as staphylococci or Streptococcus pneumoniae.
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© 1998 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
