Abstract
The coexistence of a pathogen population with an ever-increasing resistance to many
antibiotics and a patient population characterized by increasingly complex clinical
problems has contributed to an increase in the bloodstream infections associated with
gram-positive bacteria. This serious therapeutic challenge has already been associated
with an increase in infection-related morbidity and mortality, a prolongation of hospital
stays, and an escalation of healthcare costs. Vancomycin resistance, long prevalent
among the enterococci, has emerged in strains of Staphylococcus aureus. Several cases of infection caused by S. aureus strains with intermediate-level resistance to vancomycin (MIC = 8 μg/mL) have recently
been reported. As glycopeptide resistance accelerates among the gram-positive bacteria,
so does the potential for adverse clinical consequences associated with bloodstream
infections caused by these pathogens. The patients least able to tolerate the effects
of uncontrolled bloodstream infections are also those at the highest risk for the
development of infections caused by glycopeptide-resistant pathogens. In this at-risk
population, a poor outcome may be anticipated if effective antibiotic therapy is unavailable.
Appropriate rationing of vancomycin and other antimicrobial agents that increase the
selection of antibiotic-resistant strains of gram-positive bacteria and the rapid
development of novel antimicrobial agents with reliable gram-positive activity must
be immediate priorities if the threat posed by glycopeptide-resistant gram-positive
pathogens is to be countered.
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