Skip to main content
SpringerLink
Log in

Emerging Resistance to Antimicrobial Agents in Gram-Positive Bacteria

Enterococci, Staphylococci and Nonpneumococcal Streptococci

  • Published:
Drugs Aims and scope Submit manuscript

Summary

Staphylococci (Staphylococcus aureus and coagulase-negative Staphylococcus species) and enterococci are the aetiological organisms in 47 to 52% of nosocomial blood stream infections and approximately 30% of all nosocomial infections in the US. In European intensive care units, almost half of all infections are attributed to staphylococci. The streptococci have also become increasingly important because of the modified virulence of Streptococcus pyogenes strains, and the emerging role of the viridans group streptococci as a cause of potentially fatal bacteraemia in the neutropenic host. Resistance to available antimicrobial agents is increasing and includes, in particular, resistance to the glycopeptides (vancomycin and teicoplanin) amongst enterococci, resistance to penicillinase-resistant penicillins (oxacillin and methicillin) and fluoroquinolones (ciprofloxacin and ofloxacin) amongst staphylococci, and resistance to penicillin and some other β-lactams amongst viridans group streptococci. New compounds for effective therapy of infection with antimicrobial-resistant Gram-positive species are needed urgently. To this end, the streptogramin combinations [quinupristin/dalfopristin (RP 59500; Synercid®)], everninomycin derivatives (SCH 27899), oxazolidinones (U-100572, U-100766) and several newer fluoroquinolones (clinafloxacin, DU 6859a, grepafloxacin, levofloxacin, sparfloxacin, trovafloxacin) are under rapid development and clinical investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Schaberg DR, Culver DH, Gaynes RR Major trends in the microbial etiology of nosocomial infection. Am J Med 1991; 91 Suppl. 3B: 725–55

    Google Scholar 

  2. Murray BE. The life and times of the Enterococcus. Clin Microbial Rev 1990; 3: 46–65.

    CAS  Google Scholar 

  3. Moellering Jr RC. Emergence of Enterococcus as a significant pathogen. Clin Infect Dis 1992; 14: 1173–8.

    Article  PubMed  Google Scholar 

  4. Jones RN, Kehrberg EN, Erwin ME, et al. Prevalence of important pathogens and antimicrobial activity of parenteral drugs at numerous medical centers in the United States. I. Study on the threat of emerging resistances: real or perceived? Diagn Microbiol Infect Dis 1994; 19: 203–15.

    Article  PubMed  CAS  Google Scholar 

  5. Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. JAMA 1995; 274: 639–44.

    Article  PubMed  CAS  Google Scholar 

  6. Morrison D, Woodford N, Johnson A, et al. Review of acquired vancomycin resistance in enterococci submitted to a reference laboratory during a five year period (1988–1993) [abstract F2/5]. In: Program and Abstracts of the 3rd International Conference of the Hospital Infection Society (Book 1): London: Hospital Infection Society, 1994: 19

    Google Scholar 

  7. Swartz MN. Hospital acquired infections: diseases with increasingly limited therapies. Proc Natl Acad Sci 1994; 91: 2420–7.

    Article  PubMed  CAS  Google Scholar 

  8. Archer GL, Climo MW. Antimicrobial susceptibility of coagulase-negative staphylococci. Antimicrob Agents Chemother 1994; 38: 2231–7.

    Article  PubMed  CAS  Google Scholar 

  9. Kloos WE, Bannerman TL. Update on clinical significance of coagulase negative staphylococci. Clin Microbiol Rev 1994; 7: 117–40.

    PubMed  CAS  Google Scholar 

  10. Bochud DY, Eggiman P, Calandra T, et al. Bacteremia due to viridans streptococcus in neutropenic patients with cancer: clinical spectrum and risk factors. Clin Infect Dis 1994; 18: 25–31.

    Article  PubMed  CAS  Google Scholar 

  11. McCarthy AE, Victor G, Ramotar K, et al. Risk factors for acquiring ampicillin-resistant enterococci and clinical outcomes at a Canadian tertiary-care hospital. J Clin Microbiol 1994; 32: 2671–6.

    PubMed  CAS  Google Scholar 

  12. Jones RN, Sader HS, Erwin ME, et al. Emerging multiply resistant enterococci among clinical isolates. I. Prevalence data from 97 medical center surveillance study in the United States Diagn Microbiol Infect Dis 1995; 21: 85–93.

    Article  PubMed  CAS  Google Scholar 

  13. Woodford N, Johnson AP, Morrison D, et al. Current perspectives on glycopeptide resistance. Clin Microbiol Rev 1995; 8: 585–615.

    PubMed  CAS  Google Scholar 

  14. Freeman C, Robinson A, Cooper B, et al. In vitro antimicrobial susceptibility of glycopeptide-resistant enterococci. Diagn Microbiol Infect Dis 1995; 21: 47–50.

    Article  PubMed  Google Scholar 

  15. Cormican MG, Johnson DM, Jones RN. Activity of the quinupristin/dalfopristin combination (RP-59500; Synercid) testing against vancomycin-resistant Enterococci species. Diagn Microbiol Infect Dis 1996; 24: 59–60.

    Article  PubMed  CAS  Google Scholar 

  16. Johnson CC, Slavoski L, Schwartz M, et al. In vitro activity of RP-59500 (quinupristin/dalfopristin) against antibiotic-resistant strains of Streptococcus pneumoniae and enterococci. Diagn Microbiol Infect Dis 1995; 21: 169–73.

    Article  PubMed  CAS  Google Scholar 

  17. Sader HS, Pfaller MA, Tenover FC, et al. Evaluation and characterization of multiresistant Enterococcus faecium from 12 US medical centers. J Clin Microbiol 1994; 32: 2840–2.

    PubMed  CAS  Google Scholar 

  18. Ageles-Dominguez M, de Lencastre H, Linares J, et al. Spread and maintenance of a dominant methicillin-resistant Staphylococcus aureus (MRSA) clone during an outbreak of MRSA disease in a Spanish hospital. J Clin Microbiol 1994; 32: 2081–7.

    Google Scholar 

  19. Jones RN, Barry AL, Gardiner RV, et al. The prevalence of staphylococcal resistance to penicillinase-resistant penicillins. A retrospective and prospective trial of isolates from 40 medical centers. Diagn Microbiol Infect Dis 1989; 12: 383–94.

    Google Scholar 

  20. Archer GL, Auger P, Doern G, et al. RP-59500, a new streptogramin highly active against recent isolates of North American staphylococci. Diagn Microbiol Infect Dis 1993; 16: 223–6.

    Article  PubMed  CAS  Google Scholar 

  21. Aldridge KE, Glefand MS, Schiro DO, et al. The rapid emergence of fluoroquinolone-methicillin-resistant Staphylococcus aureus infections in a community hospital. An in vitro look at alternative antimicrobial agents. Diagn Microbiol Infect Dis 1992; 15: 601–8.

    Article  PubMed  CAS  Google Scholar 

  22. Chang SC, Hsiem WC, Luh KT. Fluoroquinolone resistance among methicillin-resistant staphylococci after usage of fluoroquinolones other than ciprofloxacin in Taiwan. Diagn Microbiol Infect Dis 1994; 19: 143–7.

    Article  PubMed  CAS  Google Scholar 

  23. Blumberg H, Rimland P, Carroll DJ, et al. Rapid development of ciprofloxacin resistance in methicillin-susceptible and -resistant Staphylococcus aureus. J Infect Dis 1991; 163: 1279–85.

    Article  PubMed  CAS  Google Scholar 

  24. Utrup LJ, Kinlay JE, Rittenhouse SF, et al. Comparison of mupirocin susceptibility of nasal and non-nasal Staphylococcus aureus. Diagn Microbiol Infect Dis 1994; 20: 171–4.

    Article  PubMed  CAS  Google Scholar 

  25. Layton MC, Evans Patterson J. Mupirocin resistance among consecutive isolates of oxacillin-resistant and borderline oxacillin-resistant Staphylococcus aureus at a university hospital. Antimicrob Agents Chemother 1994; 38: 1664–7.

    Article  PubMed  CAS  Google Scholar 

  26. Noble WC, Virani Z, Cree RGA. Co-transfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC 12201 to Staphylococcus aureus. FEMS Microbiol Lett 1992; 93: 195–8.

    Article  CAS  Google Scholar 

  27. Schwalbe RS, Stapleton JT, Gilligan PH. Emergence of vancomycin-resistance in coagulase-negative staphylococci. N Engl J Med 1987; 316: 927–31.

    Article  PubMed  CAS  Google Scholar 

  28. Biovasco F, Giovanetti E, Montanari MP. Development of in vitro resistance to glycopeptide antibiotics: assessment in staphylococci of different species. J Antimicrob Chemother 1991; 27: 71–9.

    Article  Google Scholar 

  29. Barriere JC, Bouanchaud DH, Paris JM, et al. Antimicrobial activity against Staphylococcus aureus of semisynthetic injectable streptogramins: RP 59500 and related compounds. J Antimicrob Chemother 1992; 30 Suppl. A: 1–8.

    PubMed  CAS  Google Scholar 

  30. Aldridge KE, Schrio DD, Varner LM. In vitro antistaphylococcal activity and testing of RP 59500, a new streptogramin by two methods. Antimicrob Agents Chemother 1992; 36: 854–5.

    Article  PubMed  CAS  Google Scholar 

  31. Brumfitt W, Hamilton-Miller JMT, Shah S. In vitro activity of RP-59500, a new semisynthetic streptogramin antibiotic, against Gram-positive bacteria. J Antimicrob Chemother 1992; 30: 29–37.

    PubMed  CAS  Google Scholar 

  32. Pechere JC. In vitro activity of RP-59500, a semisynthetic streptogramin, against staphylococci and streptococci. J Antimicrob Chemother 1992; 30 Suppl. A: 15–8.

    PubMed  CAS  Google Scholar 

  33. National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing. 6th International Supplement, M100-S6. Villanova, PA: NCCLS, 1995.

    Google Scholar 

  34. Potgierter E, Carmichael M, Koornhoff HJ, et al. In vitro antimicrobial susceptibility of viridans streptococci isolated from blood cultures. Eur J Clin Microbiol Infect Dis 1992; 11: 543–6.

    Article  Google Scholar 

  35. Gomez-Garces JL, Alos JI, Cogollos R. Bacteriologic characteristics and antimicrobial susceptibility of 70 clinically significant isolates of Streptococcus milleri group. Diagn Microbiol Infect Dis 1994; 19: 68–73.

    Article  Google Scholar 

  36. Torres C, Reguera JA, SanMartin MJ, et al. van A-mediated vancomycin-resistant Enterococcus spp. in sewage. J Antimicrob Chemother 1994; 33: 553–61.

    Article  PubMed  CAS  Google Scholar 

  37. Fass RJ. In vitro activity of RP-59500, a semisynthetic injectable pristinamycin against staphylococci, streptococci, and enterococci. Antimicrob Agents Chemother 1991; 35: 553–9.

    Article  PubMed  CAS  Google Scholar 

  38. Verbist L, Verhaegen J. Comparative in vitro activity of RP-59500. J Antimicrob Chemother 1992; 30 Suppl. A: 39–44.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical Microbiology Division, Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa, 52242, USA

    Martin G. Cormican &  Ronald N. Jones

Authors
  1. Martin G. Cormican
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ronald N. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cormican, M.G., Jones, R.N. Emerging Resistance to Antimicrobial Agents in Gram-Positive Bacteria. Drugs 51 (Suppl 1), 6–12 (1996). https://doi.org/10.2165/00003495-199600511-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-199600511-00004

Keywords

Search

Navigation