Gram-positive infections: lessons learnt and novel solutions

Antibiotic resistance among Gram-positive bacteria has increased relentlessly in recent years, thereby compromising the use of traditional therapies. In the hospital setting, multidrug-resistant pathogens, particularly methicillin-resistant Staphylococcus aureus (MRSA) and emerging vancomycin-resistant pathogens, cause serious infections and create a substantial financial burden. Perhaps of greater concern are the increasingly frequent reports of community-acquired MRSA (CA-MRSA). As the present distinction between CA-MRSA and hospital-acquired MRSA (HA-MRSA) begins to blur, the predicted consequences of CA-MRSA include endemic infection within the community and a potential further increase in the burden of nosocomial infection. Reducing the spread of antimicrobial resistance will require worldwide cooperation. Regulatory authorities have already been established in a number of countries to implement infection prevention and infection control initiatives. Complementary to such measures in the management of infectious disease is the development of novel therapeutic agents. Newly approved agents, such as daptomycin, are welcome additions to the increasingly narrow range of effective therapies.