Emerging antibiotic resistance in gram positive bacteria: return to the pre-antibiotic era?

SR Norrby
Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong

This is a brief summary of four problems of antibiotic resistance in gram positive bacteria. Methicillin-resistant Staphylococcus spp. remain a major nosocomial threat and have become even more important with the increased use of foreign material (e.g. vascular catheters). There has been a rapid increase in penicillin-resistant Streptococcus pneumoniae isolates. This will lead to a reevaluation of the therapy of common respiratory tract infections such as otitis, sinusitis, and pneumonia, and will create major problems for the empirical treatment of bacterial meningitis. In Group A R-haemolytic Streptococcus spp., resistance to penicillin is unlikely to emerge, but increasing use of erythromycin and other macrolides has resulted in widespread macrolide resistance. Finally, the appearance of multi-resistant Enterococcus spp. shows that we have returned to the pre-antibiotic era. These strains are resistant to all available antibiotics and have caused hospital outbreaks of untreatable and fatal infections.

Hong Kong Med J 1995;1:129-35

Key words: Penicillin resistance; Methicillin resistance; Antibiotic resistance; Pneumococcal infections; Staphylococcal infections; Streptococcal infections; Enterococcus