Colonisation and infection with resistant gram-positive cocci. Epidemiology and risk factors.

Only a few years after the introduction of penicillin, resistant staphylococci were isolated in hospitals. This situation has led to the development of semisynthetic penicillins. Today, multiresistant Gram-positive bacteria have become an increasing problem in both hospitals and the community, frequently leaving the glycopeptides as the only therapeutic option. Notable problem pathogens are methicillin-resistant Staphylococcus aureus, coagulase-negative staphylococci and glycopeptide-resistant enterococci in the nosocomial environment, and penicillin-resistant Streptococcus pneumoniae in the community. In the hospital setting, as well as in the community and in animal husbandry, crowding and poor hygiene can facilitate the spread of resistant bacteria selected by antibiotic usage. However, the precise epidemiology and frequency of each drug-resistant pathogen depends on geographical location, the patient group involved and previous antibiotic use. Active measures need to be taken to reduce the spread of these pathogens and thus preserve the efficacy of available antibiotics.