Vancomycin-resistant Staphylococcus aureus: a real and present danger?

The glycopeptide antibiotics, vancomycin and teicoplanin, are the mainstay of therapy for infections involving strains of Staphylococcus aureus that are resistant to methicillin and gentamicin. Durng the last 5 years, clinical isolates of S. aureus showing reduced susceptibility to glycopeptides have been reported from many countries around the world, often associated with prolonged glycopeptide therapy. Detection and monitoring of such strains has been hindered by the fact that vancomycin (or glycopeptide)-intermediate S. aureus (VISA) isolates may be missed on conventional disk sensitivity tests. Effective control measures are required to prevent the increasing occurrence and spread of such strains in both the hospital and community settings. An important aspect of control is promoting the judicious use of glycopeptides. The recent introduction of the alternative antibiotics quinupristin/dalfopristin and linezolid, which are active against S. aureus strains resistant to many other classes of agent, should facilitate this process.