[MRSA/MRSE-VISA/GISA/VRSA-PRP-VRE: current gram positive problem bacteria and mechanism of resistance, prevalence and clinical consequences].

The raising frequency of occurrence of multi-resistant Gram-positive pathogens has led to difficult to treat infections not only in hospitals but also in outpatient settings. Methicillin-resistant Staphylococcus aureus, the glycopeptide-susceptibility of which one cannot be sure of any more, vancomycin-resistant enterococci and penicillin-resistant pneumococci are on the top of the list of Gram-positive problem organisms nowadays. Clinical microbiology laboratories are faced with the challenge of accurately detecting emerging antibiotic resistance, which might be difficult and purpose of reporting data should be twofold: First to report adequately identified, relevant organisms as well as their susceptibility profiles to clinicians in context with adequate patient management and secondly to report continuously epidemiological data in form of statistics to the community in general and within a given setting as could be a specified hospital in particular. For reliable detection, laboratories may need to employ special screening- and susceptibility testing methods. Certain of these tests are highly specific, while others may require additional confirmatory testing for definite results. This article reports on current resistance mechanisms of gram-positive pathogens and subsequently resulting consequences for clinicians. Moreover, the frequency of occurrence in Austria in general as well as at the Vienna General Hospital in particular will be referred to.