Treatments for skin and soft-tissue and surgical site infections due to MDR Gram-positive bacteria.

Gram-positive aerobes are the most common organisms in hospitalized patients with skin and soft-tissue infections (SSTIs). Staphylococcus aureus is the most common Gram-positive aerobe among these infections with methicillin-resistant S. aureus (MRSA) the most common pathogen. The increased prevalence of MRSA has been noted in the hospital as well in the community setting. In choosing antimicrobial therapy, assessment of the infection and patient characteristics, such as animal exposure, travel history, underlying diseases, recent trauma, bites, burns, and water exposure, must be considered. Community-acquired MRSA strains are showing resistance to more antimicrobial classes, and b-lactam antibiotics can no longer be considered first-line therapy for community-acquired SSTIs. For more serious infections, there are several new antimicrobial options with good MRSA coverage, including linezolid, daptomycin, and tigecycline. Several agents are currently under clinical investigation or are being considered for approval by the US Food and Drug Administration, including ceftobiprole, dalbavancin, iclaprim, oritavancin, and telavancin.