ANTIMICROBIAL RESISTANCE IN STAPHYLOCOCCI - EPIDEMIOLOGY, MOLECULAR MECHANISMS, AND CLINICAL RELEVANCE

Staphylococcal infections continue to pose important clinical problems in children and adults. Antibiotic resistance among the staphylococci has rendered therapy of these infections a therapeutic challenge. Des pite early, uniform susceptibility to penicillin, staphylococci acquir ed a gene elaborating beta-lactamase that rendered penicillin inactive and that is borne by nearly all clinical isolates. ''Penicillinase-re sistant beta-lactams,'' such as methicillin, were introduced in the ea rly 1960s, but resistance to them has become an increasing concern. Th e mechanism of the so-called ''methicillin resistance'' is complex. Mo reover, once confined to the ecology of hospitals and other institutio ns, a recent increase in community-acquired methicillin-resistant S. a ureus infections has been observed. Glycopeptides, until now the only uniformly reliable therapeutic modality, have been increasingly used f or therapy of staphylococcal infections. The recent recognition of cli nical isolates with reduced susceptibility to glycopeptides is of conc ern.