EPIDEMIOLOGY, LABORATORY DETECTION, AND THERAPY OF PENICILLIN-RESISTANT STREPTOCOCCAL INFECTIONS

Streptococci cause a wide range of infections in humans including resp iratory tract infections, endocarditis, meningitis, bacteremias, and s kin and soft tissue lesions. Mutations in the penicillin binding prote ins target sites in these organisms have recently caused resistance to penicillins and cephalosporins. The passage of resistant genetic mate rial from one streptococcal species to another has been recognized as one of the mechanisms by which this resistance has occurred and spread . Such resistance has been a particular problem in Streptococcus pneum oniae and viridans group streptococci with penicillin resistance level s in excess of 25%, now common ir? both groups of organisms worldwide. Fourth-generation cephalosporins, with their enhanced antibacterial a ctivity against Grampositive organisms (cefpirome > cefepime) and thei r increased stability to the beta-lactamases produced by many bacteria l species, offer a new option for the treatment of potentially life-th reatening infections such as pneumococcal pneumonia and meningitis wit h or without bacteremia. Clinical trials are currently in place to eva luate the role of these agents in these, and other, indications of Gra m-positive infections. Prior studies of cefpirome therapy for infectio ns caused by Streptococcus spp. were successful, and recent expanded i n vitro investi gations profess a future for expanded use of cefpirome to treat infections produced by several Gram-positive species. (C) 19 98 Elsevier Science Inc.