Successful treatment with linezolid in two cases of methicillin-resistant Staphylococcus aureus infections in the orthopedic field

We have reported two orthopedic patients with Methicillin-resistant Staphylococcus aureus (MRSA) infections successfully treated with linezolid. The first case was a 64-years-old man with bacteremia, spondylitis and psoas abscesses caused by MRSA. He was treated with arbekacin (ABK) and vancomycin (VCM), and then became afebrile. However he complained of a recurrence of fever and oliguria, we administered linezolid for two weeks intravenously because of fluctuating renal dysfunction. Thereafter his clinical conditions improved. The second case was a 26-years-old man with MRSA infection of the pelvis after a trauma. He was treated with teicoplanin (TEIC) for two weeks. However the minimum inhibiratory concentrations (MICs) of TEIC and VCM against MRSA, isolated from the wounds, were 4 micrograms/ml each, we administered linezolid intravenously and the patient was successfully treated in four weeks. Linezolid has been proven to have high efficacy against MRSA by some trials abroad. But the agent has the indication only for VRE by the Medical Insurance in Japan. These cases also suggest that linezolid is useful for MRSA infections in these cases.     

A critical review of oxazolidinones: An alternative or replacement for glycopeptides and streptogramins?

OBJECTIVE: To review the available data on the oxazolidinones linezolid and eperezolid. DATA SELECTION: Published reports were obtained by searching MEDLINE for articles published between 1992 and 2000, inclusive. References of published papers were also obtained and reviewed. Abstracts from scientific proceedings were reviewed. DATA EXTRACTION: Due to the limited data available regarding these agents, the criteria for study inclusion were not restrictive. DATA SYNTHESIS: The oxazolidinones (eg, linezolid) are a new antimicrobial class with a unique mechanism of action. They are active against resistant Gram-positive cocci including methicillin-susceptible and -resistant Staphylococcus aureus (MRSA), methicillin-susceptible and -resistant Staphylococccus epidermidis, vancomycin-resistant enterococci (VRE) and penicillin-resistant Streptococcus pneumoniae (PRSP). Linezolid is active against anaerobes and displays modest activity against fastidious Gram-negative pathogens such as Haemophilus influenzae, but is not active against Enterobacteriaceae. Linezolid is available both orally and parenterally, and has a bioavailability of 100%. Clinical trials comparing linezolid with standard therapy have demonstrated similar bacteriological and clinical cures rates to standard therapy in community- and hospital-acquired pneumonia, uncomplicated and complicated skin and soft tissue infections, and infections caused by MRSA and VRE. Adverse effects have been minor and infrequent; however, platelets should be monitored in patients who have received more than two weeks of linezolid therapy. It is expected that these agents will have a bright future due to their excellent spectrum of activity against antibiotic-resistant Gram-positive organisms, such as MRSA, VRE and PRSP, and their excellent bioavailability. CONCLUSION: The oxazolidinones represent a new class of antimicrobials with a unique mechanism of action. They have excellent activity against susceptible and resistant Gram-positive organisms such as MRSA, methicillin-susceptible S epidermidis, VRE and PRSP, and a good adverse effect profile; they can be administered both intravenously and orally. Their potential use in Canada may be as an intravenous and oral alternative to glycopeptides and streptogramins.     

Different Trends of MRSA and VRE in a German Hospital, 1999–2005

Abstract Some of the clinically most menacing nosocomial pathogens are Methicillin-resistent Staphylococcus aureus (MRSA) and Vancomycin-resistent Enterococcus (VRE). During the last years both pathogens showed dramatic increases in colonization and infection rates in Germany. This study covers all patients positively tested for MRSA and VRE in a German University Hospital from 1999–2005. About 1,179 MRSA cases and 116 VRE cases have been reported. VRE was significantly associated with less infection, female gender, more death and higher nosocomial acquisition than MRSA. While MRSA rates increased impressively from 1999 to 2005 VRE rates decreased clearly. Assuming that compliance with hygienic measures is similar in dealing with MRSA and VRE it is quite unclear why these two major pathogens differ so much in their trends. One possibility is that the MRSA problem has been caused by an increasing share of nonnosocomially acquired MRSA.     

Susceptibility to daptomycin, quinupristin-dalfopristin and linezolid and some other antibiotics in clinical isolates of methicillin resistant and methicillin sensitive S.aureus from the Oslo area

Our study compared the susceptibility of 136 clinical isolates of Staphylococcus aureus and 119 multidrug-resistant Staphylococcus aureus (MRSA) isolates from Oslo to a range of antibiotics, including the novel antibiotics quinupristin-dalfopristin, linezolid and daptomycin. All isolates were susceptible to daptomycin, linezolid and quinupristin-dalfopristin, although a subgroup was less susceptible to the latter. There was no linkage between reduced susceptibility to daptomycin, linezolid or quinupristin-dalfopristin and resistance to other classes of antimicrobials. In addition, MRSA strains from 2004 have become more sensitive to fucidin and rifampicin.The results can be used to evaluate the appropriateness of breakpoints and to define a baseline for monitoring possible future emergence of resistance to daptomycin, quinupristin-dalfopristin and linezolid in Staphylococcus aureus in Norway.     

Optimizing therapy for MRSA pneumonia

With its remarkable armamentarium of resistance and virulence factors, Staphylococcus aureus has emerged as a dominant pathogen causing pneumonia of all classifications. Rates of methicillin resistance are increasing as clinicians struggle to find ways to prevent the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) and to effectively treat MRSA pneumonia. Community-associated MRSA has been identified as an important subset of MRSA with unique characteristics. Vancomycin remains a recommended first-line therapy for MRSA pneumonia, but resistance and therapeutic failures with vancomycin are being increasingly reported. Factors associated with vancomycin success or failure have been identified, including the genetics of the MRSA isolate, vancomycin lung penetration, minimum inhibitory concentration, and pharmacokinetic and pharmacodynamic variables. Retrospective analyses suggest that linezolid may provide improved outcomes compared with vancomycin for MRSA pneumonia, but validation in a prospective trial is currently lacking. Other treatment options are limited, but new prospects are being investigated. This paper reviews the epidemiology and pharmacotherapy of MRSA pneumonia.     

Antibiotikatherapie: Fortschritte und Resistenzentwicklung

This contribution illustrates reasons, spread, and mechanisms of development of resistance especially in gram-positive microorganisms such as methicillin resistant staphylococcus aureus (MRSA) or vancomycin resistant enterokoccus (VRE). Possibilities of overcoming these are described as well as strategies for antibacterial therapy with recently developed antibiotics against multiple resistant microorganisms. These are linezolid as an oxazolidinone, daptomycin as a lipopeptid and tigecyclin as a new glycylcycline, which are already on the market or will be launched soon in Germany. Differences in magnitude and frequency of still existing resistances between hospital and practice are discussed with respect to their importance for the internal physician.     

Treatment of community-acquired methicillin-resistant Staphylococcus aureus in children

PURPOSE OF REVIEW: The concept of methicillin-resistant Staphylococcus aureus (MRSA) associated with broad resistance, nosocomial acquisition, and known risk factors has recently been expanded. A new type of MRSA that is resistant to fewer antibiotics has emerged in pediatric practice since the mid-1990s. These isolates are community acquired and have been reported from diverse geographic regions. Awareness of these organisms is important for appropriate treatment of S. aureus infections in children. RECENT FINDINGS: Community-acquired MRSA (CA-MRSA) isolates are similar in many respects to community-acquired methicillin-susceptible S. aureus (CA-MSSA). There are usually no differences in risk factors between children with CA-MRSA infections and those with CA-MSSA infections or their household contacts. In one study, however, multivariate analysis showed that age greater than 1 year and health care contact in the preceding month were significant risk factors for CA-MRSA. Skin and soft tissue infections are the most common manifestations, although serious invasive infections and death may occur. Pneumonia has been reported more often in children with CA-MRSA than in those with CA-MSSA. Clindamycin is an effective therapy for CA-MRSA, but there is a risk for development of clindamycin resistance during treatment of a CA-MRSA that is clindamycin susceptible and inducibly erythromycin resistant. Trimethoprim-sulfamethoxazole is likely to be effective, and linezolid is a new option for treatment. SUMMARY: The appearance of CA-MRSA has important implications for therapy of infections caused by S. aureus in children. Three specific issues are the development of resistance during clindamycin therapy, insufficient data on the use of trimethoprim-sulfamethoxazole in serious CA-MRSA infections, and the appropriate role for newer antibiotics such as linezolid.     

Seeking vancomycin resistant Staphylococcus aureus among patients with vancomycin-resistant enterococci.

Clinical isolates of Staphylococcus aureus displaying intermediate resistance to vancomycin (VISA) have been identified. The objective of our study was to identify VISA colonization among patients known to be colonized or infected with vancomycin-resistant enterococci (VRE). Eight weekly point prevalence screening surveys for VRE and S. aureus were conducted on 5 hospital units. Of the 243 patients screened, 31 (12.8%) were colonized with VRE. In addition, 18 inpatients were already known to be VRE-positive. Fourteen (28.6%) of the 49 VRE-positive patients were co-colonized with S. aureus. All 30 S. aureus isolates from these 14 patients were methicillin-resistant (MRSA) but remained vancomycin-susceptible (minimal inhibitory concentration [MIC] range, 0.75-2 microg/mL). Population analysis profiling demonstrated no evidence of heteroresistant subpopulations that could grow on agar containing 3 microg/mL vancomycin for any of the MRSA isolates. Although 23 (77%) of 30 staphylococcal isolates had vancomycin MICs of 1.5 or 2 microg/mL, no VISA strains (MICs, 8-16 microg/mL) were recovered.     

金黄色葡萄球菌的临床分布及耐药性分析

目的 了解金黄色葡萄球菌的临床分布及其耐药情况.方法 对我院2007～2009年分离的金黄色葡萄球菌进行耐药监测.结果 3年共分离出金黄色葡萄球菌106株.在临床标本中,痰液分离率最高,占57.6％;感染分布以呼吸内科为主,占43.4％.MRSA对青霉素类、大环内酯类、氨基糖苷类、喹诺酮类、四环素类、克林霉素的耐药率均很高且明显高于MSSA,并呈现多重耐药;MSSA对青霉素、红霉素、庆大霉素、四环素的耐药率较高在80％左右;MRSA和MSSA对糖肽类、利奎唑胺和奎奴普汀/达福普汀都很敏感.结论 金黄色葡萄球菌耐药严重,特别是对MRSA应引起临床的重视.     

2011年医院金黄色葡萄球菌临床分布及耐药性研究

目的调查金黄色葡萄球菌(SA)和耐甲氧西林金黄色葡萄球菌(MRSA)临床分布情况及其对常用抗菌药物的耐药率。方法对我院2011年检出的SA和MRSA药敏结果分析。结果 2011年共检出SA 146株(其中MRSA 29株),菌株主要来源为痰液49株(33.56%),脓液37株(25.34%),泌尿生殖道分泌物11株(7.53%);菌株分布前三位的科室是神经外科36株(24.66%)、创伤外科24株(16.44%)、呼吸消化科17株(11.64%);其中MRSA 29株(19.8%)。分离的146株SA对万古霉素、利奈唑胺全部敏感,其中MRSA对红霉素、克林霉素、四环素和环丙沙星呈现较高的耐药率,达70%以上;MRSA对各种抗生素的耐药率均明显高于MSSA,并呈现多重耐药。结论通过对SA临床分布和耐药率的分析,有利于采取措施控制医院内MR-SA的感染及流行并能指导临床合理用药。     

Methicillin-Resistant S. aureus Ventilator-Associated Pneumonia: Strategies to Prevent and Treat

Ventilator-associated pneumonias (VAPs) due to methicillin-resistant Staphylococcus aureus (MRSA) are rising in incidence and pose unique challenges in their prevention and treatment. Risk factors for the development of MRSA VAP include nasal carriage, prior antibiotic therapy, prolonged mechanical ventilation, poor infection control practices, head trauma/coma, and viral infection. Measures to prevent the development of MRSA VAP include general VAP prevention strategies and reduction of S. aureus nasal carriage. S. aureus possesses a variety of transferable genetic elements that encode proteins conferring resistance to several antibiotics, including beta-lactams and glycopeptides. Successful treatment of MRSA VAP with currently available antibiotics has been poor. Current management guidelines recommend glycopeptides as initial therapy for MRSA VAP. However vancomycin success rates are low, ranging from only 35 to 57%. This may be due to the poor penetration of vancomycin into the lung, and alternate dosing regimens to increase tissue levels need to be further studied. Treatment with linezolid, which penetrates well into the lung, is associated with higher cure and survival rates. Further data are needed to evaluate the efficacy of new antibiotics in MRSA VAP.     

Control of multiply resistant cocci: do international comparisons help?

Antibiotic resistance has become a worldwide problem. However, the reasons for the uneven geographic distribution of antibiotic-resistant microorganisms are not fully understood. For instance, there are striking differences in the epidemiology of multiresistant gram-positive cocci between the USA and Germany. According to recent reports, the prevalence of high-level penicillin-resistant pneumococci (PRP), meticillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) in clinically relevant isolates of hospitalised patients in the USA and Germany are: PRP, 14% versus less than 1%; MRSA, 36% versus 15%; and VRE, 15% versus 1%. These disparities may be explained by several determinants: (1) diagnostic practice and laboratory recognition (all three pathogens); (2) clonal differences and pathogen transmissibility (VRE); (3) antibiotic prescribing practices (all three pathogens); (4) population characteristics, including extensive daycare exposure in the USA (PRP); (5) cultural factors (all three pathogens); (6) factors related to the health-care and legal system (all three pathogens); and (7) infection-control practices (MRSA and VRE). Understanding these determinants is important for preventing further spread of multiresistant cocci within the USA. A rational approach to national surveillance is urgently needed in Germany to preserve the favourable situation and decrease MRSA transmission. Finally, we suggest that a macro-level perspective on antibiotic resistance can broaden the understanding of this worldwide calamity, and help prevent further dissemination of multiply resistant microorganisms.     

Effects of daily bathing with chlorhexidine and acquired infection of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: a meta-analysis

Objective

Chlorhexidine gluconate (CHG) is a common and safe antimicrobial agent and has been used widely in hand hygiene and skin disinfection; however, whether daily bathing with CHG results in the reduced acquired infection of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) remains inconclusive.

Methods

We did a meta-analysis searching PubMed, Embase and the Cochrane Central Register database for available studies. Primary outcomes were acquired infection of MRSA, VRE.

Results

In all, twelve articles were available in this review. We found that daily application of chlorhexidine bathing would significantly low the acquired colonization of MRSA [incidence rate ratio (IRR) =0.58, 95% confidence interval (CI): 0.41-0.82] or VRE (IRR =0.51, 95% CI: 0.36-0.73). Remarkably, the using of CHG bathing would significantly reduce the MRSA infection (IRR =0.56, 95% CI: 0.37-0.85), MRSA ventilator associated pneumonia (VAP) (IRR =0.22, 95% CI: 0.07-0.64) and VRE infection (IRR =0.57, 95% CI: 0.33-0.97). No significant publication bias was found in this meta-analysis.

Conclusions

The application of CHG bathing would significantly decrease acquired infection of MRSA or VRE, which may be an important complementary intervention to barrier precautions.KEY WORDS : Chlorhexidine, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE)     

Recent advances in the treatment of infections due to resistant Staphylococcus aureus

PURPOSE OF REVIEW: This paper reviews recent data on the treatment of infections caused by drug-resistant Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA). This review will focus on new findings reported in the English-language medical literature from June 2003 to September 2004. RECENT FINDINGS: Despite the emergence of resistant and multidrug-resistant S. aureus, we have three effective drugs in clinical use for which little resistance has been observed: quinupristin-dalfopristin, linezolid, and daptomycin. Linezolid looks particularly promising in the treatment of MRSA pneumonia. Daptomycin displays rapid bactericidal activity in vitro, but, so far, clinical trials have only been conducted for the treatment of skin and soft-tissue infections. There are three drugs with broad-spectrum activity against Gram-positive organisms at an advanced stage of testing: two new glycopeptides with potent bacteriocidal activity and long half-lives (oritavancin and dalbavancin), and tigecycline, a minocycline derivative. These drugs have also shown efficacy in the treatment of skin and soft-tissue infections. SUMMARY: The promising data that have emerged in the last year indicate that we may have six available drugs to treat resistant S. aureus infections within the next few years. The next goal is to determine the appropriate indications and cost-effectiveness of each of these drugs in our treatment strategy against S. aureus and other Gram-positive pathogens.     

Prevalence of methicillin-resistant Staphylococcus aureus among university students in Thailand

We studied the prevalence of methicillin sensitive Staphylococcus aureus (MSSA) and methicillin resistant Staphylococcus aureus (MRSA) nasal colonization among healthy young Thai adults. MSSA nasal colonization was found in 30 of 200 subjects (15%). The prevalence of MRSAnasal carriage was 1% (2 of 200) detected by cefoxitin/oxacillin disk diffusion and oxacillin salt screening methods. These carriers were associated with health care risk factors. The two MRSA isolates were mecA positive, SCCmec type II. All S. aureus isolates were tested for antibiotic resistance. Their resistance rates to penicillin, erythromycin, clindamycin, oxacillin and cefoxitin were 96.7, 26.7, 26.7, 6.7 and 6.7%, respectively. All MSSA and MRSA isolates were susceptible to gentamicin, chloramphenicol, trimethoprim/sulfamethoxazole, rifampicin, linezolid, fusidic acid, mupirocin, ciprofloxacin and vancomycin. The results of this first study of MRSA nasal colonization among healthy young Thai adults suggests MRSA is present in the Thai community.     

Prediction rules to identify patients with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci upon hospital admission

BACKGROUND: In 2003, the Society of Healthcare Epidemiology of America (SHEA) recommended surveillance cultures upon hospital admission for patients at high risk for carriage of vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). The aim of this study was to assess the validity of factors from past medical history in defining patients at high risk for subsequent positive cultures with VRE or MRSA upon hospital admission. METHODS: Subjects were adult inpatients admitted to nonintensive care wards of the index hospital during 2001-2002. Cases had MRSA or VRE positive clinical cultures within 48 hours of hospital admission. Patients with previous history of MRSA or VRE were excluded. RESULTS: Nineteen thousand three hundred ninety-nine patients were included, with 273 cases of VRE or MRSA. Previous admission within 1 year of current admission had a sensitivity of 56.8% and a specificity of 88.4% for predicting a case of MRSA or VRE. Individually, the sensitivity and specificity for admission within the past year were 50.5% and 88.4%, respectively, for MRSA and 76.9% and 88.4%, respectively, for VRE. CONCLUSIONS: Patients with a previous hospital admission represent a high-risk population for positive culture for VRE and MRSA and may be a group of which active surveillance is indicated.     

Infection control and antimicrobial restriction practices for antimicrobial-resistant organisms in Canadian tertiary care hospitals

In 2003, a survey examining infection control and antimicrobial restriction policies and practices for preventing the emergence and transmission of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), and extended spectrum beta-lactamase (ESBL) was performed within Canadian teaching hospitals as part of the Canadian Nosocomial Infection Surveillance Program. Twenty-eight of 29 questionnaires were returned. The majority of facilities conducted admission screening for MRSA (96.4%) and VRE (89.3%) but only 1 site screened for ESBL/AmpC. Rates of MRSA, VRE, and ESBL remain low in Canada. It is believed that these lower rates may be due to intense admission screening protocols and stringent infection control policies for antimicrobial-resistant organisms (AROs) within Canadian institutions. Few (MRSA: 14.8%; VRE: 12.0%) recorded the number of patients screened. Regular prevalence surveys were done for MRSA (21.4%), VRE (35.7%), and ESBL/AmpC (3.8%). Pre-emptive precautions were applied for MRSA by 60.7% and for VRE by 75.0% of facilities. All facilities flagged patients previously identified with MRSA and VRE but only 46.2% flagged ESBL and 15.4% flagged AmpC patients. Barrier precautions varied by ARO and patient-care setting. In the inpatient non-ICU setting, more than 90% wore gowns and gloves for MRSA and VRE but only 50% for ESBL; and 57.1% wore masks for MRSA. Attempts to decolonize MRSA patients had been made by 82.1%, largely in order to place them in another facility. Policies restricting antimicrobial prescribing were reported by 21 facilities (75.0%). Further studies examining hospital infection control policies and corresponding rates of ARO infections would help in identifying and refining best practice guidelines within Canadian institutions.     

ICU机械通气患者多重耐药菌定植与感染状况调查分析

目的研究重症监护病房机械通气(mechanical ventilation,MV)患者多重耐药菌主动筛查及定植与感染状况调查分析。方法从2012年3月到2013年3月,选择128例住院患者作为研究对象。使用MRSA和ESBILs及VRE型显色培养基对样本中大肠埃希菌(Eschericia coli,EC)和肺炎克雷伯菌(Klebsiella pneumoiae,KP),以及耐甲氧西林金黄色葡萄球菌(Methicillin-resistant Staphylococcus aureus,MRSA)和耐万古霉素肠球菌(Vancomycin-resistant enterococci,VRE)等细菌进行筛查。结果 128份送检标本中共分离多重耐药菌株共计132株。其中EC 114株,占比86.36%;MRSA 8株,占比6.06%;KP 5株,占比3.79%;VRE 5株,占比3.79%。132株多重耐药菌中,整体而言,定植与感染均以EC为主;进入ICU≤48h时,共有110例患者监测到多重耐药菌,经分离后得到112株,其中由社区带入者占比56.36%(62/110),由院内其他病室带入者占比43.64%(48/110),两者对比差异无统计学意义(P0.05)。此外,社区和院内分别在EC、MRSA、KP及VRE等方面对比,差异均无统计学意义(均P0.05)。进入ICU48 h后,共有18例患者被监测出含有多重耐药菌,并分离耐药菌株20株。结论强化对ICU机械通气患者多重耐药菌的筛查与分析十分必要,此举有助于临床准确诊断和治疗,值得临床推荐应用。     

Risk of acquiring antibiotic-resistant bacteria from prior room occupants

BACKGROUND: Environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) occurs during the care of patients harboring these organisms and may increase the risk of transmission to subsequent room occupants. METHODS: Twenty-month retrospective cohort study of patients admitted to 8 intensive care units performing routine admission and weekly screening for MRSA and VRE. We assessed the relative odds of acquisition among patients admitted to rooms in which the most recent occupants were MRSA positive or VRE positive, compared with patients admitted to other rooms. RESULTS: Of 11 528 intensive care unit room stays, 10 151 occupants were eligible to acquire MRSA, and 10 349 were eligible to acquire VRE. Among patients whose prior room occupant was MRSA positive, 3.9% acquired MRSA, compared with 2.9% of patients whose prior room occupant was MRSA negative (adjusted odds ratio, 1.4; P = .04). VRE, Among patients whose prior room occupant was VRE positive, these values were 4.5% and 2.8% respectively (adjusted odds ratio, 1.4; P = .02). These excess risks accounted for 5.1% of all incident MRSA cases and 6.8% of all incident VRE cases, with a population attributable risk among exposed patients of less than 2% for either organism. Acquisition was significantly associated with longer post-intensive care unit length of stay. CONCLUSIONS: Admission to a room previously occupied by an MRSA-positive patient or a VRE-positive patient significantly increased the odds of acquisition for MRSA and VRE. However, this route of transmission was a minor contributor to overall transmission. The effect of current cleaning practices in reducing the risk to the observed levels and the potential for further reduction are unknown.     

Novel agents for resistant Gram-positive infections—a review

Gram-positive infections have increased in recent years, particularly those that are of nosocomial origin, leading to a broad use of agents with activity against these pathogens. Concomitantly, antimicrobial resistance of these pathogens also became widespread. Among the most common Gram-positive resistant pathogens are: Streptococcus pneumoniae, resistant to penicillin and macrolides, methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-intermediately-resistant S. aureus (GISA), methicillin-resistant S. epidermidis, glycopeptide-resistant enterococci and vancomycin-resistant enterococci (VRE). The response of the pharmaceutical industry to this challenge was the development of new antibiotics active against these pathogens. Among these antibiotics, this review will focus on: linezolid, an oxazolidinone; GAR-936, a tetracycline derivative; daptomycin, a lipopeptide; and ortivancin (LY333328), a glycopeptide related to vancomycin. Except for linezolid, which has been recently launched in many countries, all other agents referred to in this review are still at various developmental stages. It is hoped that in the near future most of these agents will be approved and thus the grim outlook of patients infected with resistant Gram-positive bacteria may improve.