Susceptibility change to antibiotics of Staphylococcus aureus strains isolated from skin infections between July 1994 and November 2000

 We measured the in-vitro susceptibility of 833 Staphylococcus aureus strains, isolated from skin infections at our hospital between July 1994 and November 2000, to 13 antimicrobial agents (ampicillin, methicillin, cephalexin, cefaclor, cefpodoxime proxetil, gentamicin, erythromycin, clindamycin, minocycline, vancomycin, fusidic acid, ofloxacin, and nadifloxacin). The concentrations required to inhibit 50% of the strains (MIC₅₀) of all these antimicrobial agents was extremely stable and ranged at levels below 3.13 μg/ml, except for gentamicin; in contrast, the MIC₉₀ was not uniform. The MIC₉₀ of vancomycin, fusidic acid, and nadifloxacin was very low and stable. No strain was resistant to vancomycin. The incidence of MRSA was 10%–20%. Received: November 1, 2001 / Accepted: February 4, 2002     

Susceptibility of Clostridium ramosum to antimicrobial agents

The susceptibility of 49 strains of Clostridium ramosum to 10 antibiotics was determined by agar dilution and disk diffusion tests. Results showed that, among the anaerobes, C. ramosum is second only to Bacteroides fragilis in its resistance to antimicrobial agents. All strains were susceptible to penicillin, carbenicillin, chloramphenicol, vancomycin, and metronidazole at readily achievable blood levels. Most strains (83%) were susceptible to erythromycin. There was a high level of resistance to clindamycin in 16% of the strains. All isolates were resistant to rifampin and gentamicin, and most were resistant to lincomycin. Assessment of susceptibility by measurement of inhibition zone diameters with disk diffusion tests was not satisfactory.     

Suppressive activity of erythromycin in the expression of cytokine mRNA

We investigated the in vitro effects of erythromycin (EM) on the expression of mRNA for interleukin (IL)-1β, IL-8 and tumor necrosis factor (TNF)-α (inflammatory cytokines) in lipopolysaccharide (LPS)-stimulated human peripheral whole blood (PB) and peripheral blood mononuclear cells (PBMC). In LPS-stimulated PBMC, the expression of 3 cytokines (IL-1β, IL-8, TNFα) was significanttly (P<0.05) suppressed by pretreatment with EM at therapeutic doses. In PB, suppression of expression of IL-1β and TNFα was significant (P<0.05) at therapeutic doses, but IL-8 expression was only slightly suppressed. These results suggest that EM acts as an anti-inflammatory agent by suppressing the production and secretion of inflammatory cytokines by activated monocytes.     

In vitro activity of 79 antimicrobial agents against Corynebacterium group D2.

Corynebacterium group D2 (CGD2) is involved in urinary tract infections in patients with underlying predisposing factors. This microorganism is highly resistant to a number of antimicrobial agents. We tested the activities of 79 antimicrobial agents against CGD2. beta-Lactams, aminoglycosides, and macrolides were ineffective. Fluorinated quinolones showed irregular activities, ofloxacin being the most active one. Doxycycline, rifampin, and mainly glycopeptides (vancomycin and teicoplanin) were the most active antibiotics against CGD2.     

Antimicrobial activity of human pancreatic juice and its interaction with antibiotics.

Pancreatic juice (PJ) should be a factor of variability in the antimicrobial activity of antibiotics eliminated by the pancreas during pancreatic infections. We studied its effects on the activity of antimicrobial drugs with different mechanisms of action. Samples of pure PJ were collected from 16 patients with stabilized external pancreatic fistulas. The antimicrobial activity of the juice at different concentrations (from 1.25 to 100%) alone and in combination with mezlocillin, imipenem, ceftriaxone, gentamicin, ofloxacin, and ciprofloxacin was studied by a microbiological method (continuous turbidimetric recording of bacterial growth). The human PJ showed dose-dependent antimicrobial activity that increased directly with the concentration. The activity of the antibiotics at bactericidal concentrations were not modified by the PJ, while the combination with subinhibitory concentrations produced the following variable and different effects: (i) additivity with mezlocillin, ceftriaxone, gentamicin, and ciprofloxacin and autonomy (no interaction) with imipenem and ofloxacin against Providencia rettgeri and (ii) additivity with ceftriaxone, ofloxacin, gentamicin, imipenem, and mezlocillin and autonomy with ciprofloxacin against Escherichia coli. In the presence of PJ, fluoroquinolones showed constant positive effects, while beta-lactams showed more variable antimicrobial activity. Antibiotic concentrations and PJ pharmacodynamics are the main factors determining the final effect of the interaction in vitro. These results may be useful in choosing antibiotics for the treatment of pancreatic infections when they are supplemented with the pharmacokinetic data for each drug.     

Measurement of antimicrobial agents in cerebrospinal fluid using the abbott TDx analyzer

Occasionally, requests are made by our physicians for the measurement of gentamicin, tobramycin, or vancomycin in cerebrospinal fluid (CSF) specimens during the course of treating patients for bacterial meningitis. We evaluated CSF as a specimen type for the measurement of amikacin, gentamicin, tobramycin, and vancomycin on the Abbott TDx analyzer. Coefficients of variation for CSF spiked with these antimicrobial agents ranged from 0.8% to 6.5% for intra-assay values and from 2.1% to 2.3% for inter-assay values. Serum and CSF specimens were spiked at various levels with equal amounts of the antibiotics. Correlation coefficients for serum vs. CSF for these agents were 0.999. Recoveries ranged from 86% to 134%. Sensitivity for these assays is about fourfold better for CSF than for serum. CSF appears to be an acceptable specimen type for the measurement of these antibiotics using the Abbott TDx analyzer. © 1993 Wiley-Liss, Inc.     

Development of new antibiotic resistance in methicillin-resistant but not methicillin-susceptible Staphylococcus aureus.

The frequency of infections caused by multidrug-resistant Staphylococcus aureus continues to increase while the numbers of alternative therapeutic agents remain limited. To investigate the changing patterns of in-vitro susceptibility of S. aureus to 16 antibiotics, 190 clinical isolates from two different years were studied. The MICs of methicillin-susceptible (MSSA) and methicillin-resistant (MRSA) strains isolated in 1987 were compared with those of similar numbers of strains isolated in 1989. For MRSA > or = 90% of isolates from both years were resistant to clindamycin, gentamicin and erythromycin. These strains remained highly susceptible to vancomycin (100%), minocycline (90%) and rifampicin (100%). The greatest increase in resistance was observed for ofloxacin (2% in 1987 vs 62% in 1989); cross-resistance to all of the quinolones tested was demonstrated. MSSA strains remained susceptible to vancomycin (100%), minocycline (98%), rifampicin (100%), clindamycin (90%), gentamicin (90%) and ciprofloxacin (98%). It is concluded that methicillin susceptibility is a useful marker for selecting potential agents for the treatment of infections caused by S. aureus. A combination of minocycline and rifampicin may be a useful alternative to vancomycin for treating MRSA infections.     

Synergism between penicillin, clindamycin, or metronidazole and gentamicin against species of the Bacteroides melaninogenicus and Bacteroides fragilis groups

Clinical isolates of the Bacteroides melaninogenicus and Bacteroides fragilis groups were tested for in vitro and in vivo susceptibility to penicillin, clindamycin, and metronidazole, used singly or in combination with gentamicin. The in vitro tests consisted of determinations of minimal inhibitory concentrations (MICs) carried out with or without constant amounts of gentamicin. When used alone, gentamicin had negligible effects on the bacteria but significantly reduced the MICs of penicillin, clindamycin, and metronidazole against 11, 10, and 3, of the 15 strains of the B. melaninogenicus group, respectively. The 15 strains of the B. fragilis group were all beta-lactamase producers and were highly resistant to penicillin or the combination of penicillin and gentamicin. However, gentamicin reduced the MICs of clindamycin and metronidazole against 1 and 7 strains of this group, respectively. The in vivo tests were carried out in mice and consisted of measurements of the effects of the antimicrobial agents on the sizes and bacterial content of abscesses induced by subcutaneous injection of bacterial suspensions. The results of the in vivo tests were generally consistent with those obtained in vitro with strains of the B. melaninogenicus group. Synergism between gentamicin and penicillin, clindamycin, or metronidazole was shown in 13, 10, and 3 strains of this group, respectively. In vivo synergism was not clearly demonstrated with the strains of the B. fragilis group, possibly because clindamycin and metronidazole used alone were highly efficacious. We suggest that the synergistic effect of gentamicin is due to its increased transport into the bacterial cell in the presence of penicillin and, possibly, other antimicrobial agents. The newly recognized in vitro and in vivo synergism between penicillin and other antimicrobial agents and an aminoglycoside in B. melaninogenicus may have clinical implications that deserve to be investigated.     

Effectiveness of fosfomycin combined with other antimicrobial agents against multidrug-resistant <Emphasis Type="Italic">Pseudomonas aeruginosa</Emphasis> isolates using the efficacy time index assay

We investigated the effectiveness of fosfomycin combined with other antibiotics, such as piperacillin, cefepime, ceftazidime, imipenem, meropenem, aztreonam, gentamicin, or levofloxacin, against 30 Pseudomonas aeruginosa strains, including multidrug-resistant strains, isolated from clinical specimens, using the efficacy time index (ETI) assay. The assay refers to the result of pharmacokinetics obtained from adult men volunteers, and yields an ETI to evaluate the effect of a combination of antimicrobial agents. With the ETI, based on serum concentration 3 h after the administration of two antimicrobial agents, the effectiveness of antimicrobial combinations was evaluated as follows: poor, ETI < 0.5; fair, 0.5 ≤ ETI < 1; good, 1 ≤ ETI < 8; and excellent, ETI ≥ 8. The combination of fosfomycin and cefepime (efficacy rate [excellent plus good], 76.7%) and fosfomycin/aztreonam (efficacy rate, 76.7%) appeared to be the most effective, followed by fosfomycin/meropenem (efficacy rate, 76.6%), fosfomycin/imipenem (efficacy rate, 73.3%), fosfomycin/ceftazidime (efficacy rate, 70%), fosfomycin/gentamicin (efficacy rate, 70%), fosfomycin/piperacillin (efficacy rate, 66.7%), and fosfomycin/levofloxacin (efficacy rate, 66.7%). Fosfomycin/cefepime, fosfomycin/aztreonam, and fosfomycin/meropenem may be clinically useful in selected patients, particularly for P. aeruginosa. The ETI assay provided information on the minimum inhibitory concentration (MIC) of many pairs of combined antimicrobial agents simultaneously. The ETI assay may be a useful technique with which to investigate the effect of combinations of antimicrobial agents against P. aeruginosa, including multidrug-resistant strains. Received: July 5, 2001 / Accepted: October 29, 2001     

Gentamicin- and methicillin-resistant Staphylococcus aureus: in vitro susceptibility to antimicrobial drugs

Thirteen nosocomially significant, gentamicin- and methicillin-resistant (GRMR) Staphylococcus aureus isolates, all of phage group III/M (lysotype 42E/47/53/54/75/77/83A/84/85/94/96), were uniformly resistant against augmentin, erythromycin, fosfomycin, gentamicin, methicillin, oxacillin, penicillin G, tetracycline, and tobramycin, but differed in susceptibility to cefamandole, ciprofloxacin, clindamycin, imipenem, josamycin, the synthetic chinolone Ro 23-6240, and ofloxacin. All isolates were susceptible to chloramphenicol, coumermycin, fusidic acid, novobiocin, rifampin, teicoplanin, trimethoprim-sulfamethoxazole (cotrimoxazole), and vancomycin. One isolate was of intermediate susceptibility to netilmicin. On a weight-for-weight basis, the 7 most active drugs were rifampin, coumermycin, cotrimoxazole, novobiocin, teicoplanin, fusidic acid, and vancomycin (in decreasing order) in terms of minimal inhibitory concentrations. With regard to minimal bactericidal concentrations, coumermycin, rifampin, vancomycin, teicoplanin, cotrimoxazole, ofloxacin, and ciprofloxacin (in decreasing order) were the 7 most potent antimicrobial drugs. Freshly defibrinated human blood [65% (v/v)] combined with chloramphenicol and rifampin, respectively, resulted in a weak additive effect (time kill curves). Indifferent effects were observed following combination of blood with ciprofloxacin, cotrimoxazole, coumermycin, fusidic acid, imipenem, netilmicin, novobiocin, ofloxacin, compound Ro 23-6240, teicoplanin, and vancomycin. Rifampin combined with novobiocin, teicoplanin, and vancomycin, respectively, in the presence of 65% (v/v) human blood, resulted in an additive effect. Combinations of rifampin with 9 other antimicrobial drugs in blood yielded essentially indifferent effects.     

Streptococcus faecalis: in vitro susceptibility to antimicrobial drugs, single and combined, with and without defibrinated human blood

Ampicillin, fusidic acid, gentamicin, imipenem, mezlocillin, ofloxacin, penicillin G, piperacillin, and vancomycin were examined for inhibitory and bactericidal activity in various broth media against 7 clinical isolates of Streptococcus faecalis. On a weight-for-weight basis, ampicillin, imipenem, mezlocillin, and ofloxacin proved to be more efficacious. All enterococcal isolates were resistant against gentamicin; fusidic acid and vancomycin lacked bactericidal activity. The combinations of either ampicillin, imipenem, mezlocillin, ofloxacin, piperacillin, or vancomycin with a subinhibitory concentration (4 micrograms/ml) of gentamicin, with or without added 65% (v/v) fresh defibrinated human blood, respectively, yielded additive effects against all enterococcal isolates. The addition of fresh human blood failed to enhance the antienterococcal activity of 4 micrograms/ml of gentamicin; in contrast, addition of 65% (v/v) fresh or heat-inactivated (56 degrees C, 30 min) normal rabbit, bovine, and human sera augmented the activity of gentamicin, an effect that was ablated through the addition of either 0.005 M DTT or 0.01 M MgCl2 + 0.01 M EGTA + 0.01 M CaCl2, supplements known to antagonize human serum beta-lysin, but not lysozyme activity.     

Ciprofloxacin therapy of experimental endocarditis caused by methicillin-resistant Staphylococcus epidermidis.

Ciprofloxacin or rifampin was significantly (P less than 0.05) more effective than vancomycin or the combination of vancomycin plus gentamicin for the treatment of Staphylococcus epidermidis experimental endocarditis. There were no significant differences in efficacy among any of the combinations of antimicrobial agents that included ciprofloxacin or rifampin. One animal treated with rifampin alone and one treated with the combination of vancomycin, rifampin, and gentamicin were found to be infected with rifampin-resistant strains of S. epidermidis during therapy. Resistant subpopulations of S. epidermidis were not detected during therapy with any other antimicrobial agent used alone or in combination. Ciprofloxacin alone or in combination with rifampin was effective therapy against S. epidermidis experimental endocarditis.     

In vitro activities of cefotaxime, vancomycin, quinupristin/dalfopristin, linezolid and other antibiotics alone and in combination against Propionibacterium acnes isolates from central nervous system infections

OBJECTIVES: To evaluate the antibiotic susceptibilities of Propionibacterium acnes isolates from central nervous system (CNS) infections to agents used in current treatment regimens. METHODS: MICs of 16 reference antibiotics were determined by an agar dilution method for 24 consecutive strains of P. acnes isolated from individual patients with intracranial empyema or brain abscess. Bactericidal activities of antibiotics against P. acnes PAN14 were studied at 0.25-2 x MIC using a time-kill method. RESULTS: All of the isolates were resistant to fosfomycin, intermediate or resistant to metronidazole and susceptible to all the other antibiotics tested, except for nine strains, which were intermediate to ofloxacin. Among antibiotics tested alone in time-kill experiments, vancomycin was the most effective drug and exhibited bactericidal activity after 24 h at 1x and 2 x MIC, whereas cefotaxime and ciprofloxacin were bactericidal after 48 h at 2 x MIC. No significant bactericidal activity could be demonstrated with the other antibiotics tested alone. The addition of cefotaxime to vancomycin resulted in bactericidal activity at lower concentrations (0.5 x MIC), whereas synergy was observed between quinupristin/dalfopristin and cefotaxime at 2 x MIC. In contrast, antagonism was observed between cefotaxime and linezolid, and ciprofloxacin and clindamycin. CONCLUSION: Our data suggest that P. acnes isolates causing CNS infections remain highly susceptible to most antibiotics used for the treatment of such infections. Moreover, we showed that cefotaxime, vancomycin and ciprofloxacin possess good bactericidal activities against P. acnes, and that these activities may be enhanced when vancomycin is combined with cefotaxime or when cefotaxime is combined with quinupristin/dalfopristin.     

Prolonged stability of antimicrobial activity in peritoneal dialysis solutions.

OBJECTIVE: To evaluate the stability of the antimicrobial chemical and bioactivity of gentamicin, vancomycin, and gentamicin and vancomycin in combination, and the stability of the bioactivity of ceftazidime, admixed in standard peritoneal dialysis solutions and then maintained over a 14-day period at room temperature or under refrigeration. SETTING: Peritoneal dialysis center and microbiology laboratory at a military, teaching medical center. MEASUREMENTS: Standard peritoneal dialysate bags admixed with gentamicin, vancomycin, gentamicin and vancomycin in combination, or ceftazidime were stored at either 4 degrees C or 20 degrees C for 14 days. Sequential aliquots were withdrawn and assayed for antibiotic activity by bioassay and, except for ceftazidime, immunoassay for chemical activity. The bioassay was performed using a standardized Kirby-Bauer disc method. Significance was determined by ANOVA and, where the effect size was significant at the p < 0.05 level, the application of the paired t-test or the Wilcoxon signed rank test to the difference in activity between the first and last samples. RESULTS: Antibiotic concentration by immunoassay did not significantly deteriorate over 14 days for vancomycin or gentamicin when either room temperature or refrigerated samples were studied. By bioassay, gentamicin and ceftazidime, but not vancomycin, lost moderate but significant activity over 14 days when refrigerated bags were assayed (except for an insignificant decrement in gentamicin in the combined vancomycin and gentamicin bags). Bags stored at room temperature, in general, lost significant bioactivity over 14 days, but to levels where clinical efficacy would still be expected. The vancomycin bioassay performed on the combination bags demonstrated a remarkably enhanced bioactivity, presumably reflecting synergy with gentamicin. CONCLUSION: These data indicate that the study antibiotics admixed with peritoneal dialysis fluids retain stable chemical activity, whether refrigerated or kept at room temperature, for at least 14 days. A moderate decrement in bioactivity occurred for study antibiotics when stored either refrigerated or at room temperature over 14 days, although clinically significant levels were maintained.The clinical significance of a possible synergy between vancomycin and gentamicin is yet to be determined.     

Isolation and antimicrobial susceptibility testing of fecal strains of the archaeon Methanobrevibacter smithii

BACKGROUND: The archaeon Methanobrevibacter smithii is regarded as part of the indigenous microflora of the human intestine but may be connected with pathological conditions. The microbe is extremely oxygen intolerant and is not detectable by anaerobic culture techniques for bacteria. Accordingly, to date quantitative antimicrobial susceptibility data of human isolates are missing. METHODS: The anoxic Hungate technique and a three-step culture procedure using media supplemented with antibiotics were applied to isolate M. smithii from randomly selected human feces. The minimum inhibitory concentrations (MICs) of 15 isolates and the reference strain DSM 861 were determined using a broth macrodilution test resembling the procedure for testing anaerobic bacteria. RESULTS: The 16 strains were highly resistant (MICs >64 mg/l) against penicillin G, cephalothin, vancomycin, streptomycin, gentamicin, ciprofloxacin, and clindamycin. Metronidazole inhibited the strains at MICs between 0.5 and 64 mg/l. CONCLUSIONS: Multiple-antibiotic-resistant Methanoarchaea occur in the human gut. They may be selected during therapy with common antibacterial agents and may be eliminated by the application of metronidazole.     

Susceptibility of penicillin-sensitive and -resistant strains of Streptococcus pneumoniae to new antimicrobial agents, including daptomycin, teicoplanin, cefpodoxime and quinolones

The minimal inhibitory concentrations (MICs) of nine antibiotics were determined by agar dilution on 123 strains of Streptococcus pneumoniae (65 penicillin sensitive, 42 intermediate resistant and 16 resistant). The antimicrobial agents tested were penicillin G, clindamycin, trospectomycin, daptomycin, teicoplanin, cefpodoxime, ciprofloxacin, ofloxacin and vancomycin. Of these, daptomycin, teicoplanin and vancomycin demonstrated the greatest in-vitro activity against penicillin-resistant strains (MIC90s less than or equal to 0.25 mg/l). Ciprofloxacin, ofloxacin and trospectomycin had equivalent activities unaffected by penicillin-susceptibility (MIC90 of both quinolones 2.0 mg/l, and of trospectomycin 4.0 mg/l). Cefpodoxime was also active in vitro against all strains (MIC90 2.0 mg/l), but MICs increased with increasing penicillin-MICs. Most penicillin-susceptible strains were susceptible to clindamycin, but many penicillin intermediate resistant and resistant strains were resistant to this drug. Results of this study indicate that several newly introduced and experimental antibiotics have potential in the treatment of infections caused by resistant strains of Str. pneumoniae.     

Bactericidal effects of antibiotics on slowly growing and nongrowing bacteria

Antimicrobial agents are most often tested against bacteria in the log phase of multiplication to produce the maximum bactericidal effect. In an infection, bacteria may multiply less optimally. We examined the effects of several classes of antimicrobial agents to determine their actions on gram-positive and gram-negative bacteria during nongrowing and slowly growing phases. Only ciprofloxacin and ofloxacin exhibited bactericidal activity against nongrowing gram-negative bacteria, and no antibiotics were bactericidal (3-order-of-magnitude killing) against Staphylococcus aureus. For the very slowly growing gram-negative bacteria studied, gentamicin (an aminoglycoside), imipenem (a carbapenem), meropenem (a carbapenem), ciprofloxacin (a fluoroquinolone), and ofloxacin (a fluoroquinolone) exhibited up to 5.7 orders of magnitude more killing than piperacillin or cefotaxime. This is in contrast to optimally growing bacteria, in which a wide variety of antibiotic classes produced 99.9% killing. For the gram-positive and gram-negative bacteria we examined, antibiotic killing was greatly dependent on the growth rate. The clinical implications of slow killing by chemotherapeutic agents for established bacterial infections and infections involving foreign bodies are unknown.     

Molecular characterization of epidemic multiresistant Staphylococcus haemolyticus isolates

Fifty-five Staphylococcus haemolyticus specimens isolated from patients and neonatal intensive care unit staff were tested for susceptibility to 12 antimicrobial agents. There were 34 multidrug-resistant isolates which were resistant to oxacillin, ampicillin, cefazolin, cefmetazole, imipenem, and gentamicin. These isolates had a higher frequency of resistance to tobramicin and ofloxacin, and relatively high MICs (2 to 4 μg/mL) for vancomycin, although none of the isolates were vancomycin resistant. To investigate hospital-acquired colonization and infection by multiresistant S. haemolyticus, we examined all isolates by pulsed-field gel electrophoresis (PFGE) after SmaI and SstII digestion, and detected an endemic PFGE pattern in multiresistant isolates. The results suggested that local spread of multiresistant S. haemolyticus was hospital acquired, and that the hospital staffs functioned as a reservoir.     

Vancomycin-resistant enterococci: the clinical effect of a common nosocomial pathogen

Enterococcus spp. is now the third most common pathogen among hospitalized patients, accounting for nearly 12% of nosocomial infections. Enterococcus faecalis is the most prevalent enterococcal species (85%-89%), whereas Enterococcus faecium accounts for 10%-15% of enterococcal isolates. Only 5% of E. faecalis isolates are resistant to glycopeptides. E. faecium has also been shown to be resistant to nonglycopeptide compounds, such as penicillins (97%), high-level gentamicin (52.1%), and high-level streptomycin (58.3%). Numerous risk factors for vancomycin-resistant enterococci (VRE) have been identified, including as length of hospital- or ICU-stay, proximity to a hospitalized, colonized VRE, patient severity of illness, renal failure, recent surgery, immunosuppression, and organ recipient status. An important risk factor is prior exposure to antibiotics such as vancomycin, ceftazidime, ciprofloxacin, and metronidazole, as well as the number and duration of recent antibiotics. Interventions to reduce nosocomial VRE cross-transmission have also been studied. Using gowns in addition to gloves diminished the incidence of VRE in one study, but had a negligible effect in a second study. Studies have shown that in many cases (> 60%) vancomycin usage is inappropriate. While controlling the use of vancomycin alone has only variably diminished VRE colonization, other efforts such as narrowing the spectrum of antibiotics, antiseptics, and reducing immunosuppression may be salutary. Attempts to eradicate VRE intestinal carriage with enteral agents (bacitracin, tetracycline + rifampin, novobiocin) have been reported but seem to have only a transient effect. Non-antimicrobial interventions such as removal of intravenous or bladder catheters and/or surgical or percutaneous drainage may be beneficial. In addition, the development of new antimicrobial agents such as streptogramins, glycopeptides, everninomicins, and oxazalididones will hopefully play an important role in reducing morbidity from these pathogens.