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Panminerva Medica 2002 September;44(3):179-84

lingua: Inglese

Gram-positive bacterial resistance. A challenge for the next millenium

Bassetti M., Melica G., Cenderello G., Rosso R., Di Biagio A., Bassetti D.

From the Infectious Diseases Department, S. Martino Hospital, University of Genoa School of Medicine, Genoa, Italy


Penicillin G was ­first ­used in 1941. Since ­then, the ­trend in bac­te­rial infec­tions has ­changed. New anti­bi­o­tics ­have ­been devel­oped and bac­te­rial resis­tance has ­spread as a con­se­quence. The ­spread of Gram pos­i­tive ­resistant bac­teria is ­related to an inap­pro­priate use of anti­bi­o­tics. Antibacterial ­agents are ­abused or over­used in var­ious ­fields: med­i­cine ­itself, vet­e­ri­nary sci­ence and zoo­tech­nics. Now, at the begin­ning of the ­third mil­len­nium we ­have ­been ­forced to ­limit our ther­a­peutic ­options in ­order to ­combat ­these insid­ious ene­mies. Selective anti­bi­otic pres­sure on the micro­bial pop­u­la­tion, not­ably on enter­o­cocci and staph­y­lo­cocci, ­made ­these two patho­gens recal­ci­trant to tra­di­tional chem­o­therapy. It is a ­matter of con­cern ­that ­today, van­com­ycin-­resistant Enterococcus spp. (VRE) and van­com­ycin-inter­me­diate and ­resistant Staphylococcus ­aureus (­VISA and ­VRSA) are now ­being ­observed world­wide ­among ­emerging patho­gens. Most phar­ma­ceu­tical com­pa­nies are ­today devel­oping anti­mi­cro­bial ­drugs ­that are ­active ­against Gram-pos­i­tive bac­teria. Quinupristin/dal­fo­pristin and lin­e­zolid are the ­most prom­ising ­drugs and are avail­able ­only for ­serious infec­tions; ­future ­agents ­being devel­oped for ­multi-­resistant Gram-pos­i­tive infec­tions ­include dap­tom­ycin and the gly­cy­clines, ­although ­these are ­still in the devel­op­ment ­phase. Nevertheless, our ­group has had the oppor­tu­nity to ­treat ­some ­serious infec­tions ­with ­these ­drugs and the ­good ­results ­achieved are ­reported in ­this ­review.

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