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Clinical Aspects of Antimicrobial Resistance

      Soon after penicillin was introduced into clinical use, an enzyme (penicillinase) that inactivated it was discovered. Since then, the variety of antimicrobial agents has increased substantially, along with a parallel increase in resistant pathogenic microorganisms. Resistance is now recognized against all available antimicrobial agents. Factors influencing the emergence of resistance include indiscriminate use of antibiotics, prolonged hospitalizations, increasing numbers of immunocompromised patients, and medical progress resulting in increased use of invasive procedures and devices. This article provides an update on clinical aspects of a few commonly found resistant microorganisms relevant to day-to-day clinical practice. A discussion of all resistant organisms is beyond the scope of this report. Both viral and mycobacterial resistance have been addressed in previous articles in this symposium.
      AIDS (acquired immunodeficiency syndrome), CSF (cerebrospinal fluid), DRSP (drug resistant S. pneumoniae), ESBLs (extended spectrum β-lactamases), HIV (human immunodeficiency virus), ICU (intensive-care unit), MICs (minimal inhibitory concentrations), MRSA (methicillinresistant S. aureus), PBP (penicillin-binding protein), VRE (vancomycin-resistant enterococci)
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      References

        • Cohen ML
        Epidemiology of drug resistance: implications for a post-antimicrobial era.
        Science. 1992; 257: 1050-1055
        • Acar JF
        Consequences of bacterial resistance to antibiotics in medical practice.
        Clin Infect Dis. 1997; 24: S17-S18
        • Report of the ASM task force on antibiotic resistance
        Antimicrob Agents Chemother Suppl. 1995; : 1-23
        • Thornsberry C
        • Ogilvie P
        • Kahn J
        • Maurlz Y
        • Laboratory Investigator Group
        Surveillance of antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae. and Moraxella catarrhalis in the United States in 1996-1997 respiratory season.
        Diagn Microbiol Infect Dis. 1997; 29: 249-257
        • American Society of Microbiology, Public Scientific Affairs Board
        Report of the ASM Task Force on Antibiotic Resistance. American Society of Microbiology, Washington, DC1995
        • Cetron MS
        • Jernigan OB
        • Brelman RF
        • DRSP Working Group
        Action plan for drug-resistant Streptococcus pneumoniae [editorial].
        Emerg Infect Dis. 1995; 1: 64-65
        • 1996 ASCP Susceptibility Testing Group
        • American Society of Clinical Patbotogists
        United States geographic bacteria susceptibility patterns.
        Am J Clin Pathol. 1998; 109: 144-152
        • Hlramatsu K
        • Aritaka N
        • Hanaki H
        • Kawasaki S
        • Hosoda Y
        • Hort S
        • et al.
        Dissemination in Japanese hospitals of strains of Staphylococ-cus aureus heterogeneousiy resistant to vancomycin.
        Lancet. 1997; 350: 1670-1673
        • Sieradzkl K
        • Roberts RB
        • Kaber SW
        • Tomasz A
        The development of vancomycin resistance in a patient with methicillin-resistant Staphy-lococcus aureus infection.
        N Eng J Med. 1999; 340: 517-523
        • Segat-Maurer S
        • Urban C
        • Rahal Jr, JJ
        Current perspectives on multidrug-resistant bacteria: epidemiology and control.
        Infect Dis Clin Norm Am. 1996 Dec; 10: 939-957
        • Campbell Jr, GD
        • Sllberman R
        Drugresistant Streptococcus pneumoniae.
        Clin Infect Dis. 1998; 26: 1188-1195
        • Chen DK
        • McGeer A
        • de Azavedo JC
        • Low DE
        • Canadian Bacterial Surveillance Network
        Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada.
        N Engt J Med. 1999; 341: 233-239
        • Pikis A
        • Donkersloot JA
        • Akram S
        • Keith JM
        • Campos JM
        • Rodriguez WJ
        Decreased susceptibility to imipenem among penicillin-resistant Streptococcus pneumoniae [published erratum appears in J Antimicrob Chemother 1997;40:462].
        J Antimicrob Chemother. 1997; 40: 105-108
        • Breiman RF
        • Butler JC
        • Tenover FC
        • Elliott JA
        • Facklam RR
        Emergence of drug-resistant pneumocaccal infections in the United States.
        JAMA. 1994; 271: 1831-1835
        • Eiopoulos GM
        Vancomycin-resistant enterococci: mechanism and clinical relevance.
        Infect Dis Clin North Am. 1997 Dec; 11: 851-865
        • Maranan MC
        • Moreira B
        • Boyle-Vavra S
        • Daum RS
        Antimicrobial resistance in staphylococci: epidemiology, molecular mechanisms, and clinical relevance.
        Infect Dis Clin North Am. 1997 Dec; 11: 813-849
        • Gerberdlng JL
        • McGowan Jr, JE
        • Tenover FC
        Emerging nosocomial infections and antimicrobial resistance.
        Curr Clin Top Infect Dis. 1999; 19: 83-98
        • Herold BC
        • Immergluck LC
        • Maranan MC
        • Lauderdale DS
        • Gaskin RE
        • Boyle-Vavra S
        • et al.
        Community-acquired methicillin-resistant Staphytococcus aureus in children with no identified predisposing risk.
        JAMA. 1998; 279: 593-598
        • Collignon P
        • Gosbell I
        • Vlckery A
        • Nlimmo G
        • Stylianopoulos T
        • Gottlieb T
        • Australian Group on Antimicrobial Resistance
        Community-acquired meticillin-resistant Staphylococcus aureus m Australia [letter].
        Lancet. 1998; 352: 145-146
        • Scheel O
        • Lyon DJ
        • Rosdahl VT
        • Adeyeml-Doro FA
        • Ling TK
        • Cheng AF
        In-vitro susceptibility of isolates of methicillin-resistant Staphylococcus aureus 1988-1993 [published erratum appears in J Antimicrob Chemother 1996;38:919].
        J Antimicrob Chemother. 1996; 37: 243-251
        • Acar JF
        • Goldstein FW
        Trends in bacterial resistance to fluoroquinolones.
        Clin Infect Dis. 1997; 24: S67-S73
        • Centers for Disease Control and Prevention
        Staphylococcus aureus with reduced susceptibility to vancomycin-United States, 1997 [published erratum appears in MMWR Morb Mortal Wkly Rep 1997:46:851].
        MMWR Morb Mortal Wkly Rep. 1997; 46: 765-766
        • Centers for Disease Control and Prevention
        Update: Staphylococcus aureus with reduced susceptibility to vancomycin-United States. 1997 [published erratum appears in MMWR Morb Mortal Wkly Rep 1997;46:851].
        MMWR Morb Mortal Wkly Rep. 1997; 46: 813-815
        • Raad I
        • Alrahwan A
        • Rolston K
        Staphylococcus epidermidis: emerging resistance and need for alternative agents.
        Clin Infect Dis. 1998; 26: 1182-1187
        • French GL
        Enterococci and vancomycin resistance.
        Clin Infect Dis. 1998; 27: S75-S83
        • Moellering Jr, RC
        Vancomycin-resistant enterococci.
        Clin Infect Dis. 1998; 26: 1196-1199
        • Centers for Disease Control and Prevention
        Nosocomial enterococci resistant to vancomycin-United States, 1989-1993.
        MMWR Morb Mortal Wkly Rep. 1993; 42: 597-599
        • Huycke MM
        • Sahm DF
        • Gilmore MS
        Multiple-drug resistant enterococci: the nature of the problem and an agenda for the future.
        Emerg Infect Dis. 1998; 4: 239-249
        • Nordmann P
        Trends in β-lactamase resistance among Entera-bactenaceae.
        Clin Infect Dis. 1998; 27: S100-S106
        • Lind I
        Antimicrobial resistance in Neisseria gonorrhoeae.
        Clin Infect Dis. 1997; 24: S93-S97
        • Gordon SM
        • Carlyn CJ
        • Doyle U
        • Knapp CC
        • Longworth DL
        • Hall GS
        • et al.
        The emergence of Neisseria gonorrhoeae with decreased susceptibility to ciproflonacin in Cleveland, Ohio: epidemiology and risk factors.
        Ann Intern Med. 1996; 125: 465-470
        • Drusano GL
        Infection in the intensive care unit: β-lactamase-mediated resistance among Enterobacteriaceae and optimal antimi crobial dosing.
        Clin Infect Dis. 1998; 27: S111-S116
        • Pitout JD
        • Sanders CC
        • Sanders Jr, WE
        Antimicrobial resistance with focus on beta-lactam resistance m gram-negative bacilli.
        Am J Med. 1997; 103: 5159
        • Bush K
        Metallo-β-lactamases: a class apart.
        Clm Infect Ois. 1998; 27: S48-S53
        • Rasmussen BA
        • Bush K
        • Tally FP
        Antimicrobial resistance in anaerobes.
        Clin Infect Dis. 1997; 24: S110-S120
        • MacGowan AP
        • Bowker KE
        • Bennett PM
        • Lovering AM
        Surveillance of antimicrobial resistance [letter].
        Lancet. 1998; 352: 1783
        • Denning DW
        Can we prevent azole resistance in fungi?.
        Lancet. 1995; 346: 454-455
        • Pfaller MA
        • Jones RN
        • Messer SA
        • Edmond MB
        • Wenzel RP
        National surveillance of nosocomial blood stream infection due to Candida albicans: frequency of occurrence and antifungal susceptibility in the SCOPE Program.
        Diagn Microbiol Infect Dis. 1998; 31: 327-332
        • Pfaller MA
        • Jones RN
        • Messer SA
        • Edmond MB
        • Wenzel RP
        • SCOPE Participant Group
        National surveillance of nosocomial blood stream infection due to species of Candida other than Candida albicans: frequency of occurrence and antifungal susceptibility in the SCOPE Program.
        Diagn Microbiol Infect Dis. 1998; 30: 121-129
        • Sterling TR
        • Gasser Jr, RA
        • Ziegler A
        Emergence of resistance to amphotericin B during therapy for Candida glabrata infection in an immunocompetent host.
        Clin Infect Dis. 1996; 23: 187-188
        • Denning DW
        • Baily GG
        • Hood SV
        Azole resistance in Candida.
        Eur J Clin Microbiol Infect Dis. 1997; 16: 261280
        • Levy SB
        • FitzGerald GB
        • Macone AB
        Changes in intestinal flora of farm personnel after introduction of tetracycline-supplemented feed on a farm.
        N Engl J Med. 1976; 295: 583-588
        • McGowan J
        Antimicrobial resistance on hospital organisms and its relation to antibiotics use.
        Rev Infect Dis. 1983; 5: 1033-1048
        • Baquem F
        • Martlnei-Beltran J
        • Loza E
        A review of antibiotic resistance patterns of Streptococcus pneumoniae in Europe.
        J Antimicrob Chemother. 1991; 28: 31-38
        • Guillemot D
        • Carbon C
        • Balkau B
        • Geslln P
        • Lecoeur H
        • Vauzelle-Kervraedan F
        • et al.
        Low dosage and long treatment duration of beta lactam: risk factors for carriage of penicillin-resistant Streptococcus pneumoniae.
        JAMA. 1998; 279: 365-370
        • Cartiedge JD
        • Midgley J
        • Gazzard BG
        Prior fluconazole exposure as an independent risk factor for fluconazole resistant candidosis in HIV positive patients; a case-control study.
        Genitourinary Med. 1997; 73: 471-474
        • Chavanet P
        • Lop J
        • Grappin M
        • Bonnin A
        • Duong M
        • Waldner A
        • et al.
        Cross-sectional study of the susceptibility of Candida isolates to antifungal drugs and in vitro-in vivo correlation in HIV-infected patients.
        AIDS. 1994; 8: 945-950
        • Dronde F
        • Alomo-Sanz M
        • Laguna F
        • Chaves F
        • Martlnsz-Suarez JV
        • Rodrlguez-Tudola JL
        • et al.
        Mixed orophaiyngeal candidiasis due to Candida albicans and non-albicans Candida strains in HIV-infected patients, Eur.
        J Clin Microbiol Infect Dis. 1996; 15: 446-452
        • Hoald AE
        • Cox GM
        • Sehall WA
        • Barttatt JA
        • Perfect JR
        Oropharyn-geal yeast flora and fluconazole resistance in HIV-infected patients receiving long-term continuous versus intermittent fluconazole therapy-.
        AIDS. 1996; 10: 263-268
        • Lucas GM
        • Lechtzn N
        • Puryear DW
        • Yau LL
        • Fexner CW
        • Moore RD
        Vancomycin-resistant and vancomycin-susceptible enterococcal bacteremia: comparison of clinical features and outcomes.
        Clin Infect Dis. 1998; 26: 1127-1133
        • Davor LL
        • China C
        • Eng RH
        • O'Donovan C
        • Johanton Jr, WG
        Vancomycin-resistant Enterococcus faecium in a Veterans Affairs Medical Center: association with antibiotic usage.
        Am J Infect Control. 1998; 26: 40-46
        • Gaynea R
        Antibiotic resistance in ICUs: a multifaceted problem requiring a multifaceted solution [editorial], infect.
        Control Hosp Epidemiol. 1995; 16: 328-330
        • Qulnn JP
        Clinical problems posed by multiresistant nonfermenting gram-negative pathogens.
        Clin Infect Dis. 1998; 27: S117-S124
        • Manlan FA
        • Mayor L
        • Jarma J
        • Owen A
        • Taff T
        Loss of antimicrobial susceptibility in aerobic gram-negative bacilli repeatedly isolated from patients in intensive-care units, infect.
        Control Hosp Epidemiol. 1996; 17: 222-226
        • Jacoby GA
        Extended-spectrum beta-lactamases and other enzymes providing resistance to oxyimino-beta-lactams.
        Infect Dis Clin North Am. 1997 Dec; 11: 875-888
        • Pfaller MA
        • Messer SA
        • Houston A
        • Rangal-Frauato MS
        • Wlblln T
        • Blumborg HM
        • et al.
        National Epidemiology of Mycoses Survey: a multicenter study of strain variation and antifungal susceptibility among isolates of Candida species.
        Dragn Microbiol infect Dis. 1998; 31: 289-296
        • Toltzls P
        • Hoyen C
        • Sptamar-Block S
        • Salvator AE
        • Rlce LB
        Factors that predict preexisting colonization with antibiotic-resistant gram-negative bacilli in patients admitted to a pédiatrie intensive care unit.
        Pediatrics. 1999; 103: 719-723
        • Verwaeet C
        • Verhaegen J
        • Ferdinande P
        • Schatz M
        • Van den Berghe G
        • Verblst L
        • et al.
        Randomized, controlled trial of selective digestive decontamination in 600 mechanically ventilated patients in a multidisoplinary intensive care unit.
        Crit Care Med. 1997; 25: 63-71
        • Sproat LH
        • Inglia TJ
        A multlcentre survey of hand hygiene practice in intensive care units.
        J Hosp Infect. 1994; 26: 137-148
        • Faryna A
        • Wergowake GL
        • Goldenberg K
        Impact of therapeutic guidelines on antibiotic use by residents in primary care clinics.
        J Gen Intern Med. 1987; 2: 102-107
        • Gonzales R
        • Stelner JF
        • Sande MA
        Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians.
        JAMA. 1997; 278: 901-904
        • Nyqulst AC
        • Gonzales R
        • Stelner JF
        • Sande MA
        Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis [published erratum appears in JAMA 1998;279:1702].
        JAMA. 1998; 279: 875-877
        • McCalg LF
        • Hughe JM
        Trends in antimicrobial drug prescribing among office-based physicians in the United States [published erratum appears in JAMA 1998:279:434].
        JAMA. 1995; 273: 214-219
        • Kunln CM
        Resistance to antimicrobial drugs—a worldwide calamity.
        Ann Intem Med. 1993; 118: 557-561
        • Tauxo RV
        • Puhr ND
        • Well JG
        • Hargrett-Bean N
        • Blake PA
        Antimicrobial resistance of Shigella isolates in the USA: the importance of international travelers.
        J Infect Dis. 1990; 162: 1107-1111
        • Smith KE
        • Bettor JM
        • Htdberg CW
        • Loano FT
        • Bender JB
        • Wlcklund JH
        • et al.
        Quinolone-resistant Campylobacter jejuni infections in Minnesota, 1992-1998.
        N Eng) J Med. 1999; 340: 1525-1532
        • Clavo-Sanchez AJ
        • Glron-Gonzalez JA
        • Lopez-Prteto D
        • Canueto-Qulntero J
        • Sanchez-Porto A
        • Vergara-Campot A
        • et al.
        Multivariate analysis of risk factors for infection due to penicillin-resistant and multidrug-resislant Streptococcus pneumoniae: a multicenter study.
        Clin Infect Dis. 1997; 24: 1052-1059
        • Doono JL
        • Kleaplet SL
        • Sabelln C
        Risk factors for penicillin-resistant systemic pneumococcal infections in children.
        Clin Pediatr. 1997; 36: 187-191
        • Hofmann J
        • Cetron MS
        • Farley MM
        • Baughman WS
        • Facklam RR
        • Elliott JA
        • et al.
        The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta.
        N Engt J Med. 1995; 333: 481-486
        • Boyce JM
        • Opal SM
        • Chow JW
        • Zervoa MJ
        • Potter-Bynoe G
        • Sherman CB
        • et al.
        Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance.
        J Clin Microbiol. 1994; 32: 1148-1153
        • Khachatourlan GG
        Agricultural use of antibiotics and the evolution and transfer of antibiotic-resistant bacteria.
        CMAJ. 1998; 159: 1129-1136
        • Marwick C
        Animal feed antibiotic use raises drug resistance fear.
        JAMA. 1999; 282: 120-122
        • Rlley LW
        • Cohen ML
        • Sealt JE
        • Blaser MJ
        • Blrknaaa KA
        • Hargrott NT
        • et al.
        Importance of host factors in human salmonellosis caused by multiresistant strains of Salmonella.
        J Infect Dis. 1984; 149: 87-883
        • MacDonald KL
        • Cohen ML
        • Hargrett-Boan NT
        • Wollt JG
        • Puhr ND
        • Collin SF
        • et al.
        Changes in antimicrobial resistance of Salmonella isolated from humans in the United States.
        JAMA. 1987; 258: 1496-1499
        • Grlggt DJ
        • Hall MC
        • Jin VF
        • Plddoek LJ
        Quinolone resistance in veterinary isolates of Salmonella.
        J Antimicrob Chemother. 1994; 33: 1173-1189
        • Gaunt PN
        • Plddoek LJ
        Ciprofloxacin resistant Campylobacter spp. In humans: an epidemiological and laboratory study.
        J Antimicrob Chemother. 1996; 37: 747-757
        • Throttall EJ
        • Graham A
        • Cheaaty T
        • Ward LR
        • Row B
        Resistance to ciprofloxacin in pathogenic Enterobactenaceae in England and Wales In 1996.
        J CIin Pathol. 1997; 50: 1027-1028
        • Threlfall EJ
        • Frort JA
        • Rowe B
        Fluoroquinolone resistance in Satmonellas and Campylobacters from humans [letter].
        BMJ. 1999; 318: 943-944
        • Murray BE
        Vancomycin-resistant enterococci.
        Am J Med. 1997; 102: 284-293
        • Mayor KH
        • Opal SM
        • Medairoa AA
        Mechanisms of antibiotic resistance.
        in: Mandell GL Bennett JE Dolin R Mendell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 4th ed. Churchill Livingstone, New York1995: 212-225
        • Neu HC
        The crisis of antibiotic resistance.
        Science. 1992; 257: 1064-1073
        • Carmell Y
        • Trolllet N
        • Karchmer AW
        • Samore MH
        Health and economic outcomes of antibiotic resistance in Pseudomonas aeruginosa.
        Arch Intern Med. 1999; 159: 1127-1132
        • Schlappe DA
        • Hayden MK
        • Matuahek MG
        • Hashemi FN
        • Sullivan J
        • Smith KY
        • et al.
        Ceftazidime-resistant Klebsiella pneumoniae and Escherichia coli bloodstream infection: s case-control and molecular epidemioioglc investigation.
        J Infect Dis. 1996; 174: 529-536
        • Chow JW
        • Fine MJ
        • Shlaee DM
        • Qulnn JP
        • Hooper DC
        • Johnson MP
        • et al.
        Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy.
        Ann Intern Med. 1991; 115: 585-590
        • Llndan PK
        • Paaculle AW
        • Menez R
        • Kramer DJ
        • Fung JJ
        • Pinna AD
        • et al.
        Differences in outcomes for patients with bacteremia due to vancomycin-resistant fnterococcus faecium or vancomycin-susceptible E. faecium.
        Lin Infect Dis. 1996; 22: 663-670
        • Stotor V
        • Peterson LR
        • Postelnick M
        • Noakln G
        Enterococcus faecium bacteremia: does vancomycin resistance make a difference?.
        Arch intern Med. 1998; 158: 522-527
        • Harbarth S
        • Ruttchmann O
        • Sud P
        • Phttet D
        Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus.
        Arch Intern Med. 1998; 158: 182-189
        • Ardltl M
        • Mason Jr, EO
        • Bradley JS
        • Tan TQ
        • Barton WJ
        • Schutze GE
        • et al.
        Three-year multicenter surveillance of pneumococcal meningitis in children: clinical characteristics, and outcome related to penicillin susceptibility and dexamelhasone use.
        Pediatrics. 1998; 102: 1087-1097
        • Tan TQ
        • Maeon Jr, EO
        • Barton WJ
        • Wald ER
        • Schütze GE
        • Bradley JS
        • et al.
        Clinical characteristics and outcome of children with pneumonia attributable to penicillin-susceptible and penicillin-nonsusceptibie Streptococcus pneumoniae.
        Pediatrics. 1998; 102: 1369-1375
        • Coudron PE
        • Moland ES
        • Sandort CC
        Occurrence and detection of extended-spectrum beta-lactamases in members of the family Enterobacteriaceae at a veterans medical center: seek and you may find.
        J Clin Microbiol. 1997; 35: 2593-2597
        • Centers for Disease Control and Prevention
        Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC).
        MMWR Morb Mortal WMy Rep. 1995; 44: 1-13
        • Rahman M
        Alternatives to vancomycin in treating methicillin-resistant Staphylococcus aureus infections.
        J Antimicrob Chemother. 1998; 41: 325-328
        • Cookton BD
        The emergence of mupirocin resistance: a challenge to Infection control and antibiotic prescribing practice.
        J Antimicrob Chemother. 1998; 41: 11-18
        • Murrey BE
        Diversity among multidrug-resistant enterococci.
        Emerg Infect Dis. 1998; 4: 37-47
        • Antony SJ
        • Ladner J
        • Stratton CW
        • Raudales F
        • Dummer SJ
        High-level aminogiycoside-resistant enterococcus causing endocarditis successfully treated with a combination of ampicillin, imipenem and vancomycin.
        Scand J Infect Dis. 1997; 29: 62-630
        • Brandt CM
        • Rouse MS
        • Laue NW
        • Stratton CW
        • Wilson WR
        • Steckelberg JM
        Effective treatment of multidrug-resistant entero-coccal experimental endocarditis with combinations of cell wall-active agents.
        J Infect Dis. 1996; 173: 909-913
        • Lorlan V
        • Femandee F
        Synergic activity of vancomycin-quinupristin/dalfopristin combination against Enterococcus faecium.
        J Antimicrob Chemother. 1997; 39: 63-66
        • Kang SL
        • Rybak MJ
        In-vitro bactericidal activity of quinupristin/dalfopristin alone and In combination against resistant strains of Enierocœcus species and Staphytococcus aureus.
        J Antimicrob Chemother. 1997; 39: 33-39
        • Hill RL
        • Smith CT
        • Seyed-Akhavanl M
        • Casewell MW
        Bactericidal and inhibitory activity of quinuprislin/dalfopristin against vancomycin- and gentamlcin-resistant Enterococcus faecium.
        J Antimicrob Chemother. 1997; 39: 23-28
        • Linden PK
        • Pasculle AW
        • McDevItt D
        • Kramer DJ
        Effect of quinuprislin/dalfopristin on the outcome of vancomycin-resistant Enterococcus faecium bacteremia: comparison with a control cohort.
        JAntim crobCnemoiriet. 1997; 39: 145-151
        • Noekln GA
        Vancomycin-resistant enterococci: clinical, microbiologie, and epidemiologic features.
        J Lab Clin Med. 1997; 130: 14-20
        • Rybak MJ
        • Cappelletty DM
        • MoMovan T
        • Aeschllmann JR
        • Kaatz GW
        Comparative in vitro activities and posiantibiotic effects of the oxazolidinone compounds eperezolid (PNU-100592) and linezolid (PNU100766) versus vancomycin against Staphytococcus aureus, coagulase-negative staphylococci, Enterococcus faecalis, and Enterococcus faecium.
        Antimicrob Agents Chemother. 1998; 42: 721-724
        • Petal R
        • Rouee MS
        • Piper KE
        • Cockerlll III, FR
        • Steckelberg JM
        In vitro activity of LY333328 against vancomycin-resistant enterococci, methicillin-resistant Staphytococcus aureus, and penicillin-resistant Streptococcus pneumonias.
        Diagn Microbiol Infect Dis. 1998; 30: 89-92
        • Centers for Disease Control and Prevention
        Defining the public health impact of the drug-resistant Streptococcus pneumoniae: report of a working group.
        MMWR Morb Mortal Wkty Rep. 1996; 45: 1-21
        • Hardie WD
        • Robertt NE
        • Raiting SF
        • Chrletle CD
        Complicated para pneumonic effusions in children caused by peniciltin-nonsusceptible Streptococcus pneumoniae.
        Pediatrics. 1998; 101: 388-392
        • Pallares R
        • Lina J
        • Vadillo M
        • Cabelloa C
        • Manreea F
        • Vlladrlch PF
        • et al.
        Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain [published erratum appears in N Engt J Med 1995:333:1655].
        N Engt J Med. 1995; 333: 474480
        • Leggladro RJ
        The clinical impact of resistance in the management of pneumococcal disease, infect Dis.
        Clin North Am. 1997 Dec; 11: 867-874
        • Friedland IR
        • Klugman KP
        Cerebrospinal fluid bactericidal activity against cephalosporin-resistant Streptococcus pneumoniae in children with meningitis treated with high-dosage cefotaxime.
        Antimicrob Agents Chemother. 1997; 41: 1888-1891
        • Schreiber JR
        • Jacobe MR
        Antibiotic-resistant pneumococci.
        Pediatr Clin North Am. 1995 Jun; 42: 519-537
        • John CC
        Treatment failure with use of a third-generation cephalosporin far penicillin-resistant pneumococcal meningitis: case report and review.
        Clin Infect Dis. 1994; 18: 188-193
        • Dolt C
        • Barre J
        • Cohen R
        • Bonacoral S
        • Bourrillon A
        • Blngen EH
        Bactericidal activity against intermediately cephalosporin-resistant Streptococcus pneumoniae in cerebrospinal fluid of children with bacterial meningitis treated with high doses of cefotaxime and vancomycin.
        Antimicrob Agents Chemother. 1997; 41: 2050-2052
        • Vlladrich PF
        • Gudlol F
        • Linares J
        • Pallarei R
        • Sabata I
        • Run O
        • et al.
        Evaluation of vancomycin for therapy of adult pneumococcal meningitis.
        Antimicroö Agents Ciwmotfrer. 1991; 35: 2467-2472
        • Klugman KP
        • Madhl SA
        Emergence of drug resistance: impact on bacterial meningitis, infect.
        Dis Clin North Am. 1999 Sep; 13: 637-646
        • Paris MM
        • Hlckey SM
        • Uscher Ml
        • Shetton S
        • Olsen KD
        • McCracken Jr, OH
        Effect of dexamethasone on therapy of experimental penicillin- and cephalosporin-resistant pneumococcal meningitis.
        Antimicrob Agents Chemother. 1994; 38: 1320-1324
        • Friedland IR
        • Paris M
        • Ehrett S
        • Hlckey S
        • sen K
        • McCracken Jr, GH
        Evaluation of antimicrobial regimens for treatment of experimental penicillin- and cephalosporirwesistant pneumococcal meningitis.
        Antimicrob Agents Chemother. 1993; 37: 1630-1636
        • Tunkel AR
        • Scheid WM
        Issues in the management of bacterial meningitis.
        Am Fam Physician. 1997; 56: 1355-1362
        • Fttousel F
        • Dolt C
        • Benall K
        • Bonacoral S
        • Geslln P
        • Blngen E
        Comparative in vitro killing activities of meropenem, imipenem, ceftriaxone, and ceftriaxone plus vancomycin at clinically achievable cerebrospinal fluid concentrations against penicillin-resistant Streptococcus pneumoniae isolates from children with meningitis.
        Antimicrob Agents Chemother. 1998; 42: 942-944
        • Aaensl F
        • Otero MC
        • Perez-Tamarlt D
        • Rodrlguei-Escrlbano I
        • Cabedo JL
        • Gresa S
        • et al.
        Risk/benefit in the treatment of children with imipenem-cilastatin for meningitis caused by penicillin-resistant pneumococcus.
        J Chemother. 1993; 5: 133-134
        • Sehmutihatd E
        • William KJ
        • Vukmlrovtti G
        • Chmellk V
        • Pfausler B
        • Featherstone A
        • Meropenem Meningitis Study Group
        A randomised comparison of meropenem with cefotaxime or ceftriaxone for the treatment of bacterial meningitis in adults.
        J Antimicrob Chemother. 1995; 36: 85-97
        • Wang WC
        • Wong WY
        • Rogers ZR
        • Wlilmas JA
        • Buchanan GR
        • Power DR
        Antibiotic-resistant pneumococcal infection In children with sickle cell disease in the United States.
        J Pediatr Hernatol Oncol. 1996; 18: 140-144
        • Carratala J
        • Matron A
        • Femandez-Sevllla A
        • Linares J
        • Gudlol F
        Treatment of penicillin-resistant pneumococcal bacteremia in neutropenic patients with cancer.
        Clin Infect Dis. 1997; 24: 148-152
        • Pfaller MA
        • Jones RN
        Comparative antistreptococcal activity of two newer fluoroquinolones, levofloxacin and sparíloxacin.
        Diagn Microbiol infect Dis. 1997; 29: 199-201
        • Klugman KP
        • Gootz TD
        In-vitro and in-vivo activity of tmvafloxacin against Streptococcus pneumoniae.
        J Antimicrob Chemother. 1997; 39: 51-55
        • Nuort) JP
        • Butler JC
        • Crutcher JM
        • Guevara R
        • Welch D
        • Holder P
        • et al.
        An outbreak of multidrug-resistant pneumococcal pneumonia and bacteremia among unvaccinated nursing home residents.
        N Engt J Med. 1998; 338: 1861-1868
        • Espine-Mngroff A
        Clinical relevance of antifungal resistance.
        Infect Dis Clin North Am. 1997 Dec; 11: 929-944
        • Rex JH
        • Bennett JE
        • Sugar AM
        • Pappa PG
        • van der Hont CM
        • Edward JE
        • CandMemla Study Group and the National Institute
        • et al.
        A randomized trial comparing fluconazole with ampfiotericin B for the treatment of candidemia in patients without neutropenia.
        N Engl J Med. 1994; 331: 1325-1330
        • Shlaea DM
        • Gerdlng DN
        • John Jr, JF
        • Cralg WA
        • Bernstein DL
        • Duncan RA
        • et al.
        Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals.
        Clin Infect Dis. 1997; 25: 584-599
        • Seppala H
        • Klaukka T
        • Vuopio-Varkila J
        • Muotlala A
        • Helenlu H
        • Lager K
        • Finnish Study Group for Antimicrobial Resistance
        • et al.
        The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland.
        Ai Engl J Med. 1997; 337: 441-446
        • King JW
        • White MC
        • Todd JR
        • Conrad SA
        Alterations in the microbial flora and in the incidence of bacteremia at a university hospital after adoption of amikacin as the sole formulary aminoglycoside.
        Clin Infect Dis. 1992; 14: 908-915
        • Young EJ
        • Sewell CM
        • Koza MA
        • Clerrldge JE
        Antibiotic resistance patterns during aminoglycoside restriction.
        Am J Med Sd. 1985; 290: 223-227
        • Araton VA
        • Krltlnion KG
        • Slgurdsaon JA
        • Stefansdottlr G
        • Molstad S
        • Gudmundsaon S
        Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence study.
        BMJ. 1996; 313: 387-391
        • Nowak R
        Hungary sees an improvement in penicillin resistance.
        Science. 1994; 264: 364
        • Centers for Disease Control and Prevention
        Interim guidelines for prevention and control of slaphylococcal infection associated with reduced susceptibility to vancomycin.
        MMWR Morb Mortal Wkly Rep. 1997; 46 (635): 626-628