Antimicrobial management strategies for Gram-positive bacterial resistance in the intensive care unit

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Abstract
This article summarizes the current situation with Gram-positive infections, including the two primary consequences—failure to cure and resistance—relevant to the intensive care unit. The past few years have seen Enterococcus faecium resistance to vancomycin increase from 10% of strains to approaching 60% of strains in some centers. Failure is now so frequent that vancomycin can no longer be safely used. This has lead to use of two new antibiotics, quinupristin/dalfopristin (Synercid), first marketed in the United States in September 1999, and linezolid (Zyvox), which reached the U.S. market in May 2000. Both of these agents are being used to treat culture-proven vancomycin-resistant E. faecium. The calculated areas under the inhibitory curve (AUIC) values of vancomycin, even when its minimal inhibitory concentration (MIC) is 4.0 μg/mL, show almost all vancomycin-resistant E. faecium have AUICs Staphylococcus aureus