[Strategies for management of resistant Gram-positive infections: from S. pneumoniae to MRSA]

: S. pneumoniae and methicillin-resistant S. aureus are the main Gram-positive pathogens responsible for severe infections. In the context of community infections S. pneumoniae is the leading Gram-positive pathogen causing severe infections such as purulent meningitis and pneumonia. The typical pattern of antibiotic sensitivity of this bacterium, frequently resistant to macrolides and with significantly reduced sensitivity to penicillin, is only a relative therapeutic problem in that the preserved sensitivity to third-generation cephalosporins and respiratory fluoroquinolones is sufficient to make these antibiotics valid therapeutic solutions without having to use the latest generation of drugs. On the other hand, methicillin-resistant S. aureus, one of the main bacteria responsible for nosocomial infections such as bacteraemia and respiratory tract infections in severely ill patients, is a more challenging therapeutic problem since, historically, the therapeutic options available in clinical practice have been fewer and essentially limited to glycopeptides. The recent availability of oxazolidinones and the pharmacologically more rational and appropriate use of the glycopeptides have undoubtedly brought substantial benefits; the imminent introduction of new molecules active against Gram-positive pathogens will certainly make an important contribution, although their use in clinical practice will need to be monitored.