Treatment of severe methicillin-resistant Staphylococcus aureus infections: Vancomycin or new molecules? Recent data

Abstract

Whether vancomycin is still themainstay of therapy for serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA) is currently a matter for debate. Vancomycin resistance among MRSA strains remains extremely rare. However, because of minimum inhibitory concentration (MIC) creep and of the link between vancomycin failure and higher MICs, clinicians should consider using alternative agents either empirically or when vancomycin MIC is > 1 mg/L. Despite intense researches in anti-Gram positive development over the past decade, only few agents have been licensed. Randomized controlled trials and metaanalyses suggest that linezolid is not inferior than glycopeptides for the treatment of hospital-acquired pneumonia and may be even superior in the subset of patients with MRSA infection. Daptomycin, a lipopeptide antibiotic, is extremely bactericidal and is active against biofilm-producing staphylococci. This molecule is an attractive agent for the treatment of bacteremia and endocarditis caused by MRSA. Telavancin, a lipoglycopeptide agent was shown to be non-inferior to vancomycin in the treatment of hospital-acquired pneumonia. Finally, ceftarolin is a broad-spectrum cephalosporin with in vitro activity against methicillin-resistant staphylococci.