Nosocomial pneumonia and ventilator-assisted pneumonia may be polymicrobial and can be caused by a wide spectrum of pathogens.
Potentially multidrug-resistant microorganisms often represent the core pathogens of the most severe infections.

Among Gram-positive pathogens, methicillin-resistant Staphylococcus aureus ( MRSA ) plays a key role, mainly in mechanically ventilated patients or in patients with specific risk factors.
The mainstay of treatment for MRSA pneumonia has been glycopeptide antibiotics, i.e. Vancomycin ( Vancocin ) and, to a lesser extent,Teicoplanin ( Targocid ).

However, owing to its insufficient penetration into lung compartments, Vancomycin may result in therapeutic failure or slow clinical responses.
Moreover, Vancomycin serum levels must be monitored in order to minimise nephrotoxicity and to maximise the concentration in the lung.

The emergence of staphylococci isolates with reduced susceptibility to Vancomycin suggests that glycopeptides should no longer be considered as first-line antibacterial agents for Gram-positive lung infections.
Among new therapeutic options, Linezolid ( Zyvox ) may be an appropriate choice for MRSA pulmonary infections owing to its good pharmacokinetic profile in the lung and its acceptable tolerability, especially in patients with renal insufficiency or in those receiving other nephrotoxic agents.

“ To contain the increasing emergence of drug resistance among hospitalised patients, these novel antimicrobial agents should be used judiciously, restricting their use to patients not responsive to, or intolerant of, glycopeptides, “ said Annamaria Ferrara, at University of Pavia, Italy.

Source: International Journal of Antimicrobial Agents, 2007

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