What is the significance of Gram-positive cocci?

From the Guidelines

Gram-positive cocci are a significant cause of superficial infections, including impetigo, erysipelas, and cellulitis, and should be managed with antibiotics against Gram-positive bacteria, such as streptococci and S. aureus, as recommended by the 2018 WSES/SIS-E consensus conference 1. The majority of superficial skin and soft-tissue infections (SSTIs) are caused by Gram-positive bacteria, particularly streptococci and S. aureus, as stated in the 2018 WSES/SIS-E consensus conference recommendations 1. Key points to consider when managing Gram-positive cocci infections include:

• Impetigo is a highly contagious bacterial infection of the superficial layers of the epidermis, predominantly affecting children, and is nearly always caused by β-hemolytic Streptococcus spp. and/or S. aureus 1.
• Erysipelas is a fiery red, tender, painful plaque with well-demarcated edges, commonly caused by streptococcal species, usually Staphylococcus pyogenes, with S. aureus rarely causing erysipelas 1.
• Cellulitis is an acute bacterial infection of the dermis and the subcutaneous tissue, most commonly affecting the lower extremities, and is typically caused by streptococci, with staphylococcal cellulitis being more localized 1. Treatment should begin promptly with agents effective against the typical Gram-positive pathogens, especially streptococci, and may include oral beta-lactams, macrolides, and lincosamides, with fluoroquinolones approved for the treatment of most uncomplicated cellulitis, but not adequate for treatment of MRSA infections 1. In cases where MRSA is suspected, glycopeptides and newer antimicrobials are the best options, as recommended by the 2018 WSES/SIS-E consensus conference 1.

From the FDA Drug Label

The in vitro spectrum of activity of linezolid also includes certain Gram-negative bacteria and anaerobic bacteria Linezolid has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections, as described in the INDICATIONS AND USAGE section Aerobic and facultative Gram-positive microorganisms Enterococcus faecium (vancomycin-resistant strains only) Staphylococcus aureus (including methicillin-resistant strains) Streptococcus agalactiae Streptococcus pneumoniae (including multi-drug resistant isolates [MDRSP]1) Streptococcus pyogenes

• Gram-positive cocci are significant because they include bacteria such as Staphylococcus aureus and Streptococcus species, which can cause serious infections.
• These bacteria are often resistant to multiple antibiotics, making treatment challenging.
• Linezolid is effective against certain Gram-positive cocci, including vancomycin-resistant Enterococcus faecium and methicillin-resistant Staphylococcus aureus 2.
• Daptomycin is also active against Gram-positive bacteria, including Staphylococcus aureus and Enterococcus faecalis 3.

From the Research

Significance of Gram-positive Cocci

• Gram-positive cocci, such as Staphylococcus aureus, coagulase-negative staphylococci, the enterococcus, and Streptococcus pneumoniae, are becoming increasingly resistant to traditionally used antimicrobial agents 4
• These pathogens are the most commonly encountered in clinical practice and can cause a range of infections, including bloodstream and soft tissue infections 4, 5
• The increasing resistance of gram-positive cocci to antimicrobial agents is a significant concern, as it can lead to treatment failures and increased morbidity and mortality 6, 7

Clinical Implications

• Clinicians should be aware of the usual types of infections caused by gram-positive cocci and the importance of documenting susceptibilities of infecting strains 4
• The basic mechanisms of resistance should be familiar to clinicians to ensure that an inappropriate empiric regimen is not selected 4
• Newer antimicrobial agents, such as linezolid, daptomycin, and tigecycline, have shown activity against vancomycin-resistant and methicillin-resistant gram-positive cocci 6, 8

Prevention and Control

• Increased efforts towards prevention, such as strict adherence to infection control measures, selective use of broad-spectrum antibiotics, and increased use of pneumococcal vaccine, may be useful to help stem the rising tide of infections due to resistant gram-positive cocci 4, 5
• Vaccines, such as the 7-valent pneumococcal conjugate vaccine, have been shown to be effective in reducing the incidence of invasive pneumococcal disease (IPD) 5