Antimicrobial-resistant gram-positive bacteria in PD peritonitis and the newer antibiotics used to treat them

The incidence of resistant gram-positive bacteria in noso-comial and, more recently, community-acquired infections is increasing. Staphylococci, because of their natural habitat on the skin, have always been the leading cause of peritonitis in patients receiving peritoneal dialysis (PD). These organisms have demonstrated a remarkable ability to develop resistance to antibiotics, first with penicillin, then antistaphylococcal penicillins (methicillin-resistant Staphylococcus aureus), and more recently, strains expressing resistance to vancomy-cin (vancomycin-intermediate and vancomycin-resistant S. aureus) have emerged. Enterococci are normal inhabitants of the gastrointestinal tract and occasionally cause PD peri-tonitis. In the past 15 years, vancomycin-resistant entero-cocci have emerged as significant pathogens in many areas. In the past 5 years, novel antibiotics that have activity o