8. Clindamycin resistance rates for Staphylococcus aureus will continue to rise. In our institution, 25% of pneumococcal strains and 12% of S. aureus are resistant. My colleague Dr. Christopher Harrison believes that if pneumococcal serotype 19A decreases with PCV 13, clindamycin resistance rates for pneumococcus in general may decrease. The level of resistance at which recommendations for treatment of staphylococcal infection will need to be changed is not clear. Some think alternative treatment should be considered at above 10%.
9. Speaking of resistance, vancomycin may no longer be the cornerstone of therapy for methicillin-resistant S. aureus (MRSA) infection by year's end. In the past, a typical S. aureus minimum inhibitory concentration (MIC) for vancomycin was 0.25–0.5 μg/mL. More recently, MICs of 1 (now 60% or so of isolates) or higher (still just 1%) have been seen, a phenomenon that has been termed “MIC creep.” Data in the adult population suggest that even if dosing is pushed to 60 mg/kg per day—the dosing typically used for CNS infections—clinical failures may occur at higher MICs.
10. We will need better evidence to support the utility of newer antistaphylococcal drugs including linezolid, daptomycin, telavancin, and ceftobiprole. Linezolid remains a very expensive drug choice with predictable adverse reactions, particularly neutropenia. Dosing for daptomycin (a lipopeptide), telavancin (a lipoglycopeptide), and ceftobiprole (our first fifth generation cephalosporin) are still not set.
Lastly, I predict—or at least hope for—a happy, healthy, and productive 2010 for all