The management of treatment failures for staphylococcal infections.

Therapeutic failure is a situation to be feared in severe infections due to staphylococci. In this article, we consider the difficulties faced is achieving a positive diagnosis in the context of such failures, and an approach to analysing their causes. The possible reasons for therapeutic failure must be considered systematically. The two principle causes are unquestionably the persistence in the patient of an infected, foreign body (intravenous catheter or prosthesis) and endovascular infections (thrombophlebitis or endocarditis). The rules for the prescription of antibiotics are followed, target concentrations are achieved and drug failures are a rarity today. This observation may be called into question by the emergence of strains with diminished sensitivity to glycopeptides. These therapeutic failures remain exceptional cases today. (C) 2002 Editions scientifiques et medicales Elsevier SAS.