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date: 22 September 2020

Gram-positive bacteria, such as Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus pneumoniae, have long been among the commonest bacterial pathogens of children; more recently, advances in medical practice have led to low virulence bacteria, especially coagulase-negative staphylococci, becoming important pathogens. Other Gram-positive bacteria cause a diverse range of infections. Diagnosis is mainly by microscopy and culture of material collected from the site of infection. Skin and the respiratory tract are the commonest sites of infection, meaning that suspicion of a Gram-positive bacterial infection is one of the commonest reasons why antibiotics are prescribed for children. However, Gram-positive bacteria also cause a wide range of serious invasive infections, including meningitis and bloodstream infections, that cause serious morbidity and mortality despite antibiotic treatment. Although antibiotic resistance has emerged in some Gram-positive bacteria, especially methicillin-resistant S. aureus (MRSA) and penicillin-resistant pneumococci, there are more treatment options for infections with Gram-positive bacteria, compared with Gram-negative bacteria. Because many Gram-positive bacteria are ubiquitous in healthy individuals, specific infection control measures are only indicated for certain types of infection. Good hygiene is the most important means of preventing infections with bacteria such as S. aureus. Vaccines have played an important role in almost eliminating tetanus and diphtheria in Western countries; more recently, pneumococcal vaccination has led to a reduction in the incidence of invasive pneumococcal infections such as meningitis and bacteraemia.

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