ANTIBIOTIC USE AND NOSOCOMIAL INFECTIONS IN THE USA

Gram-negative bacteriacontinue to be the most common cause ofnosocomial infection, often resulting inextended hospitalization and mortality.Ascompared with penicillins and aminogly-cosides, potent beta-lactam antibioticshave been recently introduced with fewertoxic side efTects and a broader spectrum ofantibacterial activity. The cephalosporinsare the most widely used antibiotics in theUnited States and account for almost$ 1. 6 billion in U. S. health-care dollarsin 1987, cephalosporins commanded 55%of the inpatient/parenteral market and40% of the outpatient/oral market.However, gram-negative organisms suchaspseudomonas aeruginosa and Serratiaspp. may be resistant to the older cepha-losporins, and Enterococcus, methicillin-resistant Staphylococcus spp.and Candidaalbicans are resistant to all cephalosporins.These troublesome pathogens now causean increasing numbers of nosocomialinfections and superinfections in patientswho have received prolonged antibiotictreatment Unfortunately, nosocomial infe-ctions often affect the growing number ofimmunocompromised patients. In the future,nosocomial infections will be more frequentlyassociated with the emergnce of more resistantbacterial strains. Oral monotherapy alternativesto parenteral cephalosporin therapy arebeing tested, and if proven useful mayhelp reduce the upward trend in antibioticcosts.