HOSPITAL-WIDE ANTIMICROBIAL USE AND NOSOCOMIAL ENTEROCOCCAL BACTEREMIA

Enterococci are important nosocomial pathogens capable of causing seri ous infections. Recent data from the CDC indicate that the frequency o f nosocomial enterococcal bacteremias and enterococcal resistance in t he United States is increasing. This study was undertaken to determine the amount of hospital-wide antibiotic use and the incidence of nosoc omial enterococcal infections over a several-year period. At William B eaumont Hospital, Royal Oak, Michigan, we collected information on the number of nosocomial bacteremia cases (defined as infection occurring >72 hours after a patient entered the hospital without clinical or la boratory evidence of enterococci) and the antibiotics utilized over an 8-year period (1987-1994). Information on source of bacteremia, lengt h of hospital stay, number of admissions, and antibiotic resistance wa s also obtained. The mean length of stay, 6.7 days (range, 6.3-7.1), a nd mean number of admissions, 38,843 patients (range, 37, 627-40,940), was stable between 1987 and 1994. During the study period, there was a significant increase in the amount of penicillins (P < .001), vancom ycin (P < .001), and total antibiotics (P < .001) used hospital-wide a nd a significant decline in the cephalosporins (P = .004) used hospita l-wide. From 1989 to 1994, there was a significant reduction in the nu mber of nosocomial enterococcal bacteremia infections (P = .038). A co ntrol measure to be considered for reducing nosocomial acquisition of enterococcal bacteremia may be to decrease hospital-wide cephalosporin use in favor of agents that have in vitro activity against enterococc i.