MULTIRESISTANT BACTERIA AS A HOSPITAL EPIDEMIC PROBLEM

Since the introduction of antibiotics into clinical use, bacteria have protected themselves by developing antibiotic resistance mechanisms. Currently, there are increasing problems worldwide with multiresistant bacteria. These problems are especially evident within hospitals, whe re they frequently present as nosocomial epidemics. Currently, the mos t important nosocomial resistance problems on a global scale are cause d by methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and Enterobacteriaceae with plasmid-encoded extended-spec trum beta-lactamases. In this review we describe the characteristics o f nosocomial epidemics of these three groups of multiresistant nosocom ial pathogens. Despite the differences in bacterial species, the diffe rences in mechanisms of resistance, the different ecological niches an d the different infections caused by these pathogens, there are striki ng similarities in the variables determining nosocomial spread. The ex istence of each of these multiresistant micro-organisms and their conc urrent spread seem to result from extensive antibiotic use and lapses in compliance with infection control measures. Problems with these bac teria became evident as monoclonal outbreaks, soon followed by establi shment of endemicity especially in intensive care units. Finally, ende micity seems to be established on general hospital wards and in chroni c care facilities and nursing homes, creating a continuous influx of c olonized patients into special care wards. High compliance with infect ion control measures and a prudent and more restrictive use of antibio tics are the key measures to prevent these epidemics.