THE GROWING PROBLEM OF NOSOCOMIAL BACTERIAL-RESISTANCE - AN EPIDEMIOLOGIC PERSPECTIVE WITH EMPHASIS ON THE FLUOROQUINOLONES

Today's nosocomial microbiological environment is characterised by inc reasing numbers of drug-resistant bacteria, notably methicillin-resist ant staphylococci, glycopeptide-resistant enterococci, extended-spectr um beta-lactamase-producing Enterobacteriaceae and hyperproducers (or stably derepressed mutants) of AmpC beta-lactamases. Although the prec ise prevalence of these pathogens varies between institutions and betw een countries, they are now sufficiently widespread to pose a major cl inical and therapeutic problem. Treatment options for these pathogens, especially multidrug-resistant Grampositive bacteria, are limited. Ho wever, the new broad-spectrum fluoroquinolone agents may have some pot ential against these and other pathogens. An important factor likely t o influence the efficacy of these agents is the degree of fluoroquinol one resistance in the nosocomial setting. Infection control measures a nd the rational use of the fluoroquinolones as a class must be encoura ged to ensure that the full potential of these valuable agents is real ised.