A review of traditional resistance surveillance methodologies and infection control

The hospital affords an excellent environment for the proliferation of pathogenic bacteria and for the selection of antimicrobial-resistant strains. This article traces the evolution of microbiologic surveillance techniques and highlights some of the more effective means of infection control. Traditional surveillance methods relied on nationwide antimicrobial susceptibility data for practical information regarding the nature of infectious disease trends in order to guide the selection of appropriate empiric antibiotic therapy. The application of nationwide antibiograms to the local hospital setting may mask the local emergence of rapidly developing resistances, such as chromosomally mediated type-I beta-lactamase resistance, which has been associated with increased use of certain cephalosporins. "Focused surveillance" techniques yield improved detection of emerging localized resistances within specific hospital units. In addition to unit-specific surveillance, many hospitals are now observing the advantages of an infection site-specific monitoring program. Judicious use of newer antimicrobials and implementation of detailed hospitalwide surveillance procedures will help to minimize the spread of epidemic and resistant infections. It remains the responsibility of the infection control and antibiotic utilization or advisory committees to make appropriate recommendations concerning the selection, restriction, and proper use of the newer extended-spectrum antibiotics. The clinical microbiology laboratory as a source of information remains a key participant in a quality program.