Changing patterns of bacterial nosocomial infections: a nine-year study in a general hospital.

Surveillance data on 12,944 bacterial isolates derived from nosocomial infections, reported to the Department of Microbiology and Infectious Diseases of the Hellenic Air Force and VA General Hospital over a 9-year period (1986-1994), were analyzed by the use of a microbial infection control software system. Overall, the isolation rate of Escherichia coli decreased from 25.2% in 1986 to 18.2% in 1994 and Proteus spp. from 5.3 to 2.6%. Remarkably, Pseudomonas spp. increased from 7.2 to 11.3%, Enterobacter spp. from 1.6 to 5.1%, Klebsiella spp. from 5.9 to 7.8% and Enterococcus spp. from 3 to 7.4%. Interestingly, the above phenomenon was paralleled by a significant increase in resistance rate to various antibiotics. Specifically, Staphylococcus aureus and coagulase-negative staphylococci, though they did not display any significant variation in isolation rates, showed an alarming increase in resistance rate to oxacillin, from 11 and 21% in 1986 to 51 and 75% in 1994, respectively. Enterococcus spp. sensitivity to vancomycin remained unlatered at 90%. The above-mentioned serious shift towards more resistant bacteria should be a matter of consideration.