Nonetheless, prospective surveillance projects such as ours will allow rapid detection of such infections, which initially appeared in Japan 17.18 and have been reported in the United States. Over the past two decades, enterococci have become increasingly important nosocomial pathogens. Currently, they are the third leading cause of bloodstream infections in the hospital setting. There are no currently approved, efficacious antibiotics to treat vancomycin-resistant E. faecium, and many different regimens are being tried in the United States. Significantly higher rates of vancomycin resistance in isolates from hemodialysis patients is likely to be associated with higher rates of vancomycin utilization in that population.
Yeasts continue to be important causes of nosocomial bloodstream infections.
Of interest is the sizable fraction of infections caused by non-albicans Candida species and the geographic variation in these species. Interestingly, Pseudomonas nosocomial bloodstream infections were not more prevalent in the neutropenic population, which may reflect changes in antimicrobial therapy for the empiric treatment of neutropenic fever. In general, aminoglycosides, ciprofloxacin and imipenem displayed good activity against the most common pathogens. Unfortunately, ampicillin no longer displays significant activity against any of the important hospital acquired, gram-negative organisms. Thus, it no longer has a role in the empiric treatment of gram-negative, nosocomial bloodstream infections.