Nosocomial Epidemics Seriatim

Nosocomial infections,1-3changing patterns of and increasing antibiotic resistance among the bacteria that cause those infections,4-6and the characteristics of factors involved in the transfer of resistance among them7-9have been subjects of increasing concern in recent years. In addition, there has also been a provocative challenge to physicians about the manner in which they prescribe antibiotics as possibly contributing to those problems.10These problems and concerns are well illustrated in the report of sequential outbreaks of hospital-acquired infections with resistantSerratiaandKlebsiellathat appears in this issue of theArchives(see p 581). OUTBREAK OF INFECTIONS The first infections with gentamicin sulfate-resistantSerratia marcescenswere identified at the Veterans Administration Hospital in Nashville late in 1973. After this epidemic reached its peak and the number of cases began to decline, another wave of infections occurred in the same hospital; this time they were caused