Personal Reflections on Nosocomial Staphylococcal Infections and the Development of Hospital Surveillance

Abstract

A pandemic ofstaphylococcal infections occurred in the mid-twentieth century and spanned the years from about 1946 (with gradual subsidence) to about 1966. Staphylococcus aureus, originally sensitive to penicillin in 1942, demonstrated, more than other susceptible bacteria, a capacity for the development of antibiotic resistance. Hospital personnel became carriers of antibiotic-resistant staphylococci that contaminated newborn infants and hospitalized children and adults, who then became carriers and suffered an increasing incidence of suppurative disease. Asymptomatic carriers of antibiotic-resistant epidemic strains spread them into communities, with resulting infection of others. Newer antibiotics were developed, only to lose effectiveness as the staphylococci developed resistance. Local, national, and international programs emerged for the development of epidemiologic research, hospital surveillance, and education in methods of prevention and control. Carrier rates of S. aureus among hospital personnel remained ∼33%, while the incidence of nosocomial staphylococcal infections declined. Staphylococcal pandemics may be cyclic in occurrence.