In the past several decades, nosocomial infections have emerged as one of the most serious contributors to hospital morbidity and mortality, particularly amongst patients who require intensive care. Resistant organisms, both Gram-negative and Gram-positive, are now to blame for a significant portion of hospital-acquired infections. Efforts to prevent nosocomial infection had historically focused on infection control measures, such as patient isolation. However, there have been numerous reports of the increasing prevalence of antibiotic resistance, as well as the dramatic, negative impact of the infections they cause, both in terms of patient outcomes and attributable costs, demanding new methods to halt this growing epidemic. The increasing threat of resistance may be attributed in part to the widespread and increasingly inappropriate use of antimicrobials, which inadvertently exert sufficient effect on the hospital (and now community) environment to allow the preferential selection of resistant microbes. This idea of selective antibiotic pressure is supported by data showing volume of antibiotic use and inadequate antimicrobial coverage as risk factors for increased morbidity and mortality. Accordingly, the focus of nosocomial infection control has now largely shifted towards the judicious use of antibiotic therapy. There have been numerous attempts to curtail antibiotic usage through various forms of antibiotic stewardship: formulary restriction, computerized decision-support and abbreviated course empiric therapy. Aside from the inherent difficulty of effecting change in physician practice, we are burdened, particularly in the setting of empiric therapy, with the need to balance between adequate therapy for the individual and prudent drug selection so as not to endanger other patients in the environment through resistant organism selection. Cycling chemotherapy for empiric treatment of suspected infection is a method uniquely designed to address these challenges.
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