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To the Editor.—The role of physician practice in the emergence of drug-resistant bacteria has been highlighted anew by the recent report of vancomycin-resistant Staphylococcus aureus.¹ Shortly thereafter, Dr Gonzales and colleagues² and Dr Schwartz and colleagues³ issued another call for physicians, especially those in outpatient practice, to modify their prescribing patterns. This focus on ambulatory settings is ironic, given that the case described (a patient on long-term ambulatory dialysis who had received multiple courses of vancomycin for repeated episodes of peritonitis associated with methicillin-resistant S aureus) is hardly a typical office encounter.¹

The battle against resistant strains of bacteria is unlikely to succeed if we continue to focus our exhortations on the outpatient setting and pay less attention to the widespread use of empiric antimicrobial therapy in the hospital setting. Too often, debilitated patients and those with late-stage dementia are admitted to the hospital for the infectious crises . . . [Full Text of this Article]

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