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Penicillin-resistant and multiresistant pneumococci occur throughout the world and at high prevalence in certain areas. Pneumococci resistant of cefotaxime and ceftriaxone have so far become established in Spain, South Africa and the USA, and the occurrence of such strains was recently reported in the UK. In Iceland, the first penicillin-resistant pneumococci were identified in December 1988, and by 1993 the prevalence was 20 percent. The risk factors appear to be the congregation of children at day-care centres, excessive consumption of antibiotics, and the common use of the sulphamethoxazole-trimethoprim combination (co-trimoxazole). The consumption of antibiotics in Iceland has been reduced, and the incidence of resistant pneumococci is somewhat lower than formerly.

A survey of bacterial resistance rates in four intensive care units (ICU) at a Swedish university hospital showed an increase of ampicillin resistant enterococci from 3.2 percent 1993 to 17.7 percent 1994. This increase of ampicillin-resistant enterococci was due to an increase of Enterococcus faecium with chromosomal ampicillin resistance. The survey also showed a relative high level of cefalosporine resistance, at the ICUs, among Enterobacter spp and to some extent among Escherichia coli and Klebsiella spp. A simultaneously performed survey of all blood isolates from the four hospitals in the county revealed the same development of resistance but the resistance rates were lower compared with the ICUs. To reduce the spread of resistant bacterial isolates there is a need for decreased and optimized antibiotic consumption as well as isolation of patients infected with resistant isolates.