The January 17, 1996. issue of JAMA, the journal of the AMA, was devoted to this subject. In its editorial, JAMA placed the need for this effort into perspective: "With this international theme, we hope to focus international attention on the problems before us, the challenges we face, and potential solutions. The problems are worldwide; so must be the perspective and solutions."

Researchers painted a grim picture when they released a study concluding that infectious disease deaths in the US increased by 58 percent over a 12-year period.

Robert W. Pinner, MD, Centers for Disease Control and Prevention (CDC) and his colleagues said infectious disease mortality actually increased by 39 percent when the aging of the US population was considered. "Despite historical predictions that infectious diseases would wane in the United States, these data show that infectious diseases mortality has actually been increasing in recent years."

Dr. Pinner and his colleagues sought to develop a comprehensive view of the effects of infectious diseases. To do this, they evaluated all of the diagnostic codes to determine if they represented infectious diseases, and they then analyzed cause-of-death data from 1980 to 1992, including information from filed US death certificates.

Developing a broad and comprehensive view was important, Dr. Pinner said, since it offered valuable information to public policy-makers. Infectious disease trends can change rapidly and affect public health. "To anticipate public health threats effectively, these trends must be monitored well, and policy decisions must take them into account," he said.

By dividing the deaths into disease categories, researchers were able to study trends in individual diseases as well as infectious diseases on the whole. For example, deaths from respiratory tract infections increased by 20 percent over the 12-year period, but increased by 47 percent in 1992 alone. HIV mortality contributed significantly to the high, infectious-disease, death rate‹if HIV was not considered, the death rate increase would have been 22 percent instead of 58 percent.

And finally, deaths from septicemia increased by 83 percent from 1980 to 1992. Researchers were quick to add, however, that the increase in deaths from septicemia is partially due to the aging population, but other factors such as antibiotic resistance and the change in the spectrum of causative agents may have also contributed to this increase.

Dr. Pinner and his colleagues describe the need for further research "as well as review of the validity of diagnostic information recorded on death certificates. Ensuring the validity of diagnoses listed on death certificates may be a particular issue for infectious diseases, which often require specific laboratory tests to confirm diagnoses."

CDC has published a plan that calls for investigators to monitor more accurately trends in infectious disease morbidity and mortality, to identify microbial pathogens responsible for changes in these trends and to develop and use the most effective means of prevention and control.

The article, "Strategies to Prevent and Control the Emergence and Spread of Antimicrobial-Resistant Microorganisms in Hospitals," contains a consensus statement formulated at a workshop co-sponsored by the Centers for Disease Control and Prevention and the National Foundation for Infectious Diseases (NFID).

The statement was designed to provide hospital leaders with strategic goals or actions likely to have a significant impact on antimicrobial resistance, outline outcome and process measures for evaluating progress toward each goal, describe potential barriers to success, and suggest countermeasures and novel improvement strategies.

Ten strategic goals and related process and outcome measures were agreed on for inclusion in the consensus statement-- five goals to optimize antimicrobial use and five goals to detect, report, and prevent transmission of antimicrobial resistant organisms.

The authors of the consensus statement included Donald Goldmann, MD, Robert A. Weinstein, MD, Richard P. Wenzel, MD, Ofelia C. Tablan, MD, Richard J. Duma, MD, PhD, Robert Gaynes, MD, James Schlosser, MD, and William J. Martone, MD.

"Antibiotic resistance is one of the most important problems this country will face in the next decade," said Dr. Duma, former NFID Executive Director.

Requests for reprints of the consensus statement should be addressed to Dr. Donald Goldmann, Division of Infectious Diseases, Children's Hospital, 300 Longwood Ave., Boston, MA 02115.