Abstract
Since the early 1980s, much attention has been focused on the emergence or resistance in nosocomially acquired Gram-negative pathogens. However, in the 1990s we are witnessing in North America the development and spread or multiple resistance in Gram-positive pathogens in the hospital selling as well as in the community. Methicillin resistant Staphylococcus aureus and vancomycin-resistant enterococci are now endemic in many urban centres in the United States, although less so in Canada. In some states, penicillin -resistant Streptococcus pneumoniae in the community selling has gone from rates of less than 5% in 1988 to 50% in 1994, including: resistance to third-generation cephalosporins and carbapenems. Although these same pathogens have now been identified in Canada, we may still be in a position to limit or prevent their spread.