Many of the major surveillance networks were established in the late 1990s,182 a time when resistance became recognized as a widespread problem. However, nosocomial infections had been recognized for decades, as evidenced by establishment of the National Healthcare Safety Network (NHSN) in 1970 for U.S. hospitals.182 By the end of the 1990s, several networks were in place for European hospitals (HELICS, 1994; EARSS, 1998) and U.S. intensive care facilities ((ICARW, 1995). Respiratory infections also received attention in the U.S. (TRUST, 1996) and elsewhere (Alexander Project, 1992; PROTEKT, 1999). Community care centers in Canada and Europe began collating data for resistant urinary infections (ECO-SENS, 1999). As the resistance problem increased in severity, surveillance expanded to cover "common pathogens" in medical centers and outpatient facilities, initially in 30 countries worldwide (SENTRY, 1997). To study the relationship between antibiotic use and resistance, German intensive care units set up a network (SARI) in 2000. These and other surveillance networks establish that antibiotic resistance is a serious, growing problem.
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