[Nosocomial infections: back to the future]

The increasing rate of nosocomial infections seems to be related to the wider use of invasive procedures. Evaluation of the patient risk factors for infection, use of SIRS classification and knowledge of the setting care should be utilized for the diagnostic approach. The empiric antibiotic therapy should take in account the site of the infection (bacteremia, pneumonia, urinary tract infection etc.) and the presumed pathogen; knowledge of the local epidemiology is a pre-requisite for the antibiotics choice. Among gram-positive microorganisms, methicillin-resistant staphylococci and vancomycin-resistant enterococci are responsible of difficult to treat infections; penicillin-resistant pneumococci, largely present in some european countries, might become an emerging pathogen also in Italy. The knowledge and ability of infectious diseases specialist encompasses clinical, microbiological and epidemiological fields to play a key role in the prevention and management of nosocomial infections.