I see future in small community clinics. Sooner or later, industry will have to move in this direction.

Duration of hospital stay has emerged as a common risk factor for acquiring not only MRSA but also multi-drug resistant (MDR) gram negative bacteria from most of the published literature. In turn, healthcare-associated infections determine the length of hospital stay.

Research

Burden of healthcare-associated infections in a paediatric intensive care unit of a developing country: a single centre experience using active surveillance.

https://www.ncbi.nlm.nih.gov/pubmed/21676495

Healthcare-associated infections (HAIs) are an important cause of morbidity and mortality among critically ill patients of all age groups. This prospective surveillance study was performed to estimate the burden of HAIs in a paediatric intensive care unit (PICU) of a developing country. During the 12-month study, 187 patients were treated in the PICU for ≥48h, of whom 36 patients had 44 episodes of HAIs. The crude infection rate and incidence density (ID) of HAI were 19.3/100 patients and 21/1,000 patient-days, respectively. Of the 44 episodes of HAI, 27 (61%) were healthcare-associated pneumonia (HAP), 12 (27%) were bloodstream infections (HA-BSI) and four (9%) were urinary tract infections. Mean length of stay and mortality were significantly higher in patients who developed an HAI [25 vs 7 days (P<0.0001) and 50% vs 27.8% (P<0.005), respectively]. Acinetobacter spp. were the commonest infecting bacteria in both HAP and HA-BSI. For developing countries, active surveillance is essential to reduce the burden of HAIs in high risk groups.