NEW MICROBIOLOGICA, 30, 326-331, 2007 Antibiotic resistance in long-term care facilities Silvano Esposito, Sebastiano Leone, Silvana Noviello, Filomena Ianniello, Marco Fiore Department of Infectious Diseases, Second University of Naples, Naples, Italy Long-term-care facilities (LTCFs) comprise a heterogeneous group of institutions that provide a wide variety of services to diverse groups of patients, most of whom are elderly. Infections are common in LTCFs and these are complicated by antimicrobial-resistant pathogens. The residents in LTCFs have a high frequency of colonization with antimicrobial-resistant organisms, including methicillin-resistant Staphylococcus aureus, vancomycin-resist- ant enterococci, penicillin-resistant pneumococci, extended spectrum β-lactamase-producing gram-negative organ- isms, and fluoroquinolone-resistant gram-negative organisms. Although several control programs have been pub- lished, up to now there still is a long way to go in this area of health care. This review will briefly touch upon the clinical relevance of antimicrobial resistance in LTCFs. KEY WORDS: Antibiotic resistance, Bacterial infections, Long-term care facilities SUMMARY INTRODUCTION The populations of developed countries are becoming increasingly elderly. Aging is associated with an increased frequency of chronic diseases and declining functional status necessitating insti- tutional care for at least some time for a sub- stantial proportion of the elderly. Infections are common among residents in long-term care facil- ities (LTCFs), with a frequency comparable to rates observed in acute care facilities. Infection rates vary from 1.8 to 7.1 per 1,000 resident days (Nicolle et al., 1996). Respiratory tract infections, urinary tract infections, and skin and soft tissue infections are the most common (Nicolle, 2000). The reported incidence of nursing home-acquired pneumonia ranges from 0.3 to 2.5 episodes per 1000 days of resident care (Muder, 1998; Medina- Walpole and Katz, 1998; Mylotte, 2002). At 5 nurs- ing homes in Toronto, Ontario, Canada, from 1993 through 1996, the incidence of home-acquired pneumonia was 0.7 episodes per 1000 days of res- ident care (Loeb et al., 1999). Other prospective studies on the epidemiology of infections in res- idents of LTCFs report an incidence of sympto- matic urinary infection that varies from 0.1 to 2.4 cases per 1000 resident-days; while most patients are asymptomatic, the prevalence rates of bac- teriuria are 25% to 50% (Nicolle, 1997; Nicolle, 2000). Skin and soft tissue infections include decu- bitus ulcers, infected vascular or diabetic foot ulcers, erysipelas, and other types of cellulitis. The residents of LTCFs have a high frequency of col- onization with antimicrobial-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), penicillin-resistant pneumococci (PRP), extended spectrum β-lactamase–producing gram- negative organisms (ESBL), and fluoroquinolone- resistant gram-negative organisms (FQ-R). This review will briefly touch upon clinical relevance of antimicrobial resistance in LTCFs. METHICILLIN-RESISTANT STAPHYLOCOCCI MRSA was first described in 1961, and since then it has become a worldwide problem (Jevons, 1961; Diekema et al., 2004; Tansel et al., 2003; Corresponding author Prof. Silvano Esposito Clinica Malattie Infettive Via D. Cotugno 1, 80135 Napoli, Italy E-mail: silvanoesposito@libero.it