Submitted Successfully!
To reward your contribution, here is a gift for you: A free trial for our video production service.
Thank you for your contribution! You can also upload a video entry or images related to this topic.
Version Summary Created by Modification Content Size Created at Operation
1 + 1338 word(s) 1338 2021-06-17 09:46:12 |
2 update layout and reference Meta information modification 1338 2021-07-23 08:03:06 |

Video Upload Options

Do you have a full video?

Confirm

Are you sure to Delete?
Cite
If you have any further questions, please contact Encyclopedia Editorial Office.
Rodríguez Villodres, �. Multidrug-Resistant Organisms in LTCF. Encyclopedia. Available online: https://encyclopedia.pub/entry/12341 (accessed on 29 March 2024).
Rodríguez Villodres �. Multidrug-Resistant Organisms in LTCF. Encyclopedia. Available at: https://encyclopedia.pub/entry/12341. Accessed March 29, 2024.
Rodríguez Villodres, Ángel. "Multidrug-Resistant Organisms in LTCF" Encyclopedia, https://encyclopedia.pub/entry/12341 (accessed March 29, 2024).
Rodríguez Villodres, �. (2021, July 23). Multidrug-Resistant Organisms in LTCF. In Encyclopedia. https://encyclopedia.pub/entry/12341
Rodríguez Villodres, Ángel. "Multidrug-Resistant Organisms in LTCF." Encyclopedia. Web. 23 July, 2021.
Multidrug-Resistant Organisms in LTCF
Edit

This entry presents the current knowledge about prevalence and risk factors for colonization by multidrug-resistant organisms (MDRO) in long-term care facilities (LTCF) providing useful references to establish objectives for implementing successful antimicrobial stewardship programs (ASP) that might stop the growing trend of MDRO in this setting. 

multidrug-resistant organism long term care facilities nursing homes prevalence

1. Introduction

Older adults confined to chronic care facilities are known to have an increased risk of acquiring infections, most commonly those of the skin, soft tissues, respiratory and urinary tracts, as well as gastroenteritis [1]. The recent COVID-19 outbreak has underlined the vulnerability of this group around the world [2], and the condition of frailty is gaining international attention. According to the Organization for Economic Co-operation and Development (OECD), it is expected that the population aged from 65 to 79 years will rise from about 10% in 2010 to about 15% in 2050 (https://www.oecd.org/els/health-systems/47884543.pdf; accessed on 14 December 2020). Thus, current trends in the world’s demographic structure indicate increasing requirements in long-term care settings.
The emergence of multidrug-resistant organisms (MDROs) is a major public health concern [3]. Bacteria such as extended-spectrum ß-lactamase (ESBL) Escherichia coli, ESBL Klebsiella pneumoniae, carbapenem-resistant (CR) Enterobacterales, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), and multidrug-resistant (MDR) non-fermenting species such as Pseudomonas aeruginosa and Acinetobacter baumannii are increasing in prevalence [4][5][6][7]. Although it is not an MDRO, Clostridioides difficile represents a worldwide public health concern, as it is one of the major causes of antibiotic-associated infections in healthcare settings, especially among older people living in nursing homes (NH) [8][9].
Polypharmacy and inappropriate prescriptions are well-known risk factors for adverse drug reactions, which commonly cause poor clinical outcomes in older people. Antimicrobial resistance is a major negative event resulting from inappropriate prescriptions of antimicrobials [10].
Antimicrobial stewardship programs (ASPs) have been widely implemented in hospitals, with considerable evidence of their impacts on prescription rates and some evidence that they reduce antibiotic-resistant infections [11]. Elderly care facilities and NH could also benefit from these programs. Knowledge of the epidemiology of MDROs at a local and global level is key to implementing successful antimicrobial stewardship intervention.

2. Studies Included

Initially, 182 references were selected. Among these references, 48 were excluded as follows: (i) studies that did not include MDROs, NH, or LTCF (n = 18); (ii) studies reporting infections by MDROs instead of colonization (n = 17); (iii) limited information about the prevalence of or risk factors for colonization by MDROs (n = 9); and (iv) study population duplicated in included studies (n = 4). Ultimately, 134 references were included (Figure 1). Studies included in this review were published from 1987 to 2020). The most frequent MDRO analyzed was MRSA (n = 88, 65.6%) [1][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98] followed by ESBL Enterobacterales (n = 51, 38.0%) [1][14][16][18][19][20][21][22][23][25][31][33][34][39][57][62][73][75][76][82][83][85][89][97][99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114][115][116][117][118][119][120][121][122][123][124][125] (E. coli and K. pneumoniae), VRE (n = 36, 26.8%) [1][13][14][18][20][21][22][23][25][28][31][33][34][37][38][39][57][58][59][60][64][65][66][73][74][76][82][83][89][97][106][109][126][127][128][129], CR Enterobacterales (n = 27, 20.1%) [1][13][18][19][20][21][22][34][60][67][73][82][83][97][100][103][104][108][109][110][113][118][130][131][132][133][134], C. difficile (n = 11, 8.2%) [19][37][106][109][131][135][136][137][138][139][140], MDR A. baumannii (n = 11, 8.2%) [13][20][28][37][60][64][67][74][82][85][141], and MDR P. aeruginosa (n = 8, 5.9%) [13][20][34][37][64][67][85][142]. The types of studies were as follows: 99 (73.8%) cross-sectional studies [1][15][16][17][19][26][28][29][30][31][32][34][35][37][39][40][42][43][44][46][47][50][52][54][55][57][59][60][61][62][65][68][69][70][71][72][73][75][77][78][79][80][81][82][83][84][85][87][88][89][91][92][93][96][97][98][99][100][101][102][103][104][105][106][107][108][109][111][113][116][117][118][119][120][121][122][123][124][125][126][128][129][131][132][133][134][135][137][138][140][141][143], 28 (20.9%) observational prospective studies [12][13][14][18][27][33][36][38][41][45][48][51][53][56][58][66][67][76][90][94][95][110][112][115][127][136][139][144], 3 (2.2%) observational retrospective studies [63][64][114], and 4 (2.9%) case-control studies [74][86][130][142]. The MDRO samples were isolated from various sources: nasal (n = 79, 58.9%) [12][14][15][16][18][34][36][38][40][41][42][43][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][77][78][79][80][81][82][83][84][85][86][87][88][90][91][92][93][94][95][96][97][99], perianal (n = 79, 58.9%) [12][14][17][18][19][20][21][22][23][25][28][29][31][32][33][34][38][41][46][47][51][56][57][58][59][60][64][65][66][67][73][74][75][76][78][82][83][85][93][94][99][100][102][103][104][105][106][108][109][110][111][112][113][115][116][117][118][119][120][121][122][124][126][127][128][129][130][131][132][133][134][135][136][137][138][139][140][142][144], skin (n = 33, 24.6%) [12][20][21][22][23][24][28][29][32][33][39][41][43][50][54][60][64][65][66][69][71][72][73][74][79][86][87][92][97][99][105][127][139], oropharynx (n = 24, 17.9%) [15][20][21][24][25][29][30][31][32][33][41][47][57][62][64][65][66][74][83][84][85][93][113][125], ulcers (n = 28, 20.9%) [12][14][23][29][30][31][32][33][36][41][43][47][51][56][57][63][64][65][66][71][74][78][80][81][83][93][102], urine (n = 15, 11.2%) [12][14][16][20][21][22][32][43][80][101][102][104][114][123][124], devices (n = 14, 10.4%) [12][18][23][29][30][33][41][64][65][66][68][80][93][102], and sputum (n = 3, 2.2%) [43][78][141].
Figure 1. Flowchart search strategy. IQR, interquartile range.
The studies were conducted in several continents, mainly Europe (n = 70, 52.2%) [1][13][15][16][17][18][19][20][21][22][25][30][31][32][34][36][37][39][40][46][47][48][49][50][52][53][55][57][62][63][68][70][71][72][75][76][77][79][80][83][84][85][86][88][91][92][93][98][99][101][103][104][105][107][108][109][110][114][115][116][117][118][119][120][121][123][124][136][140], North America (n = 41, 30.6%) [12][14][23][24][27][29][33][38][41][42][43][44][45][51][58][59][64][65][66][73][74][78][89][90][94][97][102][109][122][127][129][130][131][133][134][137][138][139][141][142][143][144], and Asia (n = 15, 11.2%) [26][28][35][54][60][67][69][87][95][96][100][111][112][126][132]. Seven studies reported data from Oceania (5.2%) [56][81][82][106][113][125][128] and only one from South America (0.7%) [61]. None of the studies were performed in Africa.

3. MDRO Prevalence

The overall prevalence of colonization with MDROs around the world varies between the different pathogens studied. For ESBL Enterobacterales, the median prevalence reported was 11.6%, which increased to 15.0% in the case of ESBL E. coli and decreased to 2.9% for ESBL K. pneumoniae. The overall prevalence of CR Enterobacterales was 0.8%. Among other MDR Gram-negative bacteria, such as P. aeruginosa and A. baumannii, the prevalences reported globally were 1.3% and 5.8%, respectively. In the case of Gram-positive bacteria, MRSA showed the highest prevalence at 13.2%, followed by C. difficile 5.1% and VRE 1.5% (Table 1).
Table 1. Prevalence of multidrug-resistant organisms in long term care facilities.
Multidrug-Resistant Organism No. of Articles n = 134 Percentage of Articles n = 134 (%) Microorganism Global Prevalence n = 134 (Median, IQR) Prevalence in Europe n = 70 (Median %, IQR) Prevalence in North America n = 41 (Median %, IQR) Prevalence in South America n = 1 (Median %, IQR) Prevalence in Asia n = 15 (median %, IQR) Prevalence in Oceania n = 7 (Median %, IQR) Prevalence in Africa n = 0 (Median %, IQR)
ESBL Enterobacterales 51 38.0 11.6 (5.5–24.5) 12.9 (6.3–21.4) 9 (3.4–33) - 71.6 (46.6–74) 6.0 (1.4–10.8) -
ESBL Escherichia coli 33 24.6 15.0 (7.7–41.4) 15.3 (7.8–41.2) 15 (2.9–30.3) - 82.7 (50.4–86.1) 10.4 (5.6–11.2) -
ESBL Klebsiella pneumoniae 22 16.4 2.9 (0.4–7.1) 4.2 (0.6–6.5) 0.2 (0.0–4.8) - 9.1 (8.8–9.4) 1.7 -
Carbapenem resistant Enterobacterales 27 20.1 0.8 (0.0–4.2) 0.2 (0.0–0.9) 5.0 (2.0–7.9) - 6.9 (1.4–14.6) 0.4 (0.3–0.5) -
MDR Pseudomonas aeruginosa 8 5.9 1.3 (0.2–5.3) 0.2 (0.08–1.6) 5.4 (3.2–7.6) - 3.9 - -
MDR Acinetobacter baumannii 11 8.2 5.8 (2.2–13.5) 1.9 (0–4.3) 15.0 (13.5–16.0) - 5.2 (2.9–12.3) 6.0 -
Meticillin-resistant Staphylococcus aureus 88 65.6 13.2 (6.6–25) 9.1 (4.4–19.6) 22.0 (12.0–30.0) 3.7 25.6 (13–36.8) 10 (6.5–13) -
Vancomycin-resistant Enterococcus spp. 36 26.8 1.5 (0.06–6.9) 0.4 (0.0–1.8) 4.0 (0.9–20.7) - 0.0 (0.0–4.8) 3.1 (2.5–4.5) -
Clostridioides difficile 11 8.2 5.1 (1.9–24.8) 3.7 (1.1–4.9) 26.1 (16.2–37.5) - - 1.0 -
ESBL, extended-spectrum ß-lactamase; MDR, multidrug resistant; IQR, interquartile range.
This prevalence appears to vary between continents. Asia reported the highest prevalence of ESBL Enterobacterales [100][111][112], CR Enterobacterales [60][67][100][132] and MRSA [26][28][35][54][60][67][69][87][95][96]. In contrast, the lowest prevalence of ESBL Enterobacterales, CR Enterobacterales and MRSA have been reported in Oceania [82][106][113][125], Europe [1][13][18][19][20][21][22][34][83][103][104][108][109][110][118] and South America [61]. With respect to MDR P. aeruginosa [64][142], A. baumannii [64][74][141], VRE [14][23][33][38][58][59][64][65][66][73][74][89][97][127][129] and C. difficile [131][137][138][139], North America reported the highest prevalence. However, remarkably, Asia has the lowest prevalence of VRE [28][60][126] (Table 1, Figure 2).
Figure 2. Prevalence of different MDRO in LTCF around the world. Maps were created through the online tool Mapchart.net (https://mapchart.net/world.html, accessed on 23 November 2020). ESBL, extended-spectrum ß-lactamase; MDR, multidrug-resistant.

4. MDRO Co-Colonization

Co-colonization with multiple MDROs seems variable among LTCF. For example, Jans et al. [31] reported a low rate of co-colonization (0.8%) with ESBL Enterobacterales and MRSA among 2791 residents from 60 LTCF. On the other hand, Ludden et al. [18] found that the prevalence of co-colonization with MRSA and ESBL Enterobacterales increased to 39%, although the authors only analyzed one LTCF with 64 residents. Heinze et al. [66] reported that 13.2% of the residents were co-colonized with both MRSA and VRE. When MDROs were considered, the prevalence of co-colonization ranged from 5.5% to 21% for at least two MDROs [57][85][142]. All of these studies suggest that LTCF may act as reservoirs for MDROs, through which transmission may occur via resident–resident interactions or resident–healthcare worker interactions.

5. Changes in MDRO Prevalence Over Time

In the last decade, there has been a remarkable increase in the number of publications on MDR prevalence and LTCF. Figure 3 shows a representation of the median prevalence of MDROs within 5-year periods from 1985 to 2020. In order to be able to observe if there have been changes in the prevalence of MDROs over time, we established a cut-off point in 2015 and compared two time periods (until 2015, including and after 2015). Thus, we had a balanced number of publications on both groups, for each MDRO (Table 2). The ESBL Enterobacterales prevalence increased from 10.5% [14][18][22][23][25][31][33][39][57][75][76][82][85][89][99][101][102][104][106][107][111][112][116][119][121][122][123][124][125][143] to 15.1% [1][16][19][20][21][34][62][73][83][97][100][103][105][108][109][110][113][114][115][117][118][120], but this increase seems to be due to ESBL K. pneumoniae (0.7% vs. 4.2%) rather than ESBL E. coli (18.0% vs. 14.4%). In contrast, the prevalence of CR Enterobacterales decreased from 2015 onward (2.9% vs. 0.8%) [18][22][82][104][132][133] vs. [1][13][19][20][21][34][60][67][73][83][97][100][103][108][109][110][113][118][130][131][134], as did that of MDR A. baumannii, from 10.5% to 5.2% [74][82][85][141] vs. [13][20][28][37][60][64][67]; that of VRE, from 2.8% to 0.6% [14][18][22][23][25][31][33][38][39][57][58][59][65][74][76][82][89][106][126][127][128][129] vs. [1][13][20][21][28][34][37][60][64][66][73][83][97][109] ; that of MRSA, from 16.0% to 9.6% [14][17][18][22][23][25][26][27][29][30][31][32][33][35][36][38][39][40][41][42][43][44][45][46][47][48][50][54][56][57][58][59][63][65][68][69][71][72][75][76][77][78][79][80][81][84][85][86][89][90][91][93][94][95][96][98] vs. [1][13][15][16][19][20][21][24][28][34][37][49][55][60][61][62][64][66][67][70][73][83][87][88][92][97]; and that of C. difficile, from 7.1% to 3.9% [106][137][138][139][140] vs. [19][37][109][131][135][136]. Conversely, the prevalence of MDR P. aeruginosa experienced a slight increase in recent years (0.5% vs. 2.75%) [85][142] vs. [13][20][34][37][64][67] (Table 2). At a more individual level, Kohler et al. [13] analyzed changes in the prevalence of MDROs between 2007 and 2017 in NH from Switzerland. The authors reported an increase from 1.6% to 7.8% in ESBL K. pneumoniae and from 2% to 8% in MDR P. aeruginosa. Furthermore, a decrease from 34.3% to 25.9% was observed in MRSA prevalence. However, in contrast with the global data from this review, ESBL E. coli showed an increase from 5.4% in 2007 to 21.6% in 2017. Min et al. [33], in a one-year period of study, also reported an increase in the prevalence of ESBL-Enterobacterales from 36% to 39% and of VRE, from 10% to 13%. However, in contrast with the previous study, they observed an increase in the prevalence of MRSA, from 23% to 43%.
Figure 3. Prevalence of different MDRO in LTCF in 5-year periods. ESBL, extended-spectrum ß-lactamase; MDR, multidrug-resistant; MRSA, methicillin-resistant Staphylococcus aureus.
Table 2. Changes in the prevalence of multidrug-resistant organisms, before and after 2015.
Multidrug-Resistant Organism No. of Articles (2015 or Before) n = 90 No. of Articles (After 2015) n = 44 Prevalence of MDR (2015 or Before) Median (IQR) Prevalence of MDR (After 2015) Median (IQR) Difference (%)
ESBL Enterobacterales 30 22 10.5 (3.5–31.4) 15.1 (9.1–19.9) 4.6
ESBL Escherichia coli 19 14 18.0 (5.5–40.9) 14.4 (8.1–41.4) −3.6
ESBL Klebsiella pneumoniae 10 12 0.7 (0.2–9.2) 4.2 (0.7–6.3) 3.5
Carbapenem resistant Enterobacterales 6 21 2.9 (0.1–7.5) 0.8 (0–1.9) −2.1
MDR Pseudomonas aeruginosa 2 6 0.5 (0.25–0.75) 2.75 (0.5–8.2) 2.25
MDR Acinetobacter baumannii 4 7 10.5 (5.4–15.5) 5.2 (0.3–8.9) −5.3
Meticillin-resistant Staphylococcus aureus 61 26 16.0 (7.8–23.3) 9.6 (3.9–25.5) −6.4
Vancomycin-resistant Enterococcus spp. 22 14 2.8 (0.5–5.5) 0.6 (0.001–13.0) −2.2
Clostridioides difficile 5 6 7.1 (4.6–33.0) 3.9 (1.1–15.7) −3.2

IQR, interquartile range; ESBL, extended-spectrum ß-lactamase; MDR, multidrug resistant.

References

  1. Stepan, D.; Ušaj, L.; Šter, M.P.; Galun, M.S.; Smole, H.; Beović, B. Antimicrobial prescribing in long-term care facilities: A nationwide point-prevalence study, Slovenia, 2016. Eurosurveillance 2018, 23, 1800100, doi:10.2807/1560-7917.es.2018.23.46.1800100.
  2. O’Neill, D.; Briggs, R.; Holmerová, I.; Samuelsson, O.; Gordon, A.L.; Martin, F.C.; The Special Interest Group in Long Term Care of the European Geriatric Medicine Society. COVID-19 highlights the need for universal adoption of standards of med-ical care for physicians in nursing homes in Europe. Eur. Geriatr. Med. 2020, 11, 645–650, doi:10.1007/s41999-020-00347-6.
  3. Infectious Diseases Society of America; Spellberg, B.; Blaser, M.; Guidos, R.J.; Boucher, H.W.; Bradley, J.S.; Eisenstein, B.I.; Gerding, D.; Lynfield, R.; Reller, L.B.; et al. Combating Antimicrobial Resistance: Policy Recommendations to Save Lives. Clin. Infect. Dis. 2011, 52, S397–S428, doi:10.1093/cid/cir153.
  4. van Duin, D.; Paterson, D.L. Multidrug-Resistant Bacteria in the Community. Infect. Dis. Clin. North Am. 2016, 30, 377–390, doi:10.1016/j.idc.2016.02.004.
  5. Vehreschild, M.J.G.T.; Haverkamp, M.; Biehl, L.M.; Lemmen, S.; Fätkenheuer, G. Vancomycin-resistant enterococci (VRE): A reason to isolate? Infection 2019, 47, 7–11, doi:10.1007/s15010-018-1202-9.
  6. Horcajada, J.P.; Montero, M.; Oliver, A.; Sorlí, L.; Luque, S.; Gómez-Zorrilla, S.; Benito, N.; Grau, S. Epidemiology and Treatment of Multidrug-Resistant and Extensively Drug-Resistant Pseudomonas aeruginosa Infections. Clin. Microbiol. Rev. 2019, 32, 00031-19, doi:10.1128/cmr.00031-19.
  7. Perez, F.; Hujer, A.M.; Hujer, K.M.; Decker, B.K.; Rather, P.N.; Bonomo, R.A. Global Challenge of Multidrug-Resistant Aci-netobacter baumannii. Antimicrob. Agents Chemother. 2007, 51, 3471–3484, doi:10.1128/aac.01464-06.
  8. Barbut, F.; Jones, G.; Eckert, C. Epidemiology and control of Clostridium difficile infections in healthcare settings. Curr. Opin. Infect. Dis. 2011, 24, 370–376, doi:10.1097/qco.0b013e32834748e5.
  9. Rodriguez, C.; Korsak, N.; Taminiau, B.; Avesani, V.; Van Broeck, J.; Delmée, M.; Daube, G. Clostridium difficile infection in elderly nursing home residents. Anaerobe 2014, 30, 184–187, doi:10.1016/j.anaerobe.2014.08.007.
  10. Bell, B.G.; Schellevis, F.; Stobberingh, E.; Goossens, H.; Pringle, M. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect. Dis. 2014, 14, 13, doi:10.1186/1471-2334-14-13.
  11. Molina, J.; Peñalva, G.; Gil-Navarro, M.V.; Praena, J.; Lepe, J.A.; A Pérez-Moreno, M.; Ferrándiz, C.; Aldabó, T.; Aguilar, M.; Olbrich, P.; et al. Long-Term Impact of an Educational Antimicrobial Stewardship Program on Hospital-Acquired Can-didemia and Multidrug-Resistant Bloodstream Infections: A Quasi-Experimental Study of Interrupted Time-Series Analysis. Clin. Infect. Dis. 2017, 65, 1992–1999, doi:10.1093/cid/cix692.
  12. Batina, N.G.; Crnich, C.J.; Döpfer, D. Acquisition and persistence of strain-specific methicillin-resistant Staphylococcus aure-us and their determinants in community nursing homes. BMC Infect. Dis. 2017, 17, 752, doi:10.1186/s12879-017-2837-3.
  13. Kohler, P.; Fulchini, R.; Albrich, W.C.; Egli, A.; Balmelli, C.; Harbarth, S.; Héquet, D.; Kahlert, C.R.; Kuster, S.P.; Petignat, C.; et al. Antibiotic resistance in Swiss nursing homes: Analysis of National Surveillance Data over an 11-year period between 2007 and 2017. Antimicrob. Resist. Infect. Control. 2018, 7, 88, doi:10.1186/s13756-018-0378-1.
  14. Mylotte, J.M.; Goodnough, S.; Tayara, A. Antibiotic-resistant organisms among long-term care facility residents on admission to an inpatient geriatrics unit: Retrospective and prospective surveillance. Am. J. Infect. Control. 2001, 29, 139–144, doi:10.1067/mic.2001.114225.
  15. Drayß, M.; Claus, H.; Hubert, K.; Thiel, K.; Berger, A.; Sing, A.; Van Der Linden, M.; Vogel, U.; Lâm, T.-T. Asymptomatic carriage of Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, Group A Streptococcus and Staphy-lococcus aureus among adults aged 65 years and older. PLoS ONE 2019, 14, e0212052, doi:10.1371/journal.pone.0212052.
  16. Verhoef, L.; Roukens, M.; De Greeff, S.; Meessen, N.; Natsch, S.; Stobberingh, E. Carriage of antimicrobial-resistant commen-sal bacteria in Dutch long-term-care facilities. J. Antimicrob. Chemother. 2016, 71, 2586–2592, doi:10.1093/jac/dkw183.
  17. Brugnaro, P.; Fedeli, U.; Pellizzer, G.; Buonfrate, D.; Rassu, M.; Boldrin, C.; Parisi, S.G.; Grossato, A.; Palù, G.; Spolaore, P. Clustering and Risk Factors of Methicillin-Resistant Staphylococcus aureus Carriage in Two Italian Long-Term Care Facilities. Infection 2008, 37, 216–221, doi:10.1007/s15010-008-8165-1.
  18. Ludden, C.; Cormican, M.; Vellinga, A.; Johnson, J.R.; Austin, B.; Morris, D. Colonisation with ESBL-producing and car-bapenemase-producing Enterobacteriaceae, vancomycin-resistant enterococci, and meticillin-resistant Staphylococcus aureus in a long-term care facility over one year. BMC Infect. Dis. 2015, 15, 168, doi:10.1186/s12879-015-0880-5.
  19. Giufrè, M.; Ricchizzi, E.; Accogli, M.; Barbanti, F.; Monaco, M.; De Araujo, F.P.; Farina, C.; Fazii, P.; Mattei, R.; Sarti, M.; et al. Colonization by multidrug-resistant organisms in long-term care facilities in Italy: A point-prevalence study. Clin. Microbi-ol. Infect. 2017, 23, 961–967, doi:10.1016/j.cmi.2017.04.006.
  20. Nucleo, E.; Caltagirone, M.; Marchetti, V.M.; D’Angelo, R.; Fogato, E.; Confalonieri, M.; Reboli, C.; March, A.; Sleghel, F.; Soelva, G.; et al. Colonization of long-term care facility residents in three Italian Provinces by multidrug-resistant bacteria. Antimicrob. Resist. Infect. Control. 2018, 7, 33, doi:10.1016/j.cmi.2017.04.006.
  21. March, A.; Aschbacher, R.; Sleghel, F.; Soelva, G.; Kaczor, M.; Migliavacca, R.; Piazza, A.; Mattioni Marchetti, V.; Pagani, L.; Scalzo, K.; Pasquetto, V.; Pagani, E. Colonization of residents and staff of an Italian long-term care facility and an adjacent acute care hospital geriatric unit by multidrug-resistant bacteria. New Microbiol. 2017, 40, 258–263.
  22. March, A.; Aschbacher, R.; Dhanji, H.; Livermore, D.M.; Böttcher, A.; Sleghel, F.; Maggi, S.; Noale, M.; Larcher, C.; Wood-ford, N. Colonization of residents and staff of a long-term-care facility and adjacent acute-care hospital geriatric unit by mul-tiresistant bacteria. Clin. Microbiol. Infect. 2010, 16, 934–944, doi:10.1111/j.1469-0691.2009.03024.x.
  23. Trick, W.E.; Weinstein, R.A.; DeMarais, P.L.; Kuehnert, M.J.; Tomaska, W.; Nathan, C.; Rice, T.W.; McAllister, S.K.; Carson, L.A.; Jarvis, W.R. Colonization of Skilled-Care Facility Residents with Antimicrobial-Resistant Pathogens. J. Am. Geriatr. Soc. 2001, 49, 270–276, doi:10.1046/j.1532-5415.2001.4930270.x.
  24. Roghmann, M.-C.; Lydecker, A.D.; Hittle, L.; DeBoy, R.T.; Nowak, R.G.; Johnson, J.K.; Mongodin, E.F. Comparison of the Microbiota of Older Adults Living in Nursing Homes and the Community. mSphere 2017, 2, e00210-17, doi:10.1128/msphere.00210-17.
  25. Hogardt, M.; Proba, P.; Mischler, D.; Cuny, C.; A Kempf, V.; Heudorf, U. Current prevalence of multidrug-resistant organ-isms in long-term care facilities in the Rhine-Main district, Germany, 2013. Eurosurveillance 2015, 20, 21171, doi:10.2807/1560-7917.es2015.20.26.21171.
  26. Tsao, F.-Y.; Kou, H.-W.; Huang, Y.-C. Dissemination of methicillin-resistant Staphylococcus aureus sequence type 45 among nursing home residents and staff in Taiwan. Clin. Microbiol. Infect. 2015, 21, 451–458, doi:10.1016/j.cmi.2014.12.019.
  27. Hudson, L.O.; Reynolds, C.; Spratt, B.G.; Enright, M.C.; Quan, V.; Kim, D.; Hannah, P.; Mikhail, L.; Alexander, R.; Moore, D.F.; et al. Diversity of Methicillin-Resistant Staphylococcus aureus Strains Isolated from Residents of 26 Nursing Homes in Orange County, California. J. Clin. Microbiol. 2013, 51, 3788–3795, doi:10.1128/jcm.01708-13.
  28. Cheng, V.C.C.; Chen, J.H.K.; Ng, W.C.; Wong, J.Y.H.; Chow, D.M.K.; Law, T.C.; So, S.Y.C.; Wong, S.C.Y.; Chan, T.C.; Chan, F.H.W.; et al. Emergence of Carbapenem-Resistant Acinetobacter baumannii in Nursing Homes With High Background Rates of MRSA Colonization. Infect. Control Hosp. Epidemiol. 2016, 37, 983–986, doi:10.1017/ice.2016.84.
  29. Mody, L.; Kauffman, C.A.; Donabedian, S.; Zervos, M.; Bradley, S.F. Epidemiology of Staphylococcus aureus Colonization in Nursing Home Residents. Clin. Infect. Dis. 2008, 46, 1368–1373, doi:10.1086/586751.
  30. Denis, O.; Jans, B.; Deplano, A.; Nonhoff, C.; De Ryck, R.; Suetens, C.; Struelens, M.J. Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) among residents of nursing homes in Belgium. J. Antimicrob. Chemother. 2009, 64, 1299–1306, doi:10.1093/jac/dkp345.
  31. Jans, B.; Schoevaerdts, D.; Huang, T.-D.; Berhin, C.; Latour, K.; Bogaerts, P.; Nonhoff, C.; Denis, O.; Catry, B.; Glupczynski, Y. Epidemiology of Multidrug-Resistant Microorganisms among Nursing Home Residents in Belgium. PLoS ONE 2013, 8, e64908, doi:10.1371/journal.pone.0064908.
  32. Kotilainen, P.; Routamaa, M.; Peltonen, R.; Evesti, P.; Eerola, E.; Salmenlinna, S.; Vuopio-Varkila, J.; Rossi, T. Eradication of methicillin-resistant Staphylococcus aureus from a health center ward and associated nursing home. Arch. Intern. Med. 2001, 161, 859–863, doi:10.1001/archinte.161.6.859.
  33. Min, L.; Galecki, A.; Mody, L. Functional Disability and Nursing Resource Use Are Predictive of Antimicrobial Resistance in Nursing Homes. J. Am. Geriatr. Soc. 2015, 63, 659–666, doi:10.1111/jgs.13353.
  34. Van Dulm, E.; Tholen, A.T.R.; Pettersson, A.; Van Rooijen, M.S.; Willemsen, I.; Molenaar, P.; Damen, M.; Gruteke, P.; Oost-vogel, P.; Kuijper, E.J.; et al. High prevalence of multidrug resistant Enterobacteriaceae among residents of long term care fa-cilities in Amsterdam, the Netherlands. PLoS ONE 2019, 14, e0222200, doi:10.1371/journal.pone.0222200.
  35. Verrall, A.; Merchant, R.; Dillon, J.; Ying, D.; Fisher, D. Impact of nursing home residence on hospital epidemiology of meti-cillin-resistant Staphylococcus aureus: A perspective from Asia. J. Hosp. Infect. 2013, 83, 250–252, doi:10.1016/j.jhin.2012.11.021.
  36. Stone, N.D.; Lewis, D.R.; Lowery, H.K.; Darrow, L.A.; Kroll, C.M.; Gaynes, R.P.; Jernigan, J.A.; McGowan, J.E.; Tenover, F.C.; Richards, C.L. Importance of Bacterial Burden Among Methicillin-Resistant Staphylococcus aureus Carriers in a Long-Term Care Facility. Infect. Control Hosp. Epidemiol. 2008, 29, 143–148, doi:10.1086/526437.
  37. Hübner, N.; Dittmann, K.; Begunk, R.; Kramer, A. Infection control measures and prevalence of multidrug-resistant organ-isms in non-hospital care settings in northeastern Germany: Results from a one-day point prevalence study. J. Hosp. Infect. 2017, 97, 234–240, doi:10.1016/j.jhin.2017.08.002.
  38. Mitchell, S.L.; Shaffer, M.L.; Loeb, M.B.; Givens, J.L.; Habtemariam, D.; Kiely, D.K.; D’Agata, E. Infection Management and Multidrug-Resistant Organisms in Nursing Home Residents With Advanced Dementia. JAMA Intern. Med. 2014, 174, 1660–1667, doi:10.1001/jamainternmed.2014.3918.
  39. Ruscher, C.; Pfeifer, Y.; Layer, F.; Schaumann, R.; Levin, K.; Mielke, M. Inguinal skin colonization with multidrug-resistant bacteria among residents of elderly care facilities: Frequency, persistence, molecular analysis and clinical impact. Int. J. Med. Microbiol. 2014, 304, 1123–1134, doi:10.1016/j.ijmm.2014.08.006.
  40. Greenland, K.; Rijnders, M.I.; Mulders, M.; Haenen, A.; Spalburg, E.; Van De Kassteele, J.; De Neeling, A.; Stobberingh, E. Low Prevalence of Methicillin-Resistant Staphylococcus Aureus in Dutch Nursing Homes. J. Am. Geriatr. Soc. 2011, 59, 768–769, doi:10.1111/j.1532-5415.2011.03325.x.
  41. Gibson, K.E.; McNamara, S.E.; Cassone, M.; Perri, M.B.; Zervos, M.; Mody, L.; on behalf of the Targeted Infection Prevention (TIP) Study Team, Ann Arbor, Michigan. Methicillin-Resistant Staphylococcus aureus:Site of Acquisition and Strain Variation in High-Risk Nursing Home Residents with Indwelling Devices. Infect. Control Hosp. Epidemiol. 2014, 35, 1458–1465, doi:10.1086/678599.
  42. Reynolds, C.; Quan, V.; Kim, D.; Peterson, E.; Dunn, J.; Whealon, M.; Terpstra, L.; Meyers, H.; Cheung, M.; Lee, B.; et al. Methicillin-Resistant Staphylococcus aureus (MRSA) Carriage in 10 Nursing Homes in Orange County, California. Infect. Control Hosp. Epidemiol. 2011, 32, 91–93, doi:10.1086/657637.
  43. Murphy, S.; Denman, S.; Bennett, R.G.; Greenough, W.B.; Lindsay, J.; Zelesnick, L.B. Methicillin-ResistantStaphylococcus aureusColonization in a Long-Term-Care Facility. J. Am. Geriatr. Soc. 1992, 40, 213–217, doi:10.1111/j.1532-5415.1992.tb02070.x.
  44. Storch, G.A.; Radcliff, J.L.; Meyer, P.L.; Hinrichs, J.H. Methicillin-Resistant Staphylococcus aureus in a Nursing Home. Infect. Control. 1987, 8, 24–29, doi:10.1017/s0195941700066947.
  45. Muder, R.R.; Brennen, C.; Wagener, M.M.; Vickers, R.M.; Rihs, J.D.; Hancock, G.A.; Yee, Y.C.; Miller, J.M.; Yu, V.L. Methicil-lin-Resistant Staphylococcal Colonization and Infection in a Long-Term Care Facility. Ann. Intern. Med. 1991, 114, 107–112, doi:10.7326/0003-4819-114-2-1-107.
  46. Eveillard, M.; Charru, P.; Rufat, P.; Hippeaux, M.-C.; Lancien, E.; Benselama, F.; Branger, C. Methicillin-resistant Staphylo-coccus aureus carriage in a long-term care facility: Hypothesis about selection and transmission. Age Ageing 2008, 37, 294–299, doi:10.1093/ageing/afn021.
  47. Cox, R.; Bowie, P. Methicillin-resistant Staphylococcus aureus colonization in nursing home residents: A prevalence study in Northamptonshire. J. Hosp. Infect. 1999, 43, 115–122, doi:10.1053/jhin.1999.0633.
  48. Suetens, C.; Niclaes, L.; Jans, B.; Verhaegen, J.; Schuermans, A.; Van Eldere, J.; Buntinx, F. Methicillin-Resistant Staphylo-coccus aureus Colonization Is Associated with Higher Mortality in Nursing Home Residents with Impaired Cognitive Status. J. Am. Geriatr. Soc. 2006, 54, 1854–1860, doi:10.1111/j.1532-5415.2006.00972.x.
  49. Nillius, D.; Von Müller, L.; Wagenpfeil, S.; Klein, R.; Herrmann, M. Methicillin-Resistant Staphylococcus aureus in Saarland, Germany: The Long-Term Care Facility Study. PLoS ONE 2016, 11, e0153030, doi:10.1371/journal.pone.0153030.
  50. Namnyak, S.; Adhami, Z.; Wilmore, M.; Keynes, H.; Hampton, K.; Mercieca, E.; Roker, K. Methicillin-resistant Staphylococ-cus aureus: A questionnaire and microbiological survey of nursing and residential homes in Barking, Havering and Brent-wood. J. Infect. 1998, 36, 67–72, doi:10.1016/s0163-4453(98)93234-0.
  51. Bradley, S.F.; Terpenning, M.S.; Ramsey, M.A.; Zarins, L.T.; Jorgensen, K.A.; Sottile, W.S.; Schaberg, D.R.; Kauffman, C.A. Methicillin-resistant Staphylococcus aureus: Colonization and Infection in a Long-term Care Facility. Ann. Intern. Med. 1991, 115, 417–422, doi:10.7326/0003-4819-115-6-417.
  52. Monaco, M.; Bombana, E.; Trezzi, L.; Regattin, L.; Brusaferro, S.; Pantosti, A.; Goglio, A. Meticillin-resistant Staphylococcus aureus colonising residents and staff members in a nursing home in Northern Italy. J. Hosp. Infect. 2009, 73, 182–184, doi:10.1016/j.jhin.2009.06.026.
  53. Horner, C.; Parnell, P.; Hall, D.; Kearns, A.; Heritage, J.; Wilcox, M. Meticillin-resistant Staphylococcus aureus in elderly residents of care homes: Colonization rates and molecular epidemiology. J. Hosp. Infect. 2013, 83, 212–218, doi:10.1016/j.jhin.2012.11.011.
  54. Ho, P.-L.; Lai, E.L.; Chow, K.-H.; Chow, L.S.; Yuen, K.-Y.; Yung, R.W. Molecular epidemiology of methicillin-resistant Staph-ylococcus aureus in residential care homes for the elderly in Hong Kong. Diagn. Microbiol. Infect. Dis. 2008, 61, 135–142, doi:10.1016/j.diagmicrobio.2007.12.017.
  55. Peters, C.; Dulon, M.; Kleinmüller, O.; Nienhaus, A.; Schablon, A. MRSA Prevalence and Risk Factors among Health Per-sonnel and Residents in Nursing Homes in Hamburg, Germany—A Cross-Sectional Study. PLoS ONE 2017, 12, e0169425, doi:10.1371/journal.pone.0169425.
  56. Friedewald, M.; de Wit, D. MRSA screening of nursing home, residents admitted to hospital on the NSW Central Coast. Aust. Infect. Control. 2001, 6, 119–121.
  57. Gruber, I.; Heudorf, U.; Werner, G.; Pfeifer, Y.; Imirzalioglu, C.; Ackermann, H.; Brandt, C.; Besier, S.; Wichelhaus, T.A. Mul-tidrug-resistant bacteria in geriatric clinics, nursing homes, and ambulant care—Prevalence and risk factors. Int. J. Med. Mi-crobiol. 2013, 303, 405–409, doi:10.1016/j.ijmm.2013.05.002.
  58. O’Fallon, E.; Schreiber, R.; Kandel, R.; D’Agata, E.M.C. Multidrug-Resistant Gram-Negative Bacteria at a Long-Term Care Facility: Assessment of Residents, Healthcare Workers, and Inanimate Surfaces. Infect. Control Hosp. Epidemiol. 2009, 30, 1172–1179, doi:10.1086/648453.
  59. Pop-Vicas, A.; Mitchell, S.L.; Kandel, R.; Schreiber, R.; D’Agata, E.M.C. Multidrug-Resistant Gram-Negative Bacteria in a Long-Term Care Facility: Prevalence and Risk Factors. J. Am. Geriatr. Soc. 2008, 56, 1276–1280, doi:10.1111/j.1532-5415.2008.01787.x.
  60. Chen, H.; Au, K.M.; E Hsu, K.; Lai, C.K.; Myint, J.; Mak, Y.F.; Lee, S.Y.; Wong, T.Y.; Tsang, N.C. Multidrug-resistant organ-ism carriage among residents from residential care homes for the elderly in Hong Kong: A prevalence survey with stratified cluster sampling. Hong Kong Med. J. 2018, 24, 350–360, doi:10.12809/hkmj176949.
  61. Da Silveira, M.; Cunha, M.D.L.R.D.S.D.; De Souza, C.S.M.; Correa, A.A.F.; Fortaleza, C.M.C.B. Nasal colonization with methicillin-resistant Staphylococcus aureus among elderly living in nursing homes in Brazil: Risk factors and molecular epi-demiology. Ann. Clin. Microbiol. Antimicrob. 2018, 17, 1–5, doi:10.1186/s12941-018-0271-z.
  62. Kwetkat, A.; Pfister, W.; Pansow, D.; Pletz, M.W.; Sieber, C.C.; Hoyer, H. Naso- and oropharyngeal bacterial carriage in nursing home residents: Impact of multimorbidity and functional impairment. PLoS ONE 2018, 13, e0190716, doi:10.1371/journal.pone.0190716.
  63. Manzur, A.; Domínguez, M.A.; de Gopegui, E.R.; Mariscal, D.; Gavalda, L.; Segura, F.; Perez, J.; Pujol, M. Natural history of meticillin-resistant Staphylococcus aureus colonisation among residents in community long term care facilities in Spain. J. Hosp. Infect. 2010, 76, 215–219, doi:10.1016/j.jhin.2010.05.022.
  64. Wang, J.; Foxman, B.; Mody, L.; Snitkin, E.S. Network of microbial and antibiotic interactions drive colonization and infec-tion with multidrug-resistant organisms. Proc. Natl. Acad. Sci. USA 2017, 114, 10467–10472, doi:10.1073/pnas.1710235114.
  65. Fisch, J.; Lansing, B.; Wang, L.; Symons, K.; Cherian, K.; McNamara, S.; Mody, L. New Acquisition of Antibiotic-Resistant Organisms in Skilled Nursing Facilities. J. Clin. Microbiol. 2012, 50, 1698–1703, doi:10.1128/jcm.06469-11.
  66. Heinze, K.; Kabeto, M.; Martin, E.T.; Cassone, M.; Hicks, L.; Mody, L. Predictors of methicillin-resistant Staphylococcus au-reus and vancomycin-resistant enterococci co-colonization among nursing facility patients. Am. J. Infect. Control. 2019, 47, 415–420, doi:10.1016/j.ajic.2018.09.026.
  67. Lee, C.-M.; Lai, C.-C.; Chiang, H.-T.; Lu, M.-C.; Wang, L.-F.; Tsai, T.-L.; Kang, M.-Y.; Jan, Y.-N.; Lo, Y.-T.; Ko, W.-C.; et al. Presence of multidrug-resistant organisms in the residents and environments of long-term care facilities in Taiwan. J. Microbi-ol. Immunol. Infect. 2017, 50, 133–144, doi:10.1016/j.jmii.2016.12.001.
  68. Budimir, A.; Pal, M.P.; Bošnjak, Z.; Mareković, I.; Vuković, D.; Križan, I.R.; Milas, J.; Plečko, V.; Kalenić, S. Prevalence and molecular characteristics of methicillin-resistant Staphylococcus aureus strains isolated in a multicenter study of nursing home residents in Croatia. Am. J. Infect. Control. 2014, 42, 1197–1202, doi:10.1016/j.ajic.2014.07.032.
  69. Zhang, J.; Gu, F.-F.; Zhao, S.-Y.; Xiao, S.-Z.; Wang, Y.-C.; Guo, X.-K.; Ni, Y.-X.; Han, L.-Z. Prevalence and Molecular Epide-miology of Staphylococcus aureus among Residents of Seven Nursing Homes in Shanghai. PLoS ONE 2015, 10, e0137593, doi:10.1371/journal.pone.0137593.
  70. Moschou, A.; Maraki, S.; Giormezis, N.; Moraitaki, H.; Stafylaki, D.; Militsopoulou, M.; Spiliopoulou, I.; Papadakis, J.; Samo-nis, G.; Kofteridis, D. Prevalence and molecular epidemiology of Staphylococcus aureus nasal colonization in four nursing home residents in Crete, Greece. J. Infect. Chemother. 2020, 26, 199–204, doi:10.1016/j.jiac.2019.08.008.
  71. Cretnik, T.Z.; Vovko, P.; Retelj, M.; Juteršek, B.; Harlander, T.; Kolman, J.; Gubina, M. Prevalence and Nosocomial Spread of Methicillin-ResistantStaphylococcus aureusin a Long-Term-Care Facility in Slovenia. Infect. Control Hosp. Epidemiol. 2005, 26, 184–190, doi:10.1086/502524.
  72. Barrufet, M.P.; Vendrell, E.; Force, L.; Sauca, G.; Rodríguez, S.; Martínez, E.; Palomera, E.; Serra-Prat, M.; Capdevila, J.A.; Cornudella, J.; Llopis, A.; Robledo, M.A.; Vázquez, C. Prevalence and risk factors for meticillin-resistant Staphylococcus au-reus in an acute care hospital and long-term care facilities located in the same geographic area. Rev. Esp. Quimioter. 2014, 27, 190–195.
  73. McKinnell, J.A.; Singh, R.D.; Miller, L.G.; Kleinman, K.; Gussin, G.; He, J.; Saavedra, R.; Dutciuc, T.D.; Estevez, M.; Chang, J.; et al. The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California. Clin. Infect. Dis. 2019, 69, 1566–1573, doi:10.1093/cid/ciz119.
  74. Mody, L.; Gibson, K.E.; Horcher, A.; Prenovost, K.; McNamara, S.E.; Foxman, B.; Kaye, K.S.; Bradley, S. Prevalence of and Risk Factors for Multidrug-ResistantAcinetobacter baumanniiColonization Among High-Risk Nursing Home Residents. Infect. Control Hosp. Epidemiol. 2015, 36, 1155–1162, doi:10.1017/ice.2015.143.
  75. Hoogendoorn, M.; Smalbrugge, M.; Stobberingh, E.E.; van Rossum, S.V.; Vlaminckx, B.J.; Thijsen, S.F. Prevalence of Antibi-otic Resistance of the Commensal Flora in Dutch Nursing Homes. J. Am. Med. Dir. Assoc. 2013, 14, 336–339, doi:10.1016/j.jamda.2012.11.001.
  76. Andersson, H.; Lindholm, C.; Iversen, A.; Giske, C.G.; Örtqvist, Å.; Kalin, M.; Fossum, B. Prevalence of antibiotic-resistant bacteria in residents of nursing homes in a Swedish municipality: Healthcare staff knowledge of and adherence to principles of basic infection prevention. Scand. J. Infect. Dis. 2012, 44, 641–649, doi:10.3109/00365548.2012.671956.
  77. Barr, B.; Wilcox, M.H.; Brady, A.; Parnell, P.; Darby, B.; Tompkins, D. Prevalence of Methicillin-ResistantStaphylococcus aureusColonization Among Older Residents of Care Homes in the United Kingdom. Infect. Control Hosp. Epidemiol. 2007, 28, 853–859, doi:10.1086/516795.
  78. Furuno, J.P.; Hebden, J.N.; Standiford, H.C.; Perencevich, E.N.; Miller, R.R.; Moore, A.C.; Strauss, S.M.; Harris, A.D. Preva-lence of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii in a long-term acute care facility. Am. J. In-fect. Control. 2008, 36, 468–471, doi:10.1016/j.ajic.2008.01.003.
  79. Manzur, A.; Gavalda, L.; de Gopegui, E.R.; Mariscal, D.; Domínguez, M.A.; Perez, J.; Segura, F.; Pujol, M. Prevalence of methicillin-resistant Staphylococcus aureus and factors associated with colonization among residents in community long-term-care facilities in Spain. Clin. Microbiol. Infect. 2008, 14, 867–872, doi:10.1111/j.1469-0691.2008.02060.x.
  80. Baldwin, N.S.; Gilpin, D.; Hughes, C.M.; Kearney, M.P.; Gardiner, D.A.; Cardwell, C.; Tunney, M.M. Prevalence of Methicil-lin-Resistant Staphylococcus aureus Colonization in Residents and Staff in Nursing Homes in Northern Ireland. J. Am. Geri-atr. Soc. 2009, 57, 620–626, doi:10.1111/j.1532-5415.2009.02181.x.
  81. Flint, J.A.; Ryan, P.; Gordon, D.L. Prevalence of MRSA in South Australian nursing homes. Med. J. Aust. 1998, 169, 559–560, doi:10.5694/j.1326-5377.1998.tb123414.x.
  82. Lim, C.J.; Cheng, A.; Kennon, J.; Spelman, D.; Hale, D.; Melican, G.; Sidjabat, H.E.; Paterson, D.L.; Kong, D.; Peleg, A.Y. Prevalence of multidrug-resistant organisms and risk factors for carriage in long-term care facilities: A nested case-control study. J. Antimicrob. Chemother. 2014, 69, 1972–1980, doi:10.1093/jac/dku077.
  83. Latour, K.; Huang, T.-D.; Jans, B.; Berhin, C.; Bogaerts, P.; Noel, A.; Nonhoff, C.; Dodémont, M.; Denis, O.; Ieven, M.; et al. Prevalence of multidrug-resistant organisms in nursing homes in Belgium in 2015. PLoS ONE 2019, 14, e0214327, doi:10.1371/journal.pone.0214327.
  84. Mossong, J.; Gelhausen, E.; Decruyenaere, F.; Devaux, A.; Perrin, M.; Even, J.; Heisbourg, E. Prevalence, risk factors and molecular epidemiology of methicillin-resistantStaphylococcus aureus(MRSA) colonization in residents of long-term care fa-cilities in Luxembourg, 2010. Epidemiol. Infect. 2012, 141, 1199–1206, doi:10.1017/s0950268812001999.
  85. Del Rosario-Quintana, C.; Tosco-Núñez, T.; Lorenzo, L.; Martín-Sánchez, A.M.; Molina-Cabrillana, J. Prevalencia y factores asociados a la colonización de microorganismos multirresistentes en centros de larga estancia de Gran Canaria. Revista Espa-ñola de Geriatría y Gerontología 2015, 50, 232–236, doi:10.1016/j.regg.2014.11.006.
  86. Vovko, P.; Retelj, M.; Cretnik, T.Z.; Jutersek, B.; Harlander, T.; Kolman, J.; Gubina, M. Risk Factors for Colonization With Methicillin-ResistantStaphylococcus aureusin a Long-Term-Care Facility in Slovenia. Infect. Control Hosp. Epidemiol. 2005, 26, 191–195, doi:10.1086/502525.
  87. Gu, F.-F.; Zhang, J.; Zhao, S.-Y.; Yang, Z.-R.; Zhang, Y.-L.; Xiao, S.-Z.; Wang, S.; Guo, X.-K.; Qu, J.-M.; Ni, Y.-X.; et al. Risk factors for methicillin-resistant Staphylococcus aureus carriage among residents in 7 nursing homes in Shanghai, China. Am. J. Infect. Control. 2016, 44, 805–808, doi:10.1016/j.ajic.2016.01.032.
  88. Becker, J.; Diel, R. Screening for Methicillin-resistant Staphylococcus aureus in a residence home for elderly in Germany. J. Occup. Med. Toxicol. 2017, 12, 3, doi:10.1186/s12995-017-0149-6.
  89. El Emam, K.; Arbuckle, L.; Essex, A.; Samet, S.; Eze, B.; Middleton, G.; Buckeridge, D.; Jonker, E.; Moher, E.; Earle, C. Secure Surveillance of Antimicrobial Resistant Organism Colonization or Infection in Ontario Long Term Care Homes. PLoS ONE 2014, 9, e93285, doi:10.1371/journal.pone.0093285.
  90. Cederna, J.E.; Terpenning, M.S.; Ensberg, M.; Bradley, S.F.; Kauffman, C.A. StaphylococcusaureusNasal Colonization in a Nursing Home: Eradication With Mupirocin. Infect. Control Hosp. Epidemiol. 1990, 11, 13–16, doi:10.1086/646072.
  91. Lasseter, G.; Charlett, A.; Lewis, D.L.; Donald, I.P.; Howelljones, R.; McNulty, C.A.M. Staphylococcus aureus carriage in care homes: Identification of risk factors, including the role of dementia. Epidemiol. Infect. 2010, 138, 686–696, doi:10.1017/s0950268810000233.
  92. Galán-Sánchez, F.; Pérez-Eslava, M.; Machuca, J.; Trujillo-Soto, T.; Arca-Suárez, J.; Rodríguez-Iglesias, M. Staphylococcus aureus carriage in older populations in community residential care homes: Prevalence and molecular characterization of MRSA isolates. Enfermedades Infecciosas y Microbiología Clínica 2019, 37, 172–175, doi:10.1016/j.eimc.2018.05.011.
  93. Kerttula, A.-M.; Lyytikäinen, O.; Virolainen, A.; Finne-Soveri, H.; Agthe, N.; Vuopio-Varkila, J. Staphylococcus aureus colo-nization among nursing home residents in a large Finnish nursing home. Scand. J. Infect. Dis. 2007, 39, 996–1001, doi:10.1080/00365540701466207.
  94. Lee, Y.-L.; Cesario, T.; Gupta, G.; Flionis, L.; Tran, C.; Decker, M.; Thrupp, L. Surveillance of colonization and infection with Staphylococcus aureus susceptible or resistant to methicillin in a community skilled-nursing facility. Am. J. Infect. Control. 1997, 25, 312–321, doi:10.1016/s0196-6553(97)90023-7.
  95. Chan, T.C.; Cheng, V.C.C.; Hung, I.F.N.; Chan, F.H.W.; Ng, W.C.; Yuen, K.Y. The Association between Methicillin Resistant Staphylococcus aureus Colonization and Mortality in Chinese Nursing Home Older Adults: A 2-Year Prospective Cohort. J. Am. Med. Dir. Assoc. 2015, 16, 796–797, doi:10.1016/j.jamda.2015.05.020.
  96. Cheng, V.C.; Tai, J.W.; Wong, Z.S.; Chen, J.H.; Pan, K.B.; Hai, Y.; Ng, W.-C.; Chow, D.M.; Yau, M.C.; Chan, J.F.; et al. Transmission of methicillin-resistant staphylococcus aureus in the long term care facilities in Hong Kong. BMC Infect. Dis. 2013, 13, 1–205, doi:10.1186/1471-2334-13-205.
  97. McKinnell, J.A.; Miller, L.G.; Singh, R.; Kleinman, K.; Peterson, E.M.; Evans, K.D.; Dutciuc, T.D.; Heim, L.; Gombosev, A.; Estevez, M.; et al. Prevalence of and Factors Associated With Multidrug Resistant Organism (MDRO) Colonization in 3 Nursing Homes. Infect. Control Hosp. Epidemiol. 2016, 37, 1485–1488, doi:10.1017/ice.2016.215.
  98. O’Sullivan, N.; Keane, C. Risk factors for colonization with methicillin-resistant Staphylococcus aureus among nursing home residents. J. Hosp. Infect. 2000, 45, 206–210, doi:10.1053/jhin.2000.0759.
  99. Eveillard, M.; LaFargue, S.; Guet, L.; Mangeol, A.; Piquet, J.; Quenon, J.-L.; Fauvelle, F. Association between Institutionaliza-tion and Carriage of Multiresistant Bacteria in the Elderly at the Time of Admission to a General Hospital. Eur. J. Clin. Micro-biol. Infect. Dis. 1999, 18, 133–136, doi:10.1007/s100960050241.
  100. Dandachi, I.; Sokhn, E.S.; Najem, E.; Azar, E.; Daoud, Z. Carriage of beta-lactamase-producing Enterobacteriaceae among nursing home residents in north Lebanon. Int. J. Infect. Dis. 2016, 45, 24–31, doi:10.1016/j.ijid.2016.02.007.
  101. Van Der Donk, C.; Schols, J.; Driessen, C.; Hagenouw, R.; Meulendijks, A.; Stobberingh, E. Prevalence and Spread of Multi-drug Resistant Escherichia coli Isolates Among Nursing Home Residents in the Southern Part of the Netherlands. J. Am. Med. Dir. Assoc. 2013, 14, 199–203, doi:10.1016/j.jamda.2012.09.026.
  102. Wiener, J.; Quinn, J.P.; Bradford, P.A.; Goering, R.; Nathan, C.; Bush, K.; Weinstein, R.A. Multiple Antibiotic–Resistant Klebsiella and Escherichia coli in Nursing Homes. JAMA 1999, 281, 517–523, doi:10.1001/jama.281.6.517.
  103. Birgand, G.; Hayatgheib, N.; Bémer, P.; Guilloteau, V.; Legeay, C.; Perron, S.; Chapelet, G.; Corvec, S.; Bourigault, C.; Batard, E.; et al. Multi-drug-resistant Enterobacteriacae carriage in highly exposed nursing homes: Prevalence in western France. J. Hosp. Infect. 2017, 97, 258–259, doi:10.1016/j.jhin.2017.07.032.
  104. Cochard, H.; Aubier, B.; Quentin, R.; Van Der Mee-Marquet, N.; Du Centre, R.D.H. Extended-Spectrumβ-Lactamase–Producing Enterobacteriaceae in French Nursing Homes: An Association between High Carriage Rate among Residents, En-vironmental Contamination, Poor Conformity with Good Hygiene Practice, and Putative Resident-to-Resident Transmission. Infect. Control Hosp. Epidemiol. 2014, 35, 384–389, doi:10.1086/675599.
  105. Leitner, E.; Zechner, E.; Ullrich, E.; Zarfel, G.; Luxner, J.; Pux, C.; Pichler, G.; Schippinger, W.; Krause, R.; Zollner-Schwetz, I. Low prevalence of colonization with multidrug-resistant gram-negative bacteria in long-term care facilities in Graz, Austria. Am. J. Infect. Control. 2018, 46, 76–80, doi:10.1016/j.ajic.2017.07.004.
  106. Stuart, R.L.; Kotsanas, D.; Webb, B.; Vandergraaf, S.; E Gillespie, E.; Hogg, G.G.; Korman, T. Prevalence of antimicrobial‐resistant organisms in residential aged care facilities. Med. J. Aust. 2011, 195, 530–533, doi:10.5694/mja11.10724.
  107. Thibaut, S.; Caillon, J.; Marquet, A.; Grandjean, G.; Potel, G.; Ballereau, F.; Microbiology Laboratories of the MedQual Net-work. Epidemiology of third-generation cephalosporin-resistant community-acquired Enterobacteria isolated from elderly pa-tients. Méd. Mal. Infect. 2014, 44, 57–62, doi:10.1016/j.medmal.2013.11.008.
  108. Rodrigues, C.; Machado, E.; Fernandes, S.; Peixe, L.; Novais, Â. Different Escherichia coli B2-ST131 clades (B and C) produc-ing extended-spectrum β-lactamases (ESBL) colonizing residents of Portuguese nursing homes. Epidemiol. Infect. 2017, 145, 3303–3306, doi:10.1017/s0950268817002266.
  109. Terveer, E.; Fallon, M.; Kraakman, M.; Ormond, A.; Fitzpatrick, M.; Caljouw, M.; Martin, A.; Van Dorp, S.; Wong, M.; Kui-jper, E. Corrigendum to “Spread of ESBL-producing Escherichia coli in nursing home residents in Ireland and the Nether-lands may reflect infrastructural differences” [J Hosp Infect 103 (2019) 160–164]. J. Hosp. Infect. 2020, 103, 160–164, doi:10.1016/j.jhin.2020.01.011.
  110. Valenza, G.; Nickel, S.; Pfeifer, Y.; Pietsch, M.; Voigtländer, E.; Lehner-Reindl, V.; Höller, C. Prevalence and genetic diversity of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in nursing homes in Bavaria, Germany. Veter- Microbiol. 2017, 200, 138–141, doi:10.1016/j.vetmic.2015.10.008.
  111. Jallad, M.A.; Naoufal, R.; Irani, J.; Azar, E. Extended Spectrum Beta-Lactamase Carriage State among Elderly Nursing Home Residents in Beirut. Sci. World J. 2015, 2015, 1–7, doi:10.1155/2015/987580.
  112. Yamamoto, Y.; Luvsansharav, U.-O.; Hirai, I.; Niki, M.; Nakata, A.; Yoshinaga, A.; Matsuura, N.; Kawakami, F. Fecal car-riage of CTX-M β-lactamase-producing Enterobacteriaceae in nursing homes in the Kinki region of Japan. Infect. Drug Resist. 2013, 6, 67–70, doi:10.2147/IDR.S43868.
  113. Gorrie, C.L.; Mirceta, M.; Wick, R.R.; Judd, L.M.; Wyres, K.L.; Thomson, N.R.; A Strugnell, R.; Pratt, N.F.; Garlick, J.S.; Wat-son, K.M.; et al. Antimicrobial-Resistant Klebsiella pneumoniae Carriage and Infection in Specialized Geriatric Care Wards Linked to Acquisition in the Referring Hospital. Clin. Infect. Dis. 2018, 67, 161–170, doi:10.1093/cid/ciy027.
  114. Pulcini, C.; Clerc-Urmes, I.; Attinsounon, C.A.; Fougnot, S.; Thilly, N. Antibiotic resistance of Enterobacteriaceae causing urinary tract infections in elderly patients living in the community and in the nursing home: A retrospective observational study. J. Antimicrob. Chemother. 2018, 74, 775–781, doi:10.1093/jac/dky488.
  115. Hagel, S.; Makarewicz, O.; Hartung, A.; Weiß, D.; Stein, C.; Brandt, C.; Schumacher, U.; Ehricht, R.; Patchev, V.; Pletz, M.W. ESBL colonization and acquisition in a hospital population: The molecular epidemiology and transmission of resistance genes. PLoS ONE 2019, 14, e0208505, doi:10.1371/journal.pone.0208505.
  116. Rooney, P.J.; O’Leary, M.C.; Loughrey, A.C.; McCalmont, M.; Smyth, B.; Donaghy, P.; Badri, M.; Woodford, N.; Karisik, E.; Livermore, D.M. Nursing homes as a reservoir of extended-spectrum -lactamase (ESBL)-producing ciprofloxacin-resistant Escherichia coli. J. Antimicrob. Chemother. 2009, 64, 635–641, doi:10.1093/jac/dkp220.
  117. Blom, A.; Ahl, J.; Månsson, F.; Resman, F.; Tham, J. The prevalence of ESBL-producing Enterobacteriaceae in a nursing home setting compared with elderly living at home: A cross-sectional comparison. BMC Infect. Dis. 2016, 16, 111, doi:10.1186/s12879-016-1430-5.
  118. Broussier, M.; Gbaguidi-Haoré, H.; Rachidi-Berjamy, F.; Bertrand, X.; Slekovec, C. Prevalence, genetic diversity of and factors associated with ESBL-producing Enterobacterales carriage in residents of French nursing homes. J. Hosp. Infect. 2020, 104, 469–475, doi:10.1016/j.jhin.2019.12.008.
  119. Willemsen, I.; Nelson, J.; Hendriks, Y.; Mulders, A.; Verhoeff, S.; Mulder, P.; Roosendaal, R.; Van Der Zwaluw, K.; Verhulst, C.; Bergh, M.K.-V.D.; et al. Extensive Dissemination of Extended Spectrum β-Lactamase–Producing Enterobacteriaceae in a Dutch Nursing Home. Infect. Control Hosp. Epidemiol. 2015, 36, 394–400, doi:10.1017/ice.2014.76.
  120. Overdevest, I.; Haverkate, M.; Veenemans, J.; Hendriks, Y.; Verhulst, C.; Mulders, A.; Couprie, W.; Bootsma, M.; Johnson, J.; Kluytmans, J. Prolonged colonisation with Escherichia coli O25:ST131 versus other extended-spectrum be-ta-lactamase-producing E.coli in a long-term care facility with high endemic level of rectal colonisation, the Netherlands, 2013 to 2014. Eurosurveillance 2016, 21, 30376, doi:10.2807/1560-7917.es.2016.21.42.30376.
  121. Arvand, M.; Moser, V.; Pfeifer, Y. Prevalence of extended-spectrum- -lactamase-producing Escherichia coli and spread of the epidemic clonal lineage ST131 in nursing homes in Hesse, Germany. J. Antimicrob. Chemother. 2013, 68, 2686–2688, doi:10.1093/jac/dkt226.
  122. Lautenbach, E.; Han, J.; Santana, E.; Tolomeo, P.; Bilker, W.B.; Maslow, J. Colonization with Extended-Spectrum β-Lactamase-ProducingEscherichia coliandKlebsiellaSpecies in Long-Term Care Facility Residents. Infect. Control Hosp. Epi-demiol. 2012, 33, 302–304, doi:10.1086/664055.
  123. Van Der Mee-Marquet, N.; Savoyen, P.; Domelier-Valentin, A.-S.; Mourens, C.; Quentin, R.; Réseau des Hygiénistes du Cen-tre Study Group. CTX-M–Type Fluoroquinolone-Resistant Escherichia coli: Analysis of the Colonization of Residents and In-animate Surfaces 1 Year after a First Case of Urinary Tract Infection at a Nursing Home in France. Infect. Control Hosp. Epi-demiol. 2010, 31, 968–970, doi:10.1086/655835.
  124. Bertrand, X.; Amara, M.; Sauget, M.; Clément, M.-C.; Talon, D.; Domelier-Valentin, A.-S.; Quentin, R.; van der Mee-Marquet, N. Extended-spectrum beta-lactamase-producing Enterobacteriacae: Unexpected low prevalence of carriage in elderly French residents. Age Ageing 2012, 41, 233–237, doi:10.1093/ageing/afr173.
  125. Etherton-Beer, C.D.; Inglis, T.; Waterer, G. Prevalence of oropharyngeal antibiotic-resistant flora among residents of aged care facilities: A pilot study. Respirol. 2015, 20, 1139–1141, doi:10.1111/resp.12545.
  126. Benenson, S.; Cohen, M.J.; Block, C.; Stern, S.; Weiss, Y.; Moses, A.E.; JIRMI Group. Vancomycin-Resistant Enterococci in Long-Term Care Facilities. Infect. Control Hosp. Epidemiol. 2009, 30, 786–789, doi:10.1086/598345.
  127. Elizaga, M.L.; Weinstein, R.A.; Hayden, M.K. Patients in Long-Term Care Facilities: A Reservoir for Vancomycin-Resistant Enterococci. Clin. Infect. Dis. 2002, 34, 441–446, doi:10.1086/338461.
  128. Padiglione, A.A.; Grabsch, E.; Wolfe, R.; Gibson, K.; Grayson, M.L. The Prevalence of Fecal Colonization With VRE Among Residents of Long-Term–Care Facilities in Melbourne, Australia. Infect. Control Hosp. Epidemiol. 2001, 22, 576–578, doi:10.1086/501955.
  129. Silverblatt, F.J.; Tibert, C.; Mikolich, D.; Blazek-D’Arezzo, J.; Alves, J.; Tack, M.; Agatiello, P. Preventing the Spread of Van-comycin-Resistant Enterococci in a Long-Term Care Facility. J. Am. Geriatr. Soc. 2000, 48, 1211–1215, doi:10.1111/j.1532-5415.2000.tb02592.x.
  130. Cunha, C.; Kassakian, S.Z.; Chan, R.; Tenover, F.C.; Ziakas, P.; Chapin, K.C.; Mermel, L.A. Screening of nursing home resi-dents for colonization with carbapenem-resistant Enterobacteriaceae admitted to acute care hospitals: Incidence and risk factors. Am. J. Infect. Control. 2016, 44, 126–130, doi:10.1016/j.ajic.2015.09.019.
  131. Prasad, N.; Labaze, G.; Kopacz, J.; Chwa, S.; Platis, D.; Pan, C.X.; Russo, D.; LaBombardi, V.J.; Osorio, G.; Pollack, S.; et al. Asymptomatic rectal colonization with carbapenem-resistant Enterobacteriaceae and Clostridium difficile among residents of a long-term care facility in New York City. Am. J. Infect. Control. 2016, 44, 525–532, doi:10.1016/j.ajic.2015.11.021.
  132. Ben-David, D.; Masarwa, S.; Navon-Venezia, S.; Mishali, H.; Fridental, I.; Rubinovitch, B.; Smollan, G.; Carmeli, Y.; Schwa-ber, M.J.; Israel PACF CRKP (Post-Acute-Care Facility Carbapenem-Resistant Klebsiella pneumoniae) Working Group. Car-bapenem-Resistant Klebsiella pneumoniaein Post-Acute-Care Facilities in Israel. Infect. Control Hosp. Epidemiol. 2011, 32, 845–853, doi:10.1086/661279.
  133. Prabaker, K.; Lin, M.Y.; McNally, M.; Cherabuddi, K.; Ahmed, S.; Norris, A.; Lolans, K.; Odeh, R.; Chundi, V.; Weinstein, R.A.; et al. Transfer from High-Acuity Long-Term Care Facilities Is Associated with Carriage ofKlebsiella pneumoniae-Carbapenemase–ProducingEnterobacteriaceae: A Multihospital Study. Infect. Control Hosp. Epidemiol. 2012, 33, 1193–1199, doi:10.1086/668435.
  134. Reuben, J.; Donegan, N.; Wortmann, G.; DeBiasi, R.; Song, X.; Kumar, P.; McFadden, M.; Clagon, S.; Mirdamadi, J.; White, D.; et al. Healthcare Antibiotic Resistance Prevalence—DC (HARP-DC): A Regional Prevalence Assessment of Car-bapenem-Resistant Enterobacteriaceae (CRE) in Healthcare Facilities in Washington, District of Columbia. Infect. Control Hosp. Epidemiol. 2017, 38, 921–929, doi:10.1017/ice.2017.110.
  135. Leitner, E.; Schreiner, E.; Neuhold, M.; Bozic, M.; Pux, C.; Pichler, G.; Schippinger, W.; Steinmetz, I.; Krause, R.; Zoll-ner-Schwetz, I. Low prevalence of Clostridium difficile colonization in patients in long-term care facilities in Graz, Austria: A point-prevalence study. Am. J. Infect. Control. 2020, 48, 1144–1147, doi:10.1016/j.ajic.2019.12.011.
  136. Rodriguez, C.; Taminiau, B.; Korsak, N.; Avesani, V.; Van Broeck, J.; Brach, P.; Delmée, M.; Daube, G. Longitudinal survey of Clostridium difficile presence and gut microbiota composition in a Belgian nursing home. BMC Microbiol. 2016, 16, 1–12, doi:10.1186/s12866-016-0848-7.
  137. Walker, K.J.; Gilliland, S.S.; Vance-Bryan, K.; Moody, J.A.; Larsson, A.J.; Rotschafer, J.C.; Guay, D.R.P. Clostridium difficile-Colonization in Residents of Long-Term Care Facilities: Prevalence and Risk Factors. J. Am. Geriatr. Soc. 1993, 41, 940–946, doi:10.1111/j.1532-5415.1993.tb06759.x.
  138. Thomas, D.R.; Bennett, R.G.; Laughon, B.E.; Iii, W.B.G.; Bartlett, J.G. Postantibiotic Colonization withClostridium difficilein Nursing Home Patients. J. Am. Geriatr. Soc. 1990, 38, 415–420, doi:10.1111/j.1532-5415.1990.tb03539.x.
  139. Riggs, M.M.; Sethi, A.K.; Zabarsky, T.F.; Eckstein, E.C.; Jump, R.L.P.; Donskey, C.J. Asymptomatic Carriers Are a Potential Source for Transmission of Epidemic and Nonepidemic Clostridium difficile Strains among Long-Term Care Facility Resi-dents. Clin. Infect. Dis. 2007, 45, 992–998, doi:10.1086/521854.
  140. Arvand, M.; Moser, V.; Schwehn, C.; Bettge-Weller, G.; Hensgens, M.P.; Kuijper, E.J. High Prevalence of Clostridium difficile Colonization among Nursing Home Residents in Hesse, Germany. PLoS ONE 2012, 7, e30183, doi:10.1371/journal.pone.0030183.
  141. Mortensen, E.; Trivedi, K.K.; Rosenberg, J.; Cody, S.H.; Long, J.; Jensen, B.J.; Vugia, D.J. Multidrug-ResistantAcinetobacter baumanniiInfection, Colonization, and Transmission Related to a Long-Term Care Facility Providing Subacute Care. Infect. Control Hosp. Epidemiol. 2014, 35, 406–411, doi:10.1086/675612.
  142. O’Fallon, E.; Kandell, R.; Schreiber, R.; D’Agata, E.M.C. Acquisition of Multidrug-Resistant Gram-Negative Bacteria: Inci-dence and Risk Factors within a Long-Term Care Population. Infect. Control Hosp. Epidemiol. 2010, 31, 1148–1153, doi:10.1086/656590.
  143. Kahvecioglu, D.; Ramiah, K.; Mcmaughan, D.; Garfinkel, S.; McSorley, V.; Nguyen, Q.N.; Yang, M.; Pugliese, C.; Mehr, D.; Phillips, C.D. Multidrug-Resistant Organism Infections in US Nursing Homes: A National Study of Prevalence, Onset, and Transmission across Care Settings, October 1, 2010-December 31, 2011. Infect. Control Hosp. Epidemiol. 2014, 35, S48–S55, doi:10.1086/677835.
  144. D’Agata, E.M.C.; Habtemariam, D.; Mitchell, S. Multidrug-Resistant Gram-Negative Bacteria: Inter- and Intradissemination Among Nursing Homes of Residents With Advanced Dementia. Infect. Control Hosp. Epidemiol. 2015, 36, 930–935, doi:10.1017/ice.2015.97.
More
Information
Contributor MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
View Times: 442
Revisions: 2 times (View History)
Update Date: 05 Aug 2021
1000/1000