Skip to main content

Advertisement

SpringerLink
Log in

Colonization with Multidrug-Resistant Organisms in Nursing Homes: Scope, Importance, and Management

  • Infectious Diseases in the Elderly (KS Kaye and D Kaye, Section Editors)
  • Published:
Current Geriatrics Reports Aims and scope Submit manuscript

Abstract

Bacterial infections are among the most common causes of morbidity and mortality in nursing homes (NHs) and other long-term care facilities. Multidrug-resistant organisms (MDROs) represent an ever-increasing share of causative agents of infection, and their prevalence in NHs is now just as high as in acute care facilities, or even higher. Indeed, NHs are now considered a major reservoir of MDROs for the community at large. Asymptomatic colonization is usually a prerequisite to development of symptomatic infection. While progress has been made in defining epidemiology of MDROs in NHs, few studies have evaluated the role of changing health care delivery in introducing and further transmitting MDROs in this setting. Furthermore, the factors influencing the spread of colonization and the key prognostic indicators leading to symptomatic infections in the burgeoning short stay population need to be explored further. The difficulty of this task lies in the heterogeneity of NHs in terms of focus of care, organization and resources, and on the diversity among the many MDRO species encountered, which harbor different resistance genes and with a different prevalence depending on the geographic location, local antimicrobial pressure, and residents risk factors such as use of indwelling devices, functional disability, wounds, and other comorbidities. We present literature findings on the scope and importance of colonization as a pathway to infection with MDROs in NHs, underline important open questions that need further research, and discuss the strength of the evidence for current and proposed screening, prevention, and management interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality.Healthcare Cost and Utilization Project (HCUP). Quick National or State Statistics. 2012. http://hcupnet.ahrq.gov/

  2. Aronow WS. Clinical causes of death of 2372 older persons in a nursing home during 15-year follow-up. J Am Med Dir Assoc. 2000;1:95–6.

    CAS  PubMed  Google Scholar 

  3. Strausbaugh LJ, Joseph CL. The burden of infection in long-term care. Infect Control Hosp Epidemiol. 2000;21:674–9.

    Article  CAS  PubMed  Google Scholar 

  4. JW, Palumbo FB, Fitterman L, Speedie SM. Incidence and characteristics of antibiotic use in aged nursing home patients. J Am Geriatr Soc. 1991;39:963-72.

  5. Bradley SF, Terpenning MS, Ramsey MA, Zarins LT, Jorgensen KA, Sottile WS, et al. Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med. 1991;115:417–22.

    Article  CAS  PubMed  Google Scholar 

  6. Kikutani T, Tamura F, Tashiro H, Yoshida M, Konishi K, Hamada R. Relationship between oral bacteria count and pneumonia onset in elderly nursing home residents. Geriatr Gerontol Int. 2014; in press

  7. Vlek AL, Cooper BS, Kypraios T, Cox A, Edgeworth JD, Auguet OT. Clustering of antimicrobial resistance outbreaks across bacterial species in the intensive care unit. Clin Infect Dis. 2013;57(1):65–76.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Fisch J, Lansing B, Wang L, Symons K, Cherian K, McNamara S, et al. New acquisition of antibiotic-resistant organisms in skilled nursing facilities. J Clin Microbiol. 2012;50(5):1698–703. This report highlights important considerations on the specific risk factors for acquisition of MDROs in NHs.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Dommeti P, Wang L, Flannery EL, Symons K, Mody L. Patterns of ciprofloxacin-resistant gram-negative bacteria colonization in nursing home residents. Infect Control Hosp Epidemiol. 2011;32:177–80.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Wang L, Lansing B, Symons K, Flannery EL, Fisch J, Cherian K, et al. Infection rate and colonization with antibiotic-resistant organisms in skilled nursing facility residents with indwelling devices. Eur J Clin Microbiol Infect Dis. 2012;31:1797–804.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Pop-Vicas A, Mitchell SL, Kandel R, Schreiber R, D’Agata EM. Multidrug-resistant gram-negative bacteria in a long-term care facility: prevalence and risk factors. J Am Geriatr Soc. 2008;56:1276–80.

    Article  PubMed  Google Scholar 

  12. McBryde ES, Bradley LC, Whitby M, McElwain DL. An investigation of contact transmission of methicillin-resistant Staphylococcus aureus. J Hosp Infect. 2004;58:104–8.

    Article  CAS  PubMed  Google Scholar 

  13. Murphy CR, Quan V, Kim D, Peterson E, Whealon M, Tan G, et al. Nursing home characteristics associated with methicillin-resistant Staphylococcus aureus (MRSA) burden and transmission. BMC Infect Dis. 2012;12:269–17.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Centers for Disease Control and Prevention Antibiotic Resistance Threats, 2013 (http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf

  15. Spencer RC. The emergence of epidemic, multiple-antibiotic-resistant Stenotrophomonas (Xanthomonas) maltophilia and Burkholderia (Pseudomonas) cepacia. J Hosp Infect. 1995;30(Suppl):453–64.

    Article  PubMed  Google Scholar 

  16. Dantes R, Mu Y, Belflower R, Aragon D, Dumyati G, Harrison LH, et al. . National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Intern Med. 2013;173(21):1970–8. Updated and exhaustive report highlighting the prevalence and clinical significance of MRSA in the USA and discussing its evolving epidemiology.

    PubMed  Google Scholar 

  17. Moran GJ, Abrahamian FM, Lovecchio F, Talan DA. Acute bacterial skin infections: developments since the 2005 Infectious Diseases Society of America (IDSA) guidelines. J Emerg Med. 2013;44(6):e397–412.

    Article  PubMed  Google Scholar 

  18. Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J, Srinivasan A, et al. National Healthcare Safety Network (NHSN) Team and Participating NHSN Facilities. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 18 2009-2010. Infect Control Hosp Epidemiol. 2013;34:1–14. This paper presents the latest national trends regarding the burden of MDR pathogens in healthcare-associated infections, and represent a complete source to understand the dimension of the problem.

    Article  PubMed  Google Scholar 

  19. European Antimicrobial Resistance Surveillance System (EARSS) annual report 2008. http://www.ecdc.europa.eu/en/activities/surveillance/EARS-Net/Documents/2008_EARSS_Annual_Report.pdf

  20. Jr TP, McKinnon PS. Burden of methicillin-resistant Staphylococcus aureus: focus on clinical and economic outcomes. Pharmacotherapy. 2007;27(7):1001–12.

    Article  Google Scholar 

  21. Campanile F, Bongiorno D, Falcone M, Vailati F, Pasticci MB, Perez M, et al. Changing Italian nosocomial-community trends and heteroresistance in Staphylococcus aureus from bacteremia and endocarditis. Eur J Clin Microbiol Infect Dis. 2012;31:739–45.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Mody L, Bradley SF, Galecki A, Olmsted RN, Fitzgerald JT, Kauffman CA, et al. Conceptual model for reducing infections and antimicrobial resistance in skilled nursing facilities: focusing on residents with indwelling devices. Clin Infect Dis. 2011;52:654–61.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Murphy S, Denman S, Bennett RG, Greenough 3rd WB, Lindsay J, Zelesnick LB. Methicillin-resistant Staphylococcus aureus colonization in a long-term-care facility. J Am Geriatr Soc. 1992;40(3):213–7.

    CAS  PubMed  Google Scholar 

  24. Hudson LO, Reynolds C, Spratt BG, Enright MC, Quan V, Kim D, et al. Diversity of methicillin-resistant Staphylococcus aureus strains isolated from residents of 26 nursing homes in Orange County, California. J Clin Microbiol. 2013;51:3788–95.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Crnich CJ, Duster M, Hess T, Zimmerman DR, Drinka P. Antibiotic resistance in non-major metropolitan skilled nursing facilities: prevalence and interfacility variation. Infect Control Hosp Epidemiol. 2012;33:1172–4.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Furuno JP, Shurland SM, Zhan M, Johnson JK, Venezia RA, Harris AD, et al. Comparison of the methicillin-resistant Staphylococcus aureus acquisition among rehabilitation and nursing home residents. Infect Control Hosp Epidemiol. 2011;32:244–9.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Orsi GB, Ciorba V. Vancomycin resistant enterococci healthcare associated infections. Ann Ig. 2013;25(6):485–92.

    CAS  PubMed  Google Scholar 

  28. Benenson S, Cohen MJ, Block C, Stern S, Weiss Y, Moses AE, et al. Vancomycin-resistant enterococci in long-term care facilities. Infect Control Hosp Epidemiol. 2009;30(8):786–9.

    Article  PubMed  Google Scholar 

  29. Brennen C, Wagener MM, Muder RR. Vancomycin-resistant Enterococcus faecium in a long-term care facility. J Am Geriatr Soc. 1998;46:157–60.

    CAS  PubMed  Google Scholar 

  30. Morris Jr JG, Shay DK, Hebden JN, McCarter Jr RJ, Perdue BE, Jarvis W, et al. Enterococci resistant to multiple antimicrobial agents, including vancomycin. Establishment of endemicity in a 20 university medical center. Ann Intern Med. 1995;123:250–9.

    Article  CAS  PubMed  Google Scholar 

  31. Kristich CJ, Rice LB, Arias CA. Enterococcal infection—treatment and antibiotic resistance. 2014 Feb 6. In: Gilmore MS, Clewell DB, Ike Y, Shankar N, editors. Enterococci: From Commensals to Leading Causes of Drug Resistant Infection [Internet]. Boston: Massachusetts Eye and Ear Infirmary; 2014

  32. Tarasi A, Capone A, Venditti M. Options for the treatment of patients with severe infections caused by enterococci exhibiting high-level resistance to aminoglycosides. J Antimicrob Chemother. 1998;42(1):113–4.

    Article  CAS  PubMed  Google Scholar 

  33. Edmond MB, Ober JF, Dawson JD, Weinbaum DL, Wenzel RP. Vancomycin-resistant enterococcal bacteremia: natural history and attributable mortality. Clin Infect Dis. 1996;23:1234–9.

    Article  CAS  PubMed  Google Scholar 

  34. European Antimicrobial Resistance Surveillance System (EARSS) publications. http://www.ecdc.europa.eu/en/publications/Publications/Forms/ECDC_DispForm.aspx?ID=998

  35. TESSy, The European Surveillance Network, EARSS Net. http://www.ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/database.aspx. An interactive database allowing quick visualization of updated antimicrobial resistance data by country, in table, graph and map format

  36. Dalhoff A. Global fluoroquinolone resistance epidemiology and implications for clinical use. Interdiscip Perspect Infect Dis. 2012;2012:976273.

    PubMed Central  PubMed  Google Scholar 

  37. Lautenbach E, Marsicano R, Tolomeo P, Heard M, Serrano S, Stieritz DD. Epidemiology of antimicrobial resistance among gram-negative organisms recovered from patients in a multistate network of long-term care facilities. Infect Control Hosp Epidemiol. 2009;30:790–3.

    Article  PubMed Central  PubMed  Google Scholar 

  38. O’Fallon E, Gautam S, D’Agata EM. Colonization with multidrug-resistant gram-negative bacteria: prolonged duration and frequent cocolonization. Clin Infect Dis. 2009;48(10):1375–81.

    Article  PubMed  Google Scholar 

  39. Rooney PJ, O’Leary MC, Loughrey AC, McCalmont M, Smyth B, Donaghy P, et al. Nursing homes as a reservoir of extended-spectrum beta-lactamase (ESBL)-producing ciprofloxacin-resistant Escherichia coli. J Antimicrob Chemother. 2009;64:635–41.

    Article  CAS  PubMed  Google Scholar 

  40. Viray M, Linkin D, Maslow JN, Stieritz DD, Carson LS, Bilker WB, et al. Longitudinal trends in antimicrobial susceptibilities across long-term-care facilities: emergence of fluoroquinolone resistance. Infect Control Hosp Epidemiol. 2005;26:56–62.

    Article  PubMed  Google Scholar 

  41. De Vecchi E, Sitia S, Romanò CL, Ricci C, Mattina R, Drago L. Aetiology and antibiotic resistance patterns of urinary tract infections in the elderly: a 6-month study. J Med Microbiol. 2013;62(Pt 6):859–63.

    Article  PubMed  Google Scholar 

  42. Point Prevalence LTCFs antimicrobial European Survey. http://www.ecdc.europa.eu/en/publications/Publications/healthcare-associated-infections-point-prevalence-survey-long-term-care-facilities-2013.pdf

  43. Strausbaugh LJ, Jacobson C, Sewell DL, Potter S, Ward TT. Antimicrobial therapy for methicillin-resistant Staphylococcus aureus colonization in residents and staff of a Veterans Affairs nursing home care unit. Infect Control Hosp Epidemiol. 1992;13:151–9.

    Article  CAS  PubMed  Google Scholar 

  44. McKinnell JA, Miller LG, Eells SJ, Cui E, Huang SS. A systematic literature review and meta-analysis of factors associated with methicillin-resistant Staphylococcus aureus colonization at time of hospital or intensive care unit admission. Infect Control Hosp Epidemiol. 2013;34:1077–86.

    Article  PubMed  Google Scholar 

  45. Kindschuh W, Russo D, Kariolis I, Wehbeh W, Urban C. Comparison of a hospital-wide antibiogram with that of an associated long-term care facility. J Am Geriatr Soc. 2012;60:798–800.

    Article  PubMed  Google Scholar 

  46. Troillet N, Carmeli Y, Samore MH, Dakos J, Eichelberger K, DeGirolami PC, et al. Carriage of methicillin-resistant Staphylococcus aureus at hospital admission. Infect Control Hosp Epidemiol. 1998;19:181–5.

    Article  CAS  PubMed  Google Scholar 

  47. Strausbaugh LJ, Crossley KB, Nurse BA, Thrupp LD. Antimicrobial resistance in long-term-care facilities. Infect Control Hosp Epidemiol. 1996;17(2):129–40.

    Article  CAS  PubMed  Google Scholar 

  48. van Buul LW, van der Steen JT, Veenhuizen RB, Achterberg WP, Schellevis FG, Essink RT, et al. Antibiotic use and resistance in long term care facilities. J Am Med Dir Assoc. 2012;13:568.e1–13. This meta-analysis study highlights the proven risk factors for colonization and infection with MDROs in a sintetic way, and stratifies findings according to the strength of evidence.

    Google Scholar 

  49. O’Fallon E, Schreiber R, Kandel R, D’Agata EM. Multidrug-resistant gram-negative bacteria at a long-term care facility: assessment of residents, healthcare workers, and inanimate surfaces. Infect Control Hosp Epidemiol. 2009;30:1172–9.

    Article  PubMed  Google Scholar 

  50. Min L, Galecki A, Mody L. Functional disability and nursing resource utilization are predictive of antimicrobial resistance in nursing homes. J Am Geriatr Soc. 2015 in press

  51. von Baum H, Schmidt C, Svoboda D, Bock-Hensley O, Wendt C. Risk factors for methicillin-resistant Staphylococcus aureus carriage in residents of German nursing homes. Infect Control Hosp Epidemiol. 2002;23(9):511–5.

    Article  Google Scholar 

  52. Yoshikawa TT. Antibiotic-resistant bacterial infections. In: Yoshikawa TT, Rajagopalan S, editors. Antibiotic therapy for geriatric patients. New York: Taylor and Francis; 2006. p. 617–24.

    Google Scholar 

  53. Shurland SM, Stine OC, Venezia RA, Zhan M, Furuno JP, Miller RR, et al. USA300 methicillin-resistant S. aureus (USA300 MRSA) colonization and the risk of MRSA infection in residents of extended-care facilities. Epidemiol Infect. 2012;140:390–9.

    Article  CAS  PubMed  Google Scholar 

  54. Wertheim HF, Vos MC, Ott A, van Belkum A, Voss A, Kluytmans JA, et al. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet. 2004;364:703–5.

    Article  PubMed  Google Scholar 

  55. Muder RR, Brennen C, Wagener MM, Vickers RM, Rihs JD, Hancock GA, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med. 1991;114:107–12.

    Article  CAS  PubMed  Google Scholar 

  56. Mest DR, Wong DH, Shimoda KJ, Mulligan ME, Wilson SE. Nasal colonization with methicillin-resistant Staphylococcus aureus on admission to the surgical intensive care unit increases the risk of infection. Anesth Analg. 1994;78:644–50.

    CAS  PubMed  Google Scholar 

  57. Pujol M, Peña C, Pallares R, Ariza J, Ayats J, Dominguez MA, et al. Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. Am J Med. 1996;100:509–16.

    Article  CAS  PubMed  Google Scholar 

  58. Davis KA, Stewart JJ, Crouch HK, Florez CE, Hospenthal DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis. 2004;39:776–82.

    Article  PubMed  Google Scholar 

  59. 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. doi:10.1016/j.ijmm.2014.08.006.

    PubMed  Google Scholar 

  60. Niclaes L, Buntinx F, Banuro F, Lesaffre E, Heyrman J. Consequences of MRSA carriage in nursing home residents. Epidemiol Infect. 1999;122:235–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  61. Mulhausen PL, Harrell LJ, Weinberger M, Kochersberger GG, Feussner JR. Contrasting methicillin-resistant Staphylococcus aureus colonization in Veterans Affairs and community nursing homes. Am J Med. 1996;100:24–31.

    Article  CAS  PubMed  Google Scholar 

  62. Manzur A, De Gopegui ER, Dominguez M, Mariscal D, Gavalda L, Perez JL, et al. Clinical significance of methicillin-resistant Staphylococcus aureus colonization in residents in community long-term-care facilities in Spain. Epidemiol Infect. 2012;140:400–6.

    Article  CAS  PubMed  Google Scholar 

  63. Schoevaerdts D, Agelas JP, Ingels MG, Jamart J, Frennet M, Huang TD, et al. Health outcomes of older patients colonized by multi-drug resistant bacteria (MDRB): a one-year follow-up study. Arch Gerontol Geriatr. 2013;56:231–6.

    Article  PubMed  Google Scholar 

  64. Lee BY, Singh A, Bartsch SM, Wong KF, Kim DS, Avery TR, et al. The potential regional impact of contact precaution use in nursing homes to control methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol. 2013;34:151–60.

    Article  PubMed Central  PubMed  Google Scholar 

  65. Marwick C, Santiago VH, McCowan C, Broomhall J, Davey P. Community acquired infections in older patients admitted to hospital from care homes versus the community: cohort study of microbiology and outcomes. BMC Geriatr. 2013;13:12.

    Article  PubMed Central  PubMed  Google Scholar 

  66. Shlaes DM, Gerding DN, John Jr JF, Craig WA, Bornstein DL, Duncan RA, et al. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Clin Infect Dis. 1997;25:584–99.

    Article  CAS  PubMed  Google Scholar 

  67. Mody L. Optimizing antimicrobial use in nursing homes: no longer optional. J Am Geriatr Soc. 2007;55(8):1301–2.

    Article  PubMed Central  PubMed  Google Scholar 

  68. Stone ND, Ashraf MS, Calder J, Crnich CJ, Crossley K, Drinka PJ, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol. 2012;33(10):965–77. A key guide to a unified definition of infection and probable infection in NH residents. Adherence to the presented guidelines will lead to more accurate diagnosis and a decrease in unnecessary antibiotic therapy.

    Article  PubMed Central  PubMed  Google Scholar 

  69. Loeb M, Bentley DW, Bradley S, Crossley K, Garibaldi R, Gantz N, et al. Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference. Infect Control Hosp Epidemiol. 2001;22(2):120–4.

    Article  CAS  PubMed  Google Scholar 

  70. Monette J, Miller MA, Monette M, Laurier C, Boivin JF, Sourial N, et al. Effect of an educational intervention on optimizing antibiotic prescribing in long-term care facilities. J Am Geriatr Soc. 2007;55(8):1231–5.

    Article  PubMed  Google Scholar 

  71. Latour K, Catry B, Broex E, Vankerckhoven V, Muller A, Stroobants R, et al. Indications for antimicrobial prescribing in European nursing homes: results from a point prevalence survey. Pharmacoepidemiol Drug Saf. 2012;21:937–44.

    Article  PubMed  Google Scholar 

  72. Mody L, McNeil SA, Sun R, Bradley SE, Kauffman CA. Introduction of a waterless alcohol-based hand rub in a long-term-care facility. Infect Control Hosp Epidemiol. 2003;24(3):165–71.

    Article  PubMed  Google Scholar 

  73. Gibson KE, McNamara SE, Cassone M, Perri MB, Zervos M, Mody L. 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(12):1458–65. This study highlights how important a carefully tailored screening strategy is, with a special emphasis to the choice of the target population and the screening sites.

    Article  PubMed  Google Scholar 

  74. Hospital Infection Control Practices Advisory Committee (HICPAC). Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol. 1995;16:105–13.

    Article  Google Scholar 

  75. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control. 2007;35(10 Suppl 2):S165–93.

    Article  PubMed  Google Scholar 

  76. Tacconelli E, Cataldo MA, Dancer SJ, De Angelis G, Falcone M, Frank U, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect. 2014;20 Suppl 1:1–55. An authoritative and detailed review of effective infection control measures for specific MDR-Gram negatives in endemic and epidemic situations.

    Article  PubMed  Google Scholar 

  77. Schwaber MJ, Lev B, Israeli A, Solter E, Smollan G, Rubinovitch B, et al. Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis. 2011;52:848–55.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Marco Cassone declares that he has no conflict of interest.

Lona Mody declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Division of Geriatric and Palliative Care Medicine, University of Michigan Medical School, 300 N. Ingalls St., Rm. 905, Ann Arbor, MI, 48109, USA

    Marco Cassone & Lona Mody

  2. Geriatrics Research Education and Clinical Center (GRECC), Veteran Affairs Ann Arbor Healthcare System, 11-G GRECC, 2215 Fuller Rd, Ann Arbor, MI, 48105, USA

    Lona Mody

Authors
  1. Marco Cassone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lona Mody
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lona Mody.

Additional information

This article is part of the Topical Collection on Infectious Diseases in the Elderly

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cassone, M., Mody, L. Colonization with Multidrug-Resistant Organisms in Nursing Homes: Scope, Importance, and Management. Curr Geri Rep 4, 87–95 (2015). https://doi.org/10.1007/s13670-015-0120-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13670-015-0120-2

Keywords

Search

Navigation