ABSTRACT
The infectious disease challenges facing clinicians committed to the care of the growing number of elderly will be great (1). It is estimated that the incidence of infection in long-term care facilities (LTCFs) in the United States ranges between 1 to 10 per 1000 days of care (2,3). Surveys of medication use in nursing homes indicate that antibiotics account for nearly 40% of all medications prescribed in LTCFs (4,5). Most of the antibiotic use is empiric, without the benefit of accurate culture data or information regarding susceptibility to guide clinicians. This intense antibiotic usage creates selective pressure for the emergence of resistance. Because elderly patients are mobile between acute care settings, LTCFs, and the community, the movement of the elderly in the healthcare system has played a major role in the evolution of antibiotic resistance in this population.
