Does antimicrobial resistance matter in long-term care facilities?

Between 2000 and 2020, the percentages of the population 65 years and older in Canada and the United States will increase by 43% and 33%, respectively (Anderson GF, Hussey PS. Health Affairs 2000;19 (3): 191-203). In the United States alone, approximately 6 million persons need some type of long-term care; one third of these persons receive this care in long-term care facilities, with an estimate that demand for this type of care will double in the next 30 years, reflecting, in part, the aging population (Feder J, et al. Health Affairs 2000;19(3):40-56). Presence of an antimicrobial resistant strain in a patient always has been a factor during interfacility transfers—not infrequently an impediment to smooth transitions in care. In continuation of the theme of antimicrobial resistance, Dr Nicolle and ican PREVENT.com, an Internet based, peer-reviewed knowledge aggregator, have agreed to provide the following thought-provoking commentary for this installment of Reaction & Response that addresses the unique aspects of care of patients with such microbial strains in long-term care. QUESTION: Does antimicrobial resistance matter in long-term care facilities? The following response has been provided by Lindsay E. Nicolle, MD, professor and head of the Depart- ment of Internal Medicine, University of Manitoba, Winnipeg, Canada.