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Strain?A is widespread in the UK and was previously identified from a patient in Austria who had visited southern Italy but not the UK [31]. All three MBL-producing E.?coli isolates and 90% of ESBL-producing E.?coli isolates belonged to phylogenetic group?B2, whereas selleck screening library 3.8% of the ESBL producers belonged to group?D. These phylogenetic groups��particularly B2��account for most virulent extra-intestinal strains of the species [22]. LTCF outbreaks of E.?coli with CTX-M-15 (the commonest group?1 type) were reported in 2000�C2002 in Canada [32], and a survey in northern Italy in 2006�C2007 revealed them in 9.1�C100% of urine samples from LTCF residents with indwelling catheters [33]. Movement of patients and staff between the LTCFs and hospitals may facilitate dissemination of resistant bacteria. It is unclear whether most de?novo acquisition occurs EX 527 manufacturer in the LTCF or during occasional hospitalizations [1], but the lower colonization rates among the geriatric unit patients argue against the hospital as the main source, as does the fact that, during 2008, the prevalence of ESBL producers among routine clinical isolates from LTCF residents far exceeded that among geriatric unit patients (40% vs. 9%; p?Vatalanib (PTK787) 2HCl antibiotic treatment is a well-recognized risk factor for colonization with resistant organisms [25], including ESBL producers [1] and MRSA [24], whereas invasive medical devices are considered to be important for ESBL producers [36] and MRSA [24,25]; chronic obstructive pulmonary disease was found to be an independent risk factor for MRSA colonization among LTCF residents in our study and by others [37]. However, the most important risk factor for carriage of resistant organisms, ESBL producers and MRSA was the particular LTCF unit of residence. This is explicable, because the five units manage residents with different levels of independence, basal disease, comorbidity and functional status, all of which influence the frequency and nature of staff contact. Residents in LTCF units?2 and 5 are non-ambulatory and require extensive assistance with daily living activities, along with nursing and medical care; those in units?3 and 4 have less functional disability or comorbidity; and those in unit?1 have dementia but are ambulatory.