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Warren JI & Al, 1989; Juthani-Mehta M & Quagliariello VJ, 2010) Moreover the use of some devices, including tracheostomies and intravenous catheters, is increasing in the nursing homes, reflecting the increasing level of impairment among elderly patients admitted to these facilities. Device use has been associated with both colonization and infection with antibiotic resistant organisms in nursing home residents (Mody L & Al, 2007; 2008; Rogers MA & Al, 2008; L, & Al, 2008; 2010): from 5 to 10% of nursing home residents have long-term indwelling urinary catheters with associated persistent polymicrobial bacteriuria, urinary tract infections (Warren JW & Al, 1982; Beck-Sague C & Al, 1993; Garibaldi RA, 1999; Ha US & Cho YH, Antibiotic Resistance in Nursing Homes 21 2006; Regal RE & Al, 2006; ) and their complications (Ouslander J & Al, 1987; Warren JW & Al 1987; 1988), while enteral feeding solution given to patients with nasogastric and percutaneous feeding tubes, may be contaminated with bacteria of the family of Enterobacteriaceae, including Serratia spp and Enterobacter spp.

Attack rate of outbreaks as reported in published studies Mycobacterium tuberculosis is responsible for outbreaks spreading from one facility to another (Ijaz, K & Al, 2002). The high frequency of prior infection with Mycobacterium tuberculosis in the elderly population, coupled with the immunological decline, characteristic of elderly persons, foments higher rates of tuberculosis in the nursing home setting. A survey of 15379 reported cases in 29 state indicated that the incidence of tuberculosis among nursing home residents was 39,2 cases per 100000 population, compared with 21,5 cases per 100000 population among elderly persons living in community (Center for Disease Control, 1990b).

External catheter are also a risk factor for urinary tract infections in male residents (Smith PW & Al, 1991), but are significantly more comfortable and associated with fewer adverse effects, including symptomatic urinary infection, than indwelling catheter (Saint S & Al, 2006). Local external care is required. The reported microbiology of symptomatic urinary tract infections in nursing homes shows that E. coli in women, and Proteus Mirabilis in men are the most frequently isolated infecting organisms (Nicolle LE & Al, 1987; 1996; Ricci G & Al, 2010).

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