Three types of multidrug-resistant Escherichia coli isolates, called GEN S, GEN R, and AMG S, according to their three different aminoglycoside resistance patterns, were responsible for urinary tract colonization or infection in 87, 12, and 13 new patients, respectively, in a French 650-bed geriatric hospital over a 13-month period. The three E. coli types belonged to the same clone and phylogenetic group (group B2) and had identical transferable plasmid contents (a 120-kb plasmid), ␤-lactam and fluoroquinolone resistance genotypes (bla TEM-1B , bla CTX-M-15 , and double mutations in both the gyrA and the parC genes), and virulence factor genotypes (aer, fyuA, and irp2). They disseminated in the geriatric hospital, where the antibiotics prescribed most often were fluoroquinolones and ceftriaxone, but not in the affiliated acute-care hospital, where isolation precautions were applied to the transferred patients. Thus, E. coli isolates, both CTX-M-type ␤-lactamase producers and fluoroquinolone-resistant isolates, might present a new challenge for French health care settings.For the last 10 years, sporadically but regularly, the microbiology literature has reported on multidrug-resistant (MDR) bacteria in geriatric hospitals, long-term-care facilities, and nursing homes (14,26,30,44). The emergence of these bacteria in such health care facilities has become a public health concern because implementation of isolation precautions, which is the principal measure recommended in acute-care hospitals to avoid cross-transmission (12), is often considered deleterious for the quality of life of elderly people living in long-term-care facilities. Moreover, the elderly patients carrying MDR bacteria represent a reservoir of these bacteria in acute-care hospitals when they are transferred to them. The very least that can be done to address this double concern is to survey long-term-care facilities for the emergence and incidence of MDR bacteria and to inform clinicians in acute-care hospitals of the real or potential existence of these isolates in patients transferred from long-term-care facilities. Such a twofold approach, observation and an infection control program, is certainly more easily managed when the same microbiological department, as in Hôpital A. Paré, is in charge of the patients in both types of care settings.This article reports on molecular analyses performed with three types of MDR Escherichia coli isolates which successively emerged and spread in the 650-bed geriatric hospital which is affiliated with a 450-bed acute-care hospital, Hôpital A. Paré.It also describes the particular hygiene measures which were successfully established in the acute-care hospital to avoid secondary cases of MDR E. coli colonization or infection from the patients transferred from the geriatric hospital. MATERIALS AND METHODSPopulation and collection of bacteria. From October 2001 to October 2002, each first isolate of the family Enterobacteriaceae displaying an extended-spectrum ␤-lactamase (ESBL) production phenotype according to...

The results of this study strongly suggest that penicillin tolerance of the streptococci responsible for endocarditis has a clinical impact. Consequently, pending a larger prospective study addressing the problem of tolerance, it is clinically relevant to determine the minimal inhibitory and bactericidal penicillin concentrations for all streptococcal isolates causing endocarditis.

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