Future quantitative studies are needed to examine the impact of physical and social environments on loneliness in this population. It is important to better map the multiple factors and ways by which they impact loneliness to develop better solutions for public policy, city, and environmental planning, and individually based interventions. This effort should be viewed as a public health priority.

Implementation of STOPP/START criteria reduced the number of medications, falls, and costs in a geriatric facility. Their incorporation in those and similar settings is recommended.

Together with the information available in the MLST database, our results suggest that, like Escherichia coli and Klebsiella pneumoniae, E. cloacae harbours clonal lineages of increased epidemic potential that may be associated with resistance spread.

New Delhi metallo-␤-lactamase (NDM-1) was initially identified in various Enterobacteriaceae and recently in Acinetobacter baumannii. This study described the clonal dissemination of an NDM-2-producing A. baumannii isolate in an Israeli rehabilitation ward and the genetic surroundings of the gene. The bla NDM-2 gene was surrounded by the ble and trpF genes downstream and two copies of the ISAba125 on both sides. These are the first NDM-producing A. baumannii strains in Israel from patients with no previous travel or hospitalization on the Indian subcontinent.Carbapenem resistance in Gram-negative bacteria is an important worldwide problem, particularly because of the production of class A, D, and B metallo-␤-lactamase enzymes (MBLs) as a resistance mechanism and the facility to spread by mobile genetic elements (12). The new MBL, New Delhi metallo-␤-lactamase 1 (NDM-1), initially reported in Klebsiella pneumoniae and Escherichia coli recovered from a Swedish patient who was previously hospitalized in India (23), has disseminated to several countries and other Enterobacteriaceae (4,9,13,(15)(16)(17)(18)22). Recently, cases of NDM-producing Acinetobacter baumannii have been described in India, Egypt, and China (1, 6, 8).Five carbapenem-resistant A. baumannii isolates were recovered from female patients at the TA-Sourasky-MA Rehabilitation hospital in Tel Aviv, Israel (Table 1). The five elderly patients (mean age, 81) were hospitalized in the same geriatric rehabilitation ward. The cultures were taken as a point prevalence study from 70 patients hospitalized in two wards in the rehabilitation center. Surveillance skin cultures were taken from six body sites (armpit, thigh, and groin, bilaterally). Four of the five patients were admitted to rehabilitation after orthopedic surgery in two different orthopedic wards located in the same hospital, adjacent to the rehabilitation center. Three of the patients shared a room with each other at a point during their hospital stay, and others shared with them common facilities. None of the patients had any clinical culture that grew Acinetobacter spp., and no signs of infection due to Acinetobacter were evident. There was no specific history taken regarding travel (Table 1). Isolates were initially identified using the Vitek-2 automatic system (bioMérieux, Marcy, France) and confirmed by amplified rRNA gene restriction analysis (ARDRA) (20). The epidemiological relationship was corroborated by pulsed-field gel electrophoresis (PFGE) under conditions described elsewhere (10). PFGE results showed an identical pattern for all the strains. Multiplex PCR to identify clonal lineages (19) showed that the strains did not belong to pan-European clone I, II, or III. Multilocus sequence typing (MLST) indicated that the strain corresponded to sequence type (ST) 103 according to the Pasteur system (http://www.pasteur.fr /recherche/genopole/PF8/mlst/Abaumannii.html), which is in agreement with the ST found in the NDM-2-producing A. baumannii isolate reported from Egypt (6).Antibiotic suscep...

The effect of an orally communicated medication intervention with the STOPP/START criteria on falls was maintained over time. Direct communication between pharmacists and prescribing physicians is more efficient than written medication review and is recommended every 6 months in geriatric facilities.