title: Review on colonization of residents and staff in Italian long-term care facilities by multidrug-resistant bacteria compared with other European countries.
abstract: BACKGROUND
  Rates of colonization and infection with multidrug-resistant (MDR) bacteria are increasing worldwide, in both acute care hospitals and long-term care facilities (LTCFs). Italy has one of the highest prevalence of MDR bacteria in European countries, especially with regard to methicillin-resistantStaphylococcus aureus(MRSA) and extended-spectrum β-lactamase (ESBL) or carbapenemase producingEnterobacteriaceae(CPE).
  
  
  METHODS
  Review of studies on colonization by MDR bacteria from Italian LTCFs, risk factors for colonization and molecular characteristics of surveillance and clinical isolates, compared with other European countries.
  
  
  RESULTS
  High variability of MDR colonization has been reported within and especially between European countries. Only a few surveillance studies have been performed in Italian LTCFs; these show MRSA colonization prevalence of 7.8-38.7 % for residents and 5.2-7.0 % for staff members, ESBL prevalence of 49.0-64.0 % for residents and 5.2-14.5 % for staff and prevalence of CPE of 1.0-6.3 % for residents and 0.0-1.5 % for staff. In Italian LTCFs, as well as in other European countries, the most prevalent ESBLs from surveillance or clinicalEscherichia coliisolates were found to be CTX-M-type enzymes, particularly CTX-M-15, expressed by the pandemic ST131 clonal group; this lineage also expresses carbapenemase genes of theblaVIMandblaKPCtypes. Various risk factors for colonization of residents by MDR bacteria were identified.
  
  
  CONCLUSIONS
  The limited data from Italian LTCFs confirms these settings as important reservoirs for MDR organisms, allowing important considerations regarding the infection risk by these organisms. Nevertheless, more extended and countrywide screening studies for MDR colonization in Italian LTCFs are required. To promote further studies of various microbiological aspects related to LTCFs, the Association of Italian Clinical Microbiologists (Associazione Microbiologi Clinici Italiani; AMCLI) in 2016 has set up a new Working Group for the Study of Infections in LTCFs (Gruppo di Lavoro per lo Studio delle Infezioni nelle Residenze Sanitarie Assistite e Strutture Territoriali assimilabili; GLISTer), consisting of Clinical Microbiologists represented by the authors of this review article.
authors.affiliation: Laboratorio Aziendale di Microbiologia e Virologia, Comprensorio Sanitario di Bolzano, Bolzano, Italy.
authors.forename: Richard
authors.initials: R
authors.lastname: Aschbacher
authors.affiliation: Laboratorio Aziendale di Microbiologia e Virologia, Comprensorio Sanitario di Bolzano, Bolzano, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Pagani
authors.affiliation: U.O. di Microbiologia, Azienda Sanitaria Locale di Piacenza, Piacenza, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Confalonieri
authors.affiliation: Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, USC Microbiologia e Virologia, Bergamo, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Farina
authors.affiliation: P.O. Spirito Santo Laboratorio Analisi, Pescara, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fazii
authors.affiliation: Ospedale A. Manzoni, Laboratorio Microbiologia e Virologia, Lecco, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Luzzaro
authors.affiliation: USL Valle D'Aosta, SC Laboratorio di Microbiologia, Aosta, Italy.
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Montanera
authors.affiliation: Dipartimento SCCDP, Unità di Microbiologia e Microbiologia clinica, Pavia, Italy.
authors.forename: Aurora
authors.initials: A
authors.lastname: Piazza
authors.affiliation: Dipartimento SCCDP, Unità di Microbiologia e Microbiologia clinica, Pavia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pagani
keywords: Carbapenemase; Colonization; ESBL; LTCF; MRSA