In this issue of the Archives, D’Agata and Mitchell1 report extensive use of antibiotics in elderly nursing home residents with advanced dementia. In a cohort of 214 patients followed prospectively for 18 months, two-thirds were treated with antibiotics. Antibiotic use rose as death approached, with significant increases in the numbers of patients treated, antibiotics used, and days of treatment. These are important observations because nursing home residents, especially those with dementia, are a growing population, constitute an increasing proportion of patients hospitalized in acute care facilities, and are often found to harbor multidrug-resistant organisms.2
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