This issue offers two contributions to our expanding understanding of infections and antimicrobial resistance in the nursing home population.1,2 At any time, a greater number of North Americans are institutionalized in long-term-care facilities, primarily nursing homes, than in acute-care facilities. Despite this, until relatively recently, the burden of infections in this population and the complex and confusing issues of diagnosis and appropriate therapy have been relatively neglected. Notably, this journal has been a leader in a critical analysis of this field through the articles published over the past 8 years as Topics in Long-Term Care under the editorship of David Bentley, MD. There is now a wider and increasing interest in issues related to infection in the nursing home. The heightened profile partly may reflect the aging of our populations, but seems driven more by recognition of the nursing home as a cauldron of bacterial colonization and infection, antibiotic therapy, and antimicrobial-resistant organisms.3 The current societal focus on the potential catastrophes of antimicrobial resistance has raised the profile of the nursing home. What do we know about antimicrobial resistance in nursing homes? The prevalence of colonization with antimicrobial-resistant organisms, including methicillin-resistant Staphylococcus aureus/ (MRSA), vancomycin-resistant enterococci (VRE), and some gram-negative organisms, particularly Providencia stuartii, is high in many.3 In particular, antimicrobial-resistant organisms likely occur with greater frequency in Veterans' Affairs facilities.4 A consistent observation is that underlying patient characteristics are associated more strongly with the presence of resistant organisms in a given patient than are measures of antimicrobial use. Thus, highly debilitated patients characterized by the presence of decubitus ulcers, gastrostomy feeding tubes, and trach ostomies repeatedly have been identified as most likely harboring resistant organisms. Clinical varibles consistent with increased debility are predicto s of colonization or infection with antimicrobialresistant organisms in a given resident. The study by Muder et all confirms, again, the preeminent importance of resident characteristics, in this case for res stant Enterbacteriaceae identified through the cli ical laboratory. We also know that antimicrobialres stant organisms, once introduced, tend to persist wi hin the individual and the facility. Antimicrobial pressure from intensive, frequently broad-spectrum, antimicrobial use has some role in this persistence, as the study of Muder et al reports for Pseudomonas aeruginosa clinical isolates.' We also know that patients in long-term-care facilities frequently are transferred to acute-care facilities. The antimicrobial-resistant organisms present in the long-term-care facility are carried with the patient to the acute-care facility and occasionally may be transmitted to other patients in the acute-care facility. Transport of resistant organisms in the opposite direction, ie, from the acute-care facility to the longterm-care facility, also is frequent. The evidence from the experience with MRSA and VRE is incomplete, but suggestive that these organisms originated in acute-care facilities and were introduced from these facilities into nursing homes. The nursing home is an