KPC Type B-Lactamase, Rural Pennsylvania

To the Editor: Rural counties have been defined as those lacking a metropolitan center that has a population >50,000 persons (1). Little is known about antimicrobial drug resistance in such communities in the United States. Stevenson and colleagues (2) recently evaluated antimicrobial drug-resistant gram-positive infections in rural hospitals in Idaho and Utah. These researchers found that both methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci occurred in such settings, although some of the MRSA strains were probably community associated. Comparable studies on multidrugresistant gram-negative infections have not been performed, to our knowledge.