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Seventy-eight (52%) patients were colonized by CR pathogens and 30 (20%) of them were CRKP. Thirteen of these patients have been included in a previous study describing the first outbreak of CRKP in Greece [6]. The site of the initial isolation of CRKP was a stool in 15 (50%) cases, respiratory secretions in eight (27%) and urine in seven (23%). The most frequent colonization site of CR pathogens was the rectum in 22 cases (75%) for CRKP and the respiratory tract for P.?aeruginosa and A.?baummanni (two and three cases, respectively). Among patients colonized by CRKP, three were already colonized on admission while the rest were colonized [http://en.wikipedia.org/wiki/RVX_208 RVX-208] during their stay in the ICU. Only one patient was colonized by CRKP during hospitalization without having previously received colistin. CRKP isolates were assigned to 20 distinct clones by REP-PCR methodology. Among them, 15 developed during treatment with colistin in the study ICU, while the rest were transferred from other hospitals. Among 30 patients colonized by CRKP, 27 (90%) had received colistin (p? OR, 6.98; 95% CI, 2.0�C24.3). Among 94 patients exposed to colistin, 27 (28.7%) were colonized by CRKP. Patients colonized by CRKP had received colistin for a median of 20.0?days, compared with 14.5?days for patients not colonized by CRKP (p 0.048). Results of the univariate and multivariate analysis of risk factors for colonization by CRKP are summarized in Table?2. Fifty-one (34%) of the patients were colonized by CIR pathogens [http://www.selleckchem.com/products/BMS-777607.html buy BMS-777607] (Table?1). Among them, [http://www.selleckchem.com/products/Neratinib(HKI-272).html Neratinib price] nine patients were colonized by two and two were colonized by three CIR pathogens. Thirty-two (64%) of them had been exposed to colistin (p NS), with median length of treatment with colistin 26.0?days, compared with 14?days in patients exposed to colistin but not colonized by CIR pathogens (p 0.02). Twelve (24%) of these patients were simultaneously colonized by CRKP. Infections by CIR pathogens developed in 12 (24%) patients. All cases of infection occurred in patients previously colonized by the respective pathogens and having received treatment by colistin (p 0.003; OR, 1.7). Although colistin resistance has been considered a rare occurrence [7], increasing colistin use has been followed by reports describing clinical isolates of colistin-resistant GNB. One of the first refers to a multiclonal cluster of CRKP colonization and infection in a retrospective study based on the surveillance of faecal and bronchial flora in critically ill patients [6]. In another study 41 colistin-resistant isolates were described [8]. Similarly to the present results, in the latter study the main risk factor for colistin resistance was the use of colistin. However, the lack of surveillance data and of genotypic analysis precluded any conclusions about the way these strains were acquired. In two additional studies from Greece and one from the United States a total of 25 patients colonized or infected by KPC producing K.