Definitions
MDROs were defined as isolates with acquired resistance to at least one agent from three or more different classes of antimicrobials10. Antibiotic usage was categorized into number of courses of inpatient, outpatient, or chronic antibiotics (oral or inhaled) per year. Chronic antibiotics were defined as those used for >4 weeks and were commonly prescribed the purpose of either prophylaxis of another comorbidity (like neurogenic bladder) or suppression for tracheal colonization. Number of hospitalizations and ED visits per year were separated into pulmonary or non-pulmonary by primary reason for visit or admission. Transitional rehabilitation facility was defined by temporary inpatient admission to a local rehabilitation and subacute care hospital that facilitates transition from hospital care to home.