Skip to main content Accessibility help

Acinetobacter Outbreaks, 1977–2000

  • Maria Virginia Villegas (a1) and Alan I. Hartstein (a2)


This review of Acinetobacter outbreaks summarizes factors related to the presence and recognition of organism transmission and describes the implementation of control and prevention measures directed at limiting spread. Exogenous transmission of Acinetobacter should be considered when infections are endemic and when case rates increase. Increasing or new antimicrobial resistances in a collection of isolates also suggest transmission, and transmission can be definitively confirmed when isolates are found to be indistinguishable from or related to one another by a discriminatory genotyping test. An investigation for a common source should be conducted. When a common source cannot be found and eliminated, or once an endemically transmitted organism is established, containment or prevention efforts may require aggressive interventions, complex interventions, or both. Colonization at multiple sites, the relative ease of induction of antibiotic resistance in the organism following patient exposure to multiple drugs, and long-term environmental survival provide enhanced opportunities for the transmission of Acinetobacter between and among patients. New approaches and interventional trials are needed to define effective measures for the prevention and control of Acinetobacter infections.


Corresponding author

University of Miami School of Medicine, 1400 N. W. 10th Avenue, Dominion Tower, 8th Floor, #812A, Miami, FL 33136


Hide All
1.Bergogne-Berezin, E. The increasing significance of outbreaks of Acinetobacter spp.: the need for control and new agents. J Hosp Infect 1995;30(suppl):441452.
2.Bergogne-Berezin, E, Towner, KJ. Acinetobacter sp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996;9:148165.
3.Chastre, J, Trouillet, J. Problem pathogens (Pseudomonas aeruginosa and Acinetobacter). Semin Respir Infect 2000;15:287298.
4.Fagon, JY, Chastre, J, Hance, AJ, Montravers, P, Novara, A, Gibert, C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am f Med 1993;94:281288.
5.Lortholary, O, Fagon, JY, Hoi, AB, et al. Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis. Clin Infect Dis 1995;20:790796.
6.Weingarten, CM, Rybak, MJ, Jahns, BE, Stevenson, JG, Brown, WJ, Levine, DP. Evaluation of Acinetobacter baumannii infection and colonization, and antimicrobial treatment patterns in an urban teaching hospital. Pharmacotherapy 1999;19:10801085.
7.Sofianou, DC, Constandinidis, TC, Yannacou, M, Anastasiou, H, Sofianos, E. Analysis of risk factors for ventilator-associated pneumonia in a multi-disciplinary intensive care unit. Eur J Clin Microbiol Infect Dis 2000;19:460463.
8.Ayats, J, Corbella, X, Ardanuy, C, et al. Epidemiological significance of cutaneous, pharyngeal, and digestive tract colonization by multiresistant Acinetobacter baumannii in ICU patients. J Hosp Infect 1997;37:287295.
9.Wisplinghoff, H, Edmond, MB, Pfaller, MA, Jones, RN, Wenzel, RP, Seifert, H. Nosocomial bloodstream infections caused by Acinetobacter species in United States hospitals: clinical features, molecular epidemiology, and antimicrobial susceptibility. Clin Infect Dis 2000;31:690697.
10.Beck-Sague, C, Jarvis, WR, Martone, WJ. Outbreak investigations. In: Herwaldt, LA, Decker, MD, eds. A Practical Handbook for Hospital Epidemiologists. Thorofare, NJ: SLACK Incorporated; 1998:135144.
11.Jarvis, WR, Zaza, S. Investigation of outbreaks. In: Mayhall, CG, ed Hospital Epidemiology and Infection Control, 2nd ed. Philadelphia: Lippincott William & Wilkins; 1999:111120.
12.Wendt, C, Herwaldt, LA. Epidemics: identification and management. In Wenzel, RP, ed. Prevention and Control of Nosocomial Infections, 3rd ed Baltimore: Lippincott Williams & Wilkins; 1997:175213.
13.Smith, PW, Massanari, RM. Room humidifiers as the source of Acinetobacter infections. JAMA 1977;237:795797.
14.Abrutyn, E, Goodhart, GL, Roos, K, Anderson, R, Buxton, AL. Acinetobacter calcoaceticus outbreak associated with peritoneal dialysis. Am J Epidemiol 1978;107:328335.
15.Castle, M, Tenney, JH, Weinstein, MP, Eickhoff, TC. Outbreak of a multiply resistant Acinetobacter in a surgical intensive care unit: epidemiology and control. Heart Lung 1978;7:641644.
16.Irwin, RS, Demers, RR, Pratter, MR, et al. An outbreak of Acinetobacter infection associated with the use of a ventilator spirometer. Respir Can 1980;25:232237.
17.Reyes, MP, Ganguly, S, Fowler, M, et al. Pyrogenic reactions after inadvertent infusion of endotoxin during cardiac catheterizations. Am Intern Med 1980;93:3235.
18.Lowes, JA, Smith, J, Tabaqchali, S, Shaw, EJ. Outbreak of infection in a urological ward. BMJ 1980;280:722.
19.Cunha, BA, Gracewski, J, Klimek, JJ, McLaughlin, JC, Quintiliani, R. A common source outbreak of Acinetobacter pulmonary infections traced to Wright respirometers. Postgrad Med J 1980;56:169172.
20.French, GL, Casewell, MW, Roncoroni, AJ, Knight, S, Phillips, I. A hospital outbreak of antibiotic-resistant Acinetobacter anitratus: epidemiology and control. J Hosp Infect 1980;1:125131.
21.Carlquist, JF, Conti, M, Burke, JP. Progressive resistance in a single strain of Acinetobacter calcoaceticus recovered during a nosocomial outbreak. Am J Infect Control 1982;10:4348.
22.Kantor, RJ, Carson, LA, Graham, DR, Petersen, NJ, Favero, MS. Outbreal of pyrogenic reactions at a dialysis center. Am J Med 1983;74:449456.
23.Sherertz, RJ, Sullivan, ML. An outbreak of infections with Acinetobacter calcoaceticus in burn patients: contamination of patients' mattresses. J Infect Dis 1985;151:252258.
24.Stone, JW, Das, BC. Investigation of an outbreak of infection with Acinetobacter calcoaceticus in a special care baby unit. J Hosp Infect 1986;7:4248.
25.Gervich, DH, Grout, CS. An outbreak of nosocomial Acinetobacter infections from humidifiers. Am J Infect Control 1985;13:210215.
26.Allen, KD, Green, HT. Hospital outbreak of multi-resistant Acinetobacter anitratus: an airborne mode of spread? J Hosp Infect 1987;9:110119.
27.Vandenbroucke-Grauls, CM, Kerver, AJ, Rommes, JH, Jansen, R, den Dekker, C, Verhoef, J. Endemie Acinetobacter anitratus in a surgical intensive care unit: mechanical ventilators as reservoir. Eur J Clin Microbiol Infect Dis 1988;7:485487.
28.Hartstein, AI, Rashad, AL, Liebler, JM, et al. Multiple intensive care unit outbreak of Acinetobacter calcoaceticus subspecies anitratus respiratory infection and colonization associated with contaminated, reusable ventilator circuits and resuscitation bags. Am J Med 1988;85:624631.
29.Sakata, H, Fujita, K, Maruyama, S, Kakehashi, H, Mori, Y, Yoshiioka, H. Acinetobacter calcoaceticus biovar anitratus septicaemia in a neonatal intensive care unit: epidemiology and control. J Hosp Infect 1989;14:1522.
30.Crombach, WH, Dijkshoorn, L, Van Noort-Klaassen, M, Niessen, J, van Knippenberg-Gordebeke, G. Control of an epidemic spread of a multiresistant strain of Acinetobacter calcoaceticus in a hospital. Intensive Can Med 1989;15:166170.
31.Buisson, Y, Tran Van Nhieu, G, Ginot, L, et al. Nosocomial outbreaks due to amikacin-resistant, tobramycin-sensitive Acinetobacter species: correlation with amikacin usage. J Hosp Infect 1990;15:8393.
32.Ng, PC, Herrington, RA, Beane, CA, Ghoneim, ATM, Dear, PRF. An outbreak of Acinetobacter septicaemia in a neonatal intensive care unit. J Hosp Infect 1989;14:363368.
33.Kelkar, R, Gordon, SM, Giri, N, et al. Epidemie iatrogenic Acinetobacter spp. meningitis following administration of intrathecal methotrexate. J Hosp Infect 1989;14:233243.
34.Beck-Sagué, CM, Jarvis, WR, Brook, JH, et al. Epidemic bacteremia due to Acinetobacter baumannii in five intensive care units. Am J Epidemiol 1990;132:723733.
35.Cefai, C, Richards, J, Gould, FK, McPeake, P. An outbreak of Acinetobacter respiratory tract infection resulting from incomplete disinfection of ventilatory equipment. J Hosp Infect 1990;15:177182.
36.Contant, J, Kemeny, E, Oxley, C, Perry, E, Garber, G. Investigation of an outbreak of Acinetobacter calcoaceticus var. anitratus infections in an adult intensive care unit. Am J Infect Control 1990;18:288291.
37.Patterson, JE, Vecchio, J, Pantelick, EL, et al. Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit. Am J Med 1991;91:479483.
38.Struelens, MJ, Carlier, E, Maes, N, Serruys, E, Quint, WGV, van Belkum, A. Nosocomial colonization and infections with multiresistant Acinetobacter baumannii: outbreak delineation using DNA macrorestriction analysis and PCR-fingerprinting. J Hosp Infect 1993;25:1532.
39.Ahmed, J, Brutus, A, D'Amato, RF, Glatt, AE. Acinetobacter calcoaceticus anitratus outbreak in the intensive care unit traced to a peak flow meter. Am J Infect Control 1994;22:319321.
40.Tankovic, J, Legrand, P, De Gatimes, G, Chemineau, V, Brun-Buisson, C, Duval, J. Characterization of a hospital outbreak of imipenem-resistant Acinetobacter baumannii by phenotypic and genotypic typing methods. J Clin Microbiol 1994;2:26772681.
41.Go, ES, Urban, C, Burns, J, et al. Clinical and molecular epidemiology of Acinetobacter infections sensitive only to polymyxin B and sulbactam. Lancet 1994;344:13291332.
42.Crowe, M, Towner, KJ, Humphreys, H. Clinical and epidemiological features of an outbreak of Acinetobacter infection in an intensive therapy unit. J Med Microbiol 1995;43:5562
43.Lyytikäinen, O, Köljalg, S, Härmä, M, Vuopio-Varkila, J. Outbreak caused by two multi-resistant Acinetobacter baumannii clones in a burns unit: emergence of resistance to imipenem. J Hosp Infect 1995;31:4153.
44.Scerpella, EG, Wanger, AR, Armitige, L, Ericsson, CD. Nosocomial outbreak caused by a multiresistant clone of Acinetobacter baumannii: results of the case-control and molecular epidemiologic investigations. Infect Control Hosp Epidemiol 1995;16:9297.
45.Weernink, A, Severin, WP, Tjernberg, I, Dijkshoorn, L. Pillows, an unexpected source of Acinetobacter. J Hosp Infect 1995;29:189199.
46.Debast, SB, Meis, JF, Melchers, WJ, Hoogkamp-Korstanje, JAA, Voss, A. Use of interrepeat PCR fingerprinting to investigate an Acinetobacter baumannii outbreak in an intensive care unit. Scand J Infect Dis 1996;28:577581.
47.Levin, AS, Mendes, CM, Sinto, SI, et al. An outbreak of multiresistant Acinetobacter baumannii in a university hospital in Sao Paulo, Brazil. Infect Control Hosp Epidemiol 1996;17:366368.
48.Snelling, AM, Gerner-Smidt, P, Hawkey, PM, et al. Validation of use of whole-cell repetitive extragenic palindromic sequence-based PCR (REP-PCR) for typing strains belonging to the Acinetobacter calcoaceticus–Acinetobacter baumannii complex and application of the method to the investigation of a hospital outbreak. J Clin Microbiol 1996;34:11931202.
49.Riley, TV, Webb, SA, Cadwallader, H, Briggs, BD, Christiansen, L, Bowman, RA. Outbreak of gentamicin-resistant Acinetobacter baumannii in an intensive care unit: clinical, epidemiological and microbiological features. Pathology 1996;28:359363.
50.Kaul, R, Burt, JA, Cork, L, et al. Investigation of a multiyear multiple critical care unit outbreak due to relatively drug-sensitive Acinetobacter baumannii: risk factors and attributable mortality. J Infect Dis 1996;174:12791287.
51.Koeleman, JG, Parlevliet, GA, Dijkshoorn, L, Savelkoul, PHM, Vandenbroucke-Grauls, CMJE. Nosocomial outbreak of multi-resistant Acinetobacter baumannii on a surgical ward: epidemiology and risk factors for acquisition. J Hosp Infect 1997;37:113123.
52.Marques, MB, Waites, KB, Mangino, JE, Hines, BB, Moser, SA. Genotypic investigation of multidrug-resistant Acinetobacter baumannii infections in a medical intensive care unit. J Hosp Infect 1995;37:125135.
53.Bellamore, E, Singh, F, Pirrotta, A, Greene, VVH, Donelan, SV. Outbreak of nosocomial Acinetobacter colonization possibly mediated by nebulizer techniques. Am J Infect Control 1997;25:162.
54.Dealler, S. Nosocomial outbreak of multi-resistant Acinetobacter sp. on an intensive care unit: possible association with ventilation equipment. J Hosp Infect 1998;38:147148.
55.McDonald, LC, Walker, M, Carson, L, et al. Outbreak of Acinetobacter spp. bloodstream infections in a nursery associated with contaminated aerosols and air conditioners. Pediatr Infect Dis J 1998;17:716722.
56.Cox, MT, Roland, WE, Dolan, ME. Ventilator-related Acinetobacter outbreak in an intensive care unit. Mil Med 1998;163:389391.
57.Villers, D, Espaze, E, Coste-Burel, M, et al. Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. Ann Intern Med 1998;129:182189.
58.Biendo, M, Laurans, G, Lefebvre, JF, Daoudi, F, Eb, F. Epidemiological study of an Acinetobacter baumannii outbreak by using a combination of antibiotyping and ribotyping. J Clin Microbiol 1999;37:21702175.
59.Pillay, T, Pillay, DG, Adhikary, M, Pillay, A, Sturm, AW. An outbreak of neonatal infection with Acinetobacter linked to contaminated suction catheters. J Hosp Infect 1999;43:299304.
60.Yoo, JH, Choi, JH, Shin, WS, et al. Application of infrequent-restriction-site PCR to clinical isolates of Acinetobacter baumannii and Serratia marcescens. J Clin Microbiol 1999;37:31083112.
61.Kappstein, I, Grundmann, H, Haver, T, Niemeyer, C. Aerators as a reservoir of Acinetobacter junii: an outbreak of bacteremia in paediatric oncology patients. J Hosp Infect 2000;44:2730.
62.D'Agata, EM, Thayer, V, Schaffner, W. An outbreak of Acinetobacter baumannii: the importance of cross-transmission. Infect Control Hosp Epidemiol 2000;21:588591.
63.Corbella, X, Montero, A, Pujol, M, et al. Emergence and rapid spread of carbapenem resistance during a large and sustained hospital outbreak of multiresistant Acinetobacter baumannii. J Clin Microbiol 2000;38:40864095.
64.Reboli, AC, Houston, ED, Monteforte, JS, Wood, CA, Hamili, RJ. Discrimination of epidemic and sporadic isolates of Acinetobacter baumannii by repetitive element PCR-mediated DNA fingerprinting. J Clin Microbiol 1994;32:26352640.
65.Seifert, H, Schulze, A, Baginski, R, Pulverer, G. Comparison of four different methods for epidemiologic typing of Acinetobacter baumannii. J Clin Microbiol 1994;32:18161819.
66.Seifert, H, Gerner-Smidt, P. Comparison of ribotyping and pulsed-field gel electrophoresis for molecular typing of Acinetobacter species. J Clin Microbiol 1995;33:14021407.
67.Webster, CA, Towner, KJ. Use of RAPD-ALF analysis for investigating the frequency of bacterial cross-transmission in an adult intensive care unit. J Hosp Infect 2000;44:254260.
68.Simhon, A, Rahav, G, Shazberg, G, Block, C, Bercovier, H, Shapiro, M. Acinetobacter baumannii at a tertiary-care teaching hospital in Jerusalem, Israel. J Clin Microbiol 2001;39:389391.
69.Hartstein, AI, Morthland, VH, Rourke, MS Jr, et al. Plasmid DNA fingerprinting of Acinetobacter calcoaceticus subspecies anitratus from intubated and mechanically ventilated patients. Infect Control Hosp Epidemiol 1990;11:531538.
70.Niederman, MS. Impact of antibiotic resistance on clinical outcomes and the cost of care. Crit Care Med 2001;29(suppl 4):N114N120.
71.Kollef, MH, Sherman, G, Ward, S, Fraser, VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 1999;115:462474.
72.Getschell-White, SI, Donowitz, LG, Groschel, DH. The inanimate environment of an intensive care unit as a potential source of nosocomial bacteria: evidence for long survival of Acinetobacter calcoaceticus. Infect Control Hosp Epidemiol 1989;10:402406.
73.Houang, ETS, Chu, YW, Leung, CM, et al. Epidemiology and infection control implications of Acinetobacter spp. in Hong Kong. J Clin Microbiol 2001;39:228234.
74.Musa, EK, Desai, N, Casewell, MW. The survival of Acinetobacter calcoaceticus inoculated on fingertips and on formica. J Hosp Infect 1990;15:219227.
75.Webster, C, Towner, KJ, Humphreys, H. Survival of Acinetobacter on three clinically related inanimate surfaces. Infect Control Hosp Epidemiol 2000;21:246.
76.Peterson, LR, Noskin, GA. New technology for detection of multidrug-resistant pathogens in the clinical microbiology laboratory. Emerg Infect Dis 2001;7:306311.
77.Pfaller, MA. Molecular approaches to diagnosing and managing infectious diseases: practicality and costs. Emerg Infect Dis 2001;7:312318.
78.Cardoso, CL, Pereira, HH, Zequim, JC, Guilhermetti, M. Effectiveness of hand-cleansing agents for removing Acinetobacter baumannii strain from contaminated hands. Am J Infect Control 1999;27:327331.
79.Klein, BS, Perloff, WH, Maki, DG. Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med 1989;320:17141721
80.Hartstein, AI, Denny, MA, Morthland, VH, LeMonte, AM, Pfaller, MA. Control of methicillin-resistant Staphylococcus aureus in a hospital and an intensive care unit. Infect Control Hosp Epidemiol 1995;16:405411.
81.Weinstein, RA. Controlling antimicrobial resistance in hospitals: infection control and use of antibiotics. Emerg Infect Dis 2001;7:188192.
82.Khatib, M, Jamaleddine, G, Abdallah, A, Ibrahim, Y. Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU. Chest 1999;116:172175.
83.Singh, N, Rogers, P, Atwood, CW, Wagener, MM, Yu, VL. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. Am J Resp Crit Care Med 2000;162:505511.
84.Brooks, SE, Walczak, MA, Hameed, R. Are we doing enough to contain Acinetobacter infections? Infect Control Hosp Epidemiol 2000;21:304.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed