Skip to main content Accessibility help

The Epidemiology of Multidrug-Resistant Acinetobacter Baumannii Does the Community Represent a Reservoir?

  • Cosmina Zeana (a1), Elaine Larson (a1), Jyoti Sahni (a2), S. J. Bayuga (a3), Fann Wu (a1) and Phyllis Della-Latta (a1)...



To explore the role of the community as a potential reservoir for Acinetobacter baumannii.


Antimicrobial resistance patterns and genotypes of A. baumannii isolates from patients in two Manhattan hospitals were compared with those of A. baumannii isolates from the hands of community members.


A total of 103 isolates from two hospitals (hospital A, 81; hospital B, 22) and 23 isolates from community residents were studied. Of the hospital isolates, 36.6% were multidrug resistant (hospital A, 68.2%; hospital B, 27.8%). In contrast, there were no multidrug-resistant isolates from the community (P < .005 between hospital and community). The prevalence of A. baumannii on the hands of community residents was 10.4% (23 of 222). By molecular typing, 42 strains of A. baumannii were identified. Of the isolates from hospital A and hospital B, 55.6% (45 of 81) and 68.2% (15 of 22), respectively, were indistinguishable or closely related. In contrast, most community (83.3%) isolates were unrelated (P = .001 between hospital and community).


Acinetobacter isolates from the community, characterized by a large variety of unrelated strains (83.3%), were distinct from the hospital isolates, of which 58.3% were closely related. The absence of multidrug-resistant strains in the community compared with 36.6% prevalence among hospital isolates suggests that the reservoir for epidemic strains resides in the hospital environment itself. To our knowledge, this is the first study to examine the community as a potential reservoir for hospital strains of A. baumannii.


Corresponding author

Harlem Hospital, 506 Lenox Avenue, Room 3101 A, New York, NY 10037


Hide All
1.Garcia-Garmendia, JL, Ortiz-Leyba, C, Garnacho-Montero, J, et al. Risk factors for Acinetobacter baumannii nosocomial bacteremia in critically ill patients: a cohort study. Clin Infect Dis 2001;33:939946.
2.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.
3.Bergogne-Berezin, E, Towner, KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996;9:148165.
4.Villari, P, Iacuzio, L, Vozzella, EA, Bosco, U. Unusual genetic heterogeneity of Acinetobacter baumannii isolates in a university hospital in Italy. Am J Infect Control 1999;27:247253.
5.Husni, RN, Goldstein, LS, Arroliga, AC, et al. Risk factors for an outbreak of multi-drug-resistant Acinetobacter nosocomial pneumonia among intubated patients. Chest 1999;115:13781382.
6.Pillay, T, Pillay, DG, Adhikari, M, Pillay, ASturm, AW. An outbreak of neonatal infection with Acinetobacter linked to contaminated suction catheters. J Hosp Infect 1999;43:299304.
7.Cox, TR, Roland, WE, Dolan, ME. Ventilator-related Acinetobacter outbreak in an intensive care unit. Mil Med 1998;163:389391.
8.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.
9.Weernink, A, Severin, WP, Tjernberg, I, Dijkshoorn, L. Pillows, an unexpected source of Acinetobacter. J Hosp Infect 1995;29:189199.
10.Nagels, B, Ritter, E, Thomas, P, Schulte-Wissermann, H, Wirsing von Konig, CH. Acinetobacter baumannii colonization in ventilated preterm infants. Eur J Clin Microbiol Infect Dis 1998;17:3740.
11.McDonald, IX, 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.
12.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.
13.D'Agata, EM, Thayer, V, Schaffner, W. An outbreak of Acinetobacter baumannii: the importance of cross-transmission. Infect Control Hosp Epidemiol 2000;21:588591.
14.Fierobe, L, Lucet, JC, Deere, D, et al. An outbreak of imipenem-resistant Acinetobacter baumannii in critically ill surgical patients. Infect Control Hosp Epidemiol 2001;22:3540.
15.Manikal, VM, Landman, D, Saurina, G, Oydna, E, Lai, H, Quale, J. Endemie carbapenem-resistant Acinetobacter species in Brooklyn, New York: citywide prevalence, interinstitutional spread, and relation to antibiotic usage. Clin Infect Dis 2000;31:101106.
16.Rahal, JJ, Urban, C, Segal-Maurer, S. Nosocomial antibiotic resistance in multiple gram-negative species: experience at one hospital with squeezing the resistance balloon at multiple sites. Clin Infect Dis 2002;34:499503.
17.Dijkshoorn, L, Aucken, H, Gerner-Smidt, P, et al. Comparison of outbreak and nonoutbreak Acinetobacter baumannii strains by genotypic and phenorypic methods. J Clin Microbiol 1996;34:15191525.
18.Baron, E, Peterson, L, Finegold, S. Bailey and Scott's Diagnostic Microbiology, 9th ed. St. Louis, MO: Mosby; 1994.
19.Isenberg, H. Clinical Microbiology Procedures Handbook, vol. 1. Washington, DC: American Society for Microbiology; 1992.
20.Bean, P, Olive, M. Molecular principles underlying hepatitis C virus diagnosis. Am Clin Lab 2001;20:1921.
21.Tenover, FC, Arbeit, RD, Goering, RV. How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists. Molecular Typing Working Group of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 1997;18:426439.
22.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:22332239.
23.Seifert, H, Dijkshoorn, L, Gerner-Smidt, P, Pelzer, N, Tjernberg, I, Vaneechoutte, M. Distribution of Acinetobacter species on human skin: comparison of phenotypic and genotypic identification methods. J Clin Microbiol 1997;35:28192825.
24.Chu, YW, Leung, CM, Houang, ET, et al. Skin carriage of Acinetobacter in Hong Kong. J Clin Microbiol 1999;37:29622967.
25.Dy, ME, Nord, JA, LaBombardi, VJ, Kislak, JW. The emergence of resistant strains of Acinetobacter baumannii: clinical and infection control implications. Infect Control Hosp Epidemiol 1999;20:565567.
26.Bernards, AT, Frenay, HM, Lim, BT, Hendriks, WD, Dijkshoorn, L, van Boven, CP. Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii: an unexpected difference in epidemiologic behavior. Am J Infect Control 1998;26:544551.
27.Thurm, V, Ritter, E. Genetic diversity and clonal relationships of Acinetobacter baumannii strains isolated in a neonatal ward: epidemiological investigations by allozyme, whole-cell protein and antibiotic resistance analysis. Epidemiol Infect 1993;111:491498.
28.Spiliopoulou, I, Droukopoulou, A, Athanassiadou, A, Dimitracopoulos, G. Plasmid profiles of Acinetobacter and Enterobacter species of hospital origin: restriction endonuclease analysis of plasmid DNA and transformation of Escherichia coli by R plasmids. J Chemother 1992;4:7277.
29.McDonald, A, Amyes, SG, Paton, R. The persistence and clonal spread of a single strain of Acinetobacter 13TU in a large Scottish teaching hospital. J Chemother 1999;11:338344.
30.Webster, CA, Towner, KJ, Saunders, GL, Crewe-Brown, HH, Humphreys, H. Molecular and antibiogram relationships of Acinetobacter isolates from two contrasting hospitals in the United Kingdom and South Africa. Eur J Clin Microbiol Infect Dis 1999;18:595598.
31.Musa, EK, Desai, N, Casewell, MW. The survival of Acinetobacter calcoaceticus inoculated on fingertips and on formica. J Hosp Infect 1990;15:219227.
32.Webster, C, Towner, KJ, Humphreys, H. Survival of Acinetobacter on three clinically related inanimate surfaces. Infect Control Hosp Epidemiol 2000;21:246.
33.Debast, SB, Meis, JF, Melchers, WJ, Hoogkamp-Korstanje, JA, 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.
34.Pina, P, Guezenec, P, Grosbuis, S, Guyot, L, Ghnassia, JC, Allouch, PY. An Acinetobacter baumannii outbreak at the Versailles Hospital Center [in French]. Pathol Biol (Paris) 1998;46:385394.
35.Webster, CA, Crowe, M, Humphreys, H, Towner, KJ. Surveillance of an adult intensive care unit for long-term persistence of a multi-resistant strain of Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis 1998;17:171176.
36.Ling, ML, Ang, A, Wee, M, Wang, GC. A nosocomial outbreak of multiresistant Acinetobacter baumannii originating from an intensive care unit. Infect Control Hosp Epidemiol 2001;22:4849.
37.Levin, AS, Gobara, S, Mendes, CM, Cursino, MR, Sinto, S. Environmental contamination by multidrug-resistant Acinetobacter baumannii in an intensive care unit. Infect Control Hosp Epidemiol 2001;22:717720.
38.Allen, KD, Green, HT. Hospital outbreak of multi-resistant Acinetobacter anitratus: an airborne mode of spread? J Hosp Infect 1987;9:110119.
39.Buxton, AE, Anderson, RL, Werdegar, D, Atlas, E. Nosocomial respiratory tract infection and colonization with Acinetobacter calcoaceticus: epidemiologic characteristics. Am J Med 1978;65:507513.
40.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.
41.Roberts, SA, Findlay, R, Lang, SD. Investigation of an outbreak of multidrug resistant Acinetobacter baumannii in an intensive care burns unit. J Hosp Infect 2001;48:228232.
42.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.


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