An Approach to Controlling Acinetobacter Outbreaks in the ICUs

  • X. Corbella
Conference paper
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)


Acinetobacter baumannii has emerged as an important nosocomial pathogen over the last 15 years and hospital outbreaks are increasingly being reported worldwide [1–13]. The genus Acinetobacter has undergone many taxonomic changes, making difficult the comparison between historical and modern series. Among the 19 genomic species currently recognized, there are three usually isolated in hospitalized populations: species 2 (A. baumannii), 3 and 13 [14–17]. These three species are included in the so-called A. calcoaceticus-A. baumannii complex group [18–20]. Nowadays, isolates of A. baumannii are almost exclusively hospital-acquired and rarely found in the community [21].


Acinetobacter Baumannii Carbapenem Resistance Acinetobacter Calcoaceticus Selective Digestive Decontamination Acinetobacter Species 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Sherertz RJ, Sullivan ML (1985) An outbreak of infection with Acinetobacter calcoaceticus in burn patients: contamination of patients’ mattresses. J Infect Dis 151: 252–258PubMedCrossRefGoogle Scholar
  2. 2.
    Gerner-Smidt P (1987) Endemic occurrence of Acinetobacter calcoaceticus biovar anitratus in an intensive care unit. J Hosp Infect 10: 265–272PubMedCrossRefGoogle Scholar
  3. 3.
    Hartstein AI, Rashad AL, Liebler JM et al (1988) Multiple intensive care unit outbreak of Acinetobacter calcoaceticus subspecies anitratus respiratory infection and colonization associated with contaminated, reusable ventilator circuits and resucitation bags. Am J Med 85: 624–631PubMedCrossRefGoogle Scholar
  4. 4.
    Sakata H, Fujita K, Maruyama S et al (1989) Acinetobacter calcoaceticus biovar. anitra-tus septicaemia in a neonatal intensive care unit: epidemiology and control. J Hosp Infect 14: 15–22PubMedCrossRefGoogle Scholar
  5. 5.
    Crombach WHJ, Dijkshoorn L, van Noort-Klaassen M et al (1989) Control of an epidemic spread of a multi-resistant strain of Acinetobacter calcoaceticus in a hospital. Intensive Care Med 15: 166–170PubMedCrossRefGoogle Scholar
  6. 6.
    Buisson Y, Tran van Nhieu G, Ginot L et al (1990) Nosocomial outbreaks due to amikacin-resistant tobramycin-sensitive Acinetobacter species: correlation with amikacin usage. J Hosp Infect 15: 83–93PubMedCrossRefGoogle Scholar
  7. 7.
    Bergogne-Berezin E, Joly-Guillou ML (1991) Hospital infection with Acinetobacter spp.: an increasing problem. J Hosp Infect 18 [Suppl A]: 250–255PubMedCrossRefGoogle Scholar
  8. 8.
    Go ES, Urban C, Burns J et al (1994) Clinical and molecular epidemiology of Acinetobacter infections sensitive only to polymyxin B and sulbactam. Lancet 344: 1329–1332PubMedCrossRefGoogle Scholar
  9. 9.
    Seifert H, Boullion B, Schulze A, Pulverer G (1994) Plasmid DNA profiles of Acinetobacter baumannii: clinical application in a complex endemic setting. Infect Control Hosp Epidemiol 15: 520–528PubMedCrossRefGoogle Scholar
  10. 10.
    Bergogne-Berezin E, Towner KJ (1996) Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 9: 148–165PubMedCentralPubMedGoogle Scholar
  11. 11.
    Fang FC, Madinger NE (1996) Resistant nosocomial gram-negative bacillary pathogens: Acinetobacter baumannii, Xanthomonas maltophilia, and Pseudomonas cepacia. Curr Top Infect 16: 52–75Google Scholar
  12. 12.
    Dominguez MA, Ayats J, Ardanuy C et al (1998) Evolution and molecular characterization of epidemic clones of multiresistant Acinetobacter baumannii (1992–97). 38th Interscience Conference on Antimicrobial Agents and Chemotherapy. San Diego, Abstract K-124Google Scholar
  13. 13.
    Villers D, Espaze E, Coste-Burel M et al (1998) Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. Ann Intern Med 129: 182–189PubMedCrossRefGoogle Scholar
  14. 14.
    Tjernberg I, Ursing J (1989) Clinical starins of Acinetobacter classified by DNA-DNA hybridization. Acta Pathol Microbiol Immunol Scand 97: 595–605CrossRefGoogle Scholar
  15. 15.
    Joly-Guillou ML, Bergogne-Berezin E, Vieu JF (1991) Epidemiology of Acinetobacter strains isolated from nosocomial infections in France. In: Towner KJ, Bergogne-Berezin E, Fewson CA (eds) The biology of Acinetobacter. Plenum, New York, pp 63–68CrossRefGoogle Scholar
  16. 16.
    Seifert H, Baginsky R, Schlze A, Pulverer G (1993) The distribution of Acinetobacter species in clinical culture materials. Zentrabl Bakteriol 279: 544–552CrossRefGoogle Scholar
  17. 17.
    Dijkshoorn L, Aucken HM, Gerner-Smidt P et al (1993) Correlation of typing methods for Acinetobacter isolates from hospital outbreaks. J Clin Microbiol 31: 702–705PubMedCentralPubMedGoogle Scholar
  18. 18.
    Bouvet PJM, Jeanjean S (1989) Delineation of new proteolytic genospecies in the genus Acinetobacter. Res Microbiol 140: 291–299PubMedCrossRefGoogle Scholar
  19. 19.
    Gerner-Smidt P, Tjernberg I, Ursing J (1991) Reliability of phemotypic tests for identification of Acinetobacter species. J Clin Microbiol 29: 277–282PubMedCentralPubMedGoogle Scholar
  20. 20.
    Gennari M, Lombardi P (1993) Comparative characterization of Acinetobacter strains isolated from different foods and clinical sources. Zentrabl Bakteriol 279: 553–564CrossRefGoogle Scholar
  21. 21.
    Joly-Guillou ML, Brun Buisson C (1996) Epidemiology of Acinetobacter spp.: surveillance and management of outbreaks. In: Bergonge-Berezin E, Joly-Guillou ML, Towner KJ (eds) Acinetobacter: microbiology, epidemiology, infections, management. CRC, Boca Raton, pp 73–75Google Scholar
  22. 22.
    Mulin B, Talon D, Viel JF et al (1995) Risk factors for nosocomial colonization with multiresistant Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis 14: 569–576PubMedCrossRefGoogle Scholar
  23. 23.
    Bergogne-Berezin E (1996) Acinetobacter: a challenge to infection control. Acinetobacter 96. Fourth International Symposium on the Biology of Acinetobacter. Eilat, IsraelGoogle Scholar
  24. 24.
    Hanberger H, García Rodriguez JA, Gobernado M et al (1999) Antibiotic susceptibility among aerobic gram-negative bacilli in intensive care units in 5 European countries. JAMA 281: 67–71PubMedCrossRefGoogle Scholar
  25. 25.
    Palomar M, Alvarez Lerma F, de la Cal MA et al (1997) ICU-acquired infections in Spain. Predominant pathogens. Intensive Care Med 23 [Suppl 11: 123Google Scholar
  26. 26.
    Palomar M, Alvarez Lerma F, de la Cal MA et al (1997) Etiología y patrones de sensi- 170 X. Corbella bilidad de las infecciones adquiridas en los Servicios de Medicina Intensiva. XXXII Congreso Nacional de la Sociedad Espanola de Medicina Intensiva y Unidades Coronarias (SEMIUC)Google Scholar
  27. 27.
    Patterson JE, Vecchio J, Pantelick EL et al (1991) Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit. Am J Med 91: 479–483PubMedCrossRefGoogle Scholar
  28. 28.
    Contant J, Kemeny E, Oxley C et al (1990) Investigation of an outbreak of Acinetobacer calcoaceticus var. Anitratus infections in an adult intensive care unit. Am J Inferct Control 18: 288–291Google Scholar
  29. 29.
    Corbella X, Montero A, Pujol M et al (2000) Emergence and rapid spread of carbapenem resistance during a large and sustained hospital outbreak of multiresistant acinetobacter baumannii. J Clin Microbiol 38: 4086–4095PubMedCentralPubMedGoogle Scholar
  30. 30.
    Lortholary O, Fagon JY, Buu-Hoi A et al (1995) Nosocomial adquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis. Clin Infect Dis 20: 790–796PubMedCrossRefGoogle Scholar
  31. 31.
    Kaul R, Burt JA, Cork L et al (1996) Investigation of a multiyear critical care unit outbreak due to relatively drug-sensitive Acinetobacter baumannii: risk factors and attributable mortality. J Infect Dis 174: 1279–1287PubMedCrossRefGoogle Scholar
  32. 32.
    Tankovic J, Legrand P, de Gatines G et al (1994) Characterization of a hospital outbreak of imipenem resistant Acinetobacter baumannii by phenotypic and genotypic typing methods. J Clin Microbiol 32: 2677–2681PubMedCentralPubMedGoogle Scholar
  33. 33.
    Ayats J, Corbella X, Ardanuy Cet al (1997) Epidemiological significance of cutaneous, pharyngeal, and digestive tract colonization by multiresistant Acinetobacter baumannii in ICU patients. J Hosp Infect 37: 287–295PubMedCrossRefGoogle Scholar
  34. 34.
    Vila J, Amela M, Jimenez de Anta MT (1989) Laboratory investigation of hospital outbreak caused by two different multiresistant Acinetobacter calcoaceticus subsp. anitra-tus strains. J Clin Microbiol 27: 1086–1089PubMedCentralPubMedGoogle Scholar
  35. 35.
    Vila J, Marcos MA, Jimenez de Anta MT (1996) A comparative study of different typing methods for epidemiological typing of Acinetobacter calcoaceticus-A. baumannii complex. J Med Microbiol 44: 482–489PubMedCrossRefGoogle Scholar
  36. 36.
    Seifert H, Schulze A, Baginsky R, Pulverer G (1994) Comparison of four different typing methods for epidemiological typing of Acinetobacter baumannii. J Clin Microbiol 32: 1816–1819PubMedCentralPubMedGoogle Scholar
  37. 37.
    Dijkshoorn L (1996) Acinetobacter: Microbiology. In: Bergonge-Berezin E, Joly-Guillou ML, Towner KJ (eds) Acinetobacter: microbiology, epidemiology, infections, management. CRC, Boca Raton, pp 41–64Google Scholar
  38. 38.
    Wise KA, Tosolini FA (1990) Epidemiological surveillance of Acinetobacter species. J Hosp Infect 16: 319–329PubMedCrossRefGoogle Scholar
  39. 39.
    Timsit JF, Garrait V, Misset B et al (1993) The digestive tract is a major site for Acinetobacter baumannii colonization in intensive care unit patients. J Infect Dis 168: 1336–1337PubMedCrossRefGoogle Scholar
  40. 40.
    Corbella X, Pujol M, Ayats Jet al (1996) Relevance of digestive tract colonization in the epidemiology of multiresistant Acinetobacter baumannii. Clin Infect Dis 23: 329–334PubMedCrossRefGoogle Scholar
  41. 41.
    Grehn M, von Graevenitz A (1978) Search of Acinetobacter calcoaceticus subsp. anitra-tus: enrichment of fecal samples. J Clin Microbiol 8: 342–343PubMedCentralPubMedGoogle Scholar
  42. 42.
    Brun-Buisson C, Legrand P (1994) Can topical and nonabsorbable antimicrobials prevent cross-transmission of resistant strains in ICUs? Infect Control Hosp Epidemiol 15: 447–455PubMedCrossRefGoogle Scholar
  43. 43.
    Seifert H, Strate A, Pulverer G (1995) Nosocomial bacteremia due to Acinetobacter baumannii: clinical features, epidemiology and predictors of mortality. Medicine 74: 340–349PubMedCrossRefGoogle Scholar
  44. 44.
    Wenzel RP, Edmon MB (1998) Vancomycin-resistant Staphylococcus aureus: infection control considerations. Clin Infect Dis 27: 245–251PubMedCrossRefGoogle Scholar
  45. 45.
    French GL, Casewell MW, Roncoroni AJ et al (1980) A hospital outbreak of antibiotic resistant Acinetobacter anitratus: epidemiology and control. J Hosp Infect 1: 125–131PubMedCrossRefGoogle Scholar
  46. 46.
    Getschell-White SI, Donowitz LG, Groschel DHM (1989) 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 10: 402–406CrossRefGoogle Scholar
  47. 47.
    Musa EK, Desai N, Casewell MW (1990) The survival of Acinetobacter calcoaceticus inoculated on fingertips and on formica. J Hosp Infect 15: 219–227PubMedCrossRefGoogle Scholar
  48. 48.
    Wendt C, Dietze B, Ruden 1–1 (1994) Survival of Acinetobacter species on dry surfaces. Third International Symposium Biology of Acinetobacter. EdinburghGoogle Scholar
  49. 49.
    Corbella X, Pujol M, Argerich MJ et al (1999) Environmental sampling of Acinetobacter baumannii: moistened swabs versus moistened sterile gauze pads. Infect Control Hosp Epidemiol 20: 458–460PubMedCrossRefGoogle Scholar
  50. 50.
    Gaynes R (1995) Antibiotic resistance in ICUs: a multifaceted problem requiring a multifaceted solution. lnf Control Hosp Epidemiol 16: 328–330CrossRefGoogle Scholar
  51. 51.
    Pallarés R, Pujol M, Pena C et al (1993) Cephalosporins as a risk factor for nosocomial Enterococcus faecalis bacteremia. A matched case-control study. Arch Intern Med 153: 1581–1586Google Scholar
  52. 52.
    Pena C, Pujol M, Ardanuy C et al (1998) Epidemiology and successful control of a large outbreak due to Klebsiella pneumoniae producing extended-spectrum ß-lactamases. Antimicrob Agents Chemother 42: 53–58PubMedCentralPubMedGoogle Scholar
  53. 53.
    Bonten MJ, Hayden MK, Nathan C et al (1996) Epidemiology of colonization of patients and environment with vancomycin-resistant enterococci. Lancet 348: 1615–1619PubMedCrossRefGoogle Scholar
  54. 54.
    Corbella X, Montero A, Pujol M et al (1998) Emergence of carbapenem resistance during a large hospital endemic by multiresistant Acinetobacter baumannii: epidemiology and control measures. The 38th International Conference of Antimicrobial Agent and Chemotherapy ( ICAAC ), San DiegoGoogle Scholar
  55. 55.
    Viladrich PF, Corbella X, Corral L et al (1999) Successful treatment of carbapenemresistant Acinetobacter baumannii ventriculitis with intraventricular colistin sulphomethate sodium. Clin Infect Dis 28: 916–917CrossRefGoogle Scholar
  56. 56.
    Urban C, Go E, Mariano N et al (1993) Effect of sulbactam on infections caused by imipenem-resistant Acinetobacter calcoaceticus biotype anitratus. J Infect Dis 167: 448451Google Scholar
  57. 57.
    Jiménez-Mejías ME, Pachón J, Becerril B et al (1997) Treatment of multi-resistant Acinetobacter baumannii meningitis with ampicillin/sulbactam. Clin Infect Dis 24: 932–935PubMedCrossRefGoogle Scholar
  58. 58.
    Corbella X, Ariza J, Ardanuy C et al (1998) Efficacy of sulbactam alone and in association with ampicillin in nosocomial infections due to Acinetobacter baumannii. J Antimicrobial Chemother 42: 793–802CrossRefGoogle Scholar
  59. 59.
    Joly-Guillou ML, Wolff M, Decre D et al (1994) Colonization and infection with A. baumannii in ICU patients receiving selective digestive decontamination: results of a case control and molecular epidemiologic investigations. The 34th Interscience Conference on Antimicrobial Agents and Chemotherapy. Orlando, p 103Google Scholar
  60. 60.
    Lance-Sauders G, Hammond JMJ, Potgieter PD et al (1994) Microbiological surveillance during selective decontamination of the digestive tract ( SDD ). J Antimicrobial Chemother 34: 529–544Google Scholar

Copyright information

© Springer-Verlag Italia, Milano 2001

Authors and Affiliations

  • X. Corbella

There are no affiliations available

Personalised recommendations