Are We Doing Enough to ContainAcinetobacterInfections?

To the Editor:Nosocomial infections caused by antibiotic-resistant strains of Acinetobacter are being reported with increasing frequency and are a major source of concern.Many strains have a high level of resistance to multiple antimicrobials and are associated with a high mortality rate, especially for pneumonia and bloodstream infections. 1 Risk factors associated with infection have been reported to include intubation, prolonged stay in the intensive care unit and hospital, prior use of broad-spectrum antibiotics, 2 mechanical ventilation, 3 prior surgery, and urinary catheterization. 4ntensive efforts have been applied to preventing or containing outbreaks caused by Acinetobacter.The Centers for Disease Control and Prevention (CDC) recommendations regarding control of multidrugresistant gram-negative rods (including Acinetobacter) suggest that, in addition to Standard Precautions, Contact Precautions should be used for infected or colonized patients. 5However, despite application of these recommendations, nosocomially acquired Acinetobacter remains problematic, resulting in substantial associated morbidity and mortality, higher treatment costs, and prolonged hospital stay.It has been reported previously that Acinetobacter may be spread by the airborne route. 6-7 A recent report 8 supports this idea, based on observation that outbreaks of resistant Acinetobacter occurred in two facilities in which the index case was placed on Contact Precautions.Sedimentation plates yielded Acinetobacter both inside and outside of the infected patient's room.In contrast, no crosstransmission was observed in the facility where the index case was placed on Airborne Precautions.We also have investigated the potential for multidrug-resistant Acinetobacter to spread by the droplet and airborne route in seven patients with respiratory tract infection or colonization.Sedimentation plates were placed within a patient's room at measured intervals from the patient.The percentage of sedimentation plates