**Multidrug-Resistant Acinetobacter (MDR-A)**

Organisms, Causative Agent, or Etiologic Agent
The term MDR-A stands for multidrug-resistant Acinetobacter (MDR-A). Acinetobacter species are gram negative bacteria and have more than 25 types or species under its genus name, such as Acinetobacter baumannii. These bacteria can have a built-in resistance factor enabling them to be resistant to the antibiotics called carbapenems and penicillins. There are several ways Acinetobacter can be nonsusceptible to antibiotics, but no matter the mechanisms when an Acinetobacter species carries this resistance we refer to the bacteria as multidrug-resistant Acinetobacter or MDR-A.

Transmission
Acinetobacter species have been found in soil, water, animals and humans. In humans, it has been isolated from the skin, throat and rectum, and has been reported to be a colonizer of the respiratory tract in health care settings. Being a carrier of a bacterium without any symptoms or infection is known as being “colonized”. The germ is spread through contact. This contact can be either direct person-to-person contact or secondary contact with contaminated environmental surfaces, medical devices, or equipment. For example, a healthcare worker may touch an infected person or soiled equipment and not clean their hands before touching the next patient or patient equipment.

Symptoms
Acinetobacter can cause many types of infections, such as pneumonia, urinary tract infections, and bloodstream infections. When the same infection is caused by MDR-A the infections are harder to treat because the bacteria are very resistant to antibiotics. An individual can also be a colonized with Acinetobacter and have no symptoms.

Prevention
Generally, MDR-A affects people with underlying medical problems such as diabetes or a weakened immune system and rarely occurs outside of health care facilities. There are many prevention measures you can put in place early on to help lessen your chance of getting MDR-A.

Maintain your health now so that you lessen your chance of having to be in healthcare facilities when you are older, this includes limiting high risk behaviors. A few examples of high risk behaviors are substance abuse, riding without a helmet, violence, and unprotected sex.
When you are prescribed antibiotics take all that come in the package, take them as listed on the instructions. If you do not understand the instructions, ask your pharmacist. Do not share or save antibiotics. Do not stop taking the antibiotics even if you feel better;, finish all the antibiotics you are prescribed.
Ensure cleanliness and appropriate disinfection.
- When you visit health care facilities wash or sanitize your hands frequently and ask others to do the same before having contact with you or your belongings.
- If you are hospitalized, ask if your room has been disinfected each day and ask for equipment to be disinfected before it used on you.
- For the two items mentioned above, don’t be afraid to ask the hospital staff each time to have clean hands or to make sure equipment is disinfected. It can be scary to ask them but you want to make sure they are doing their best job. You can also visit a patient safety foundation or patient advocacy group for tips on things to look out for during your hospital stay. One example of a patient advocacy group is Louise H. Batz Foundation, you can visit their website at www.louisebatz.org
If you or someone you know is hospitalized, stay involved in the health care process. If you have an indwelling device, ask daily about when it can be removed. Examples of indwelling devices: surgical drain, central venous catheter, dialysis lines, PICCs, urinary catheter, tracheostomy tube and ventilator.

School Exclusion
MDR-A infections are rare in children. Unless directed by a physician, students with any type of MDR-A wound infection need to be excluded from attending school until drainage from wound or skin and soft tissue infection is contained and maintained in a clean, dry bandage. Restrict a child from activity that could result in the infected area being touched by others or becoming exposed, wet, soiled, or otherwise compromised.

Texas Trends
Multidrug-resistant Acinetobacter (MDR-A) has been found in Texas. The prevalence of MDR-A is currently unknown. Based on the 2012 Texas Annual Report on Health care-associated Infections Overall Antibiogram, antibiotic sensitivity for Acinetobacter baumannii ranged from 36% susceptible (Imipenem) to 70% Tetracycline.