Gram-negative Bacteria Infections in

Healthcare Settings
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General Information about gram-negative bacteria

CDC guidelines to address gram-negative bacteria
Outbreak investigations

bacteria
Gram-negative bacteria cause infections including pneumonia, bloodstream infections, wound or
surgical site infections, and meningitis in healthcare settings. Gram-negative bacteria are resistant to
multiple drugs and are increasingly resistant to most available antibiotics. These bacteria have built-in
abilities to find new ways to be resistant and can pass along genetic materials that allow other
bacteria to become drug-resistant as well. CDCs aggressive recommendations, if implemented, can
prevent the spread of gram-negatives.
Gram-negative infections include those caused by Klebsiella,Acinetobacter, Pseudomonas aeruginosa,
and E. coli., as well as many other less common bacteria.
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CDC guidelines to address gram-negative bacteria

CDC Multi-Drug Resistant Organism Guidelines address reducing infections caused by all drugresistant bacteria, including gram negatives.
CDC Guidance for Control of Infections with Carbapenem-resistant or Carbapenemaseproducing Enterobacteriaceae in Acute Care Facilities contains specific recommendations for
prevention and control of a specific emerging drug-resistant gram-negative.

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Outbreak investigations
Outbreak investigations have led to a better understanding of how to control these bacteria in
healthcare. In the past 3 years, the Division of Healthcare Quality Promotion has assisted in at least
10 investigations of outbreaks of gram negative infections.
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CDC has collaborated with state health departments in Maryland and Arizona to
successfully control outbreaks of Multidrug-resistant-Acinetobacter infections occurring
among intensive care unit patients.
CDC has worked with the Puerto Rico health department to control an outbreak of
highly resistant Klebsiella at a neonatal intensive-care unit in Puerto Rico.
CDC assisted the Ohio health departments investigation of infections caused
by Acinetobacter. These outbreaks have occurred in various healthcare facilities in the state
of Ohio and have been controlled by aggressive infection control interventions.
CDC worked with the state health department of Texas on separate outbreaks of B.
cepacia andPseudomonas.
Additionally, CDC worked with the state health department in Georgia on an unrelated
outbreak of B. cepacia.

CDC worked with the Department of Defense to investigate and

control Acinetobacter infections occurring in soldiers injured in the Middle East. This
collaboration led to important improvements in infection control in military medical facilities.
In addition to these outbreaks, CDCs reference laboratory has confirmed carbapenemase
resistance in bacteria for 32 other U.S. states.