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healthcare-associated infections (HAI) program


Acinetobacter are a group of bacteria (germs) commonly found in the environment, such as soil or water. Acinetobacter can survive in the healthcare environment for long periods of time, and can cause serious, invasive healthcare-associated infections. One particular type, Acinetobacter baumannii, is the most common cause of these infections.  

Frequently Asked Questions

What are carbapenem-resistant Acinetobacter?

Carbapenems are considered last-resort antibiotics. Acinetobacter baumannii that are resistant (no longer respond) to carbapenems are called carbapenem-resistant Acinetobacter baumannii or CRAB. CRAB are often resistant to multiple antibiotics, or multidrug-resistant.

Why are CRAB a problem?

In healthcare settings like hospitals and nursing homes, CRAB can spread through contact with contaminated surfaces or equipment, or from person to person, often via contaminated healthcare worker hands. There are limited antibiotic treatment options for patients who develop infections caused by CRAB. Patients with CRAB infections can have significantly worse outcomes than patients with non-carbapenem-resistant Acinetobacter infections. 

Who is at risk of getting CRAB?

In general, healthy people are not at risk of CRAB infection, including healthcare providers. People who have spent time in healthcare facilities like hospitals or nursing homes are at the highest risk of becoming carriers of CRAB (colonized) and developing infections. Risk factors for CRAB include:

  • Being on a mechanical ventilator (breathing machine)
  • Having indwelling medical devices such as urinary catheters or endotracheal tubes
  • Having open wounds from surgery
  • Recent stay at a long-term acute care hospital or a ventilator-equipped skilled nursing facility
  • Recent overnight stay at a healthcare facility outside the United States

How are CRAB spread?

There are different ways CRAB can spread:

  • Direct person-to-person contact through wounds or respiratory secretions
  • Indirect person-to-person contact via the hands or clothing of healthcare providers, or contact with contaminated surfaces or medical equipment

Both direct and indirect spread can happen whether a patient has an active infection or is just a carrier of CRAB (colonization). While healthcare providers can be responsible for the spread of CRAB, they themselves are not generally at risk of carrying or being infected with CRAB.

What can patients and families do to prevent CRAB infections?

Patients and families can take several important steps to help prevent multidrug-resistant infections like CRAB. Make sure to:
  • Tell your doctor if you have ever been diagnosed with a drug-resistant infection, or hospitalized elsewhere, especially outside of the United States.
  • Take antibiotics only as prescribed.
  • Expect all healthcare providers to wash their hands with soap and water or an alcohol-based hand rub before and after touching your body or tubes going into your body.  If they do not, ask them to do so.
  • In many healthcare settings, healthcare personnel will wear gloves and gowns when interacting with patients with CRAB.
If you have CRAB or are caring for someone who does, make sure to clean your own hands and practice good hygiene. This is especially important during the following activities:
  • Before preparing or eating food
  • After using the bathroom
  • Before and after changing wound dressings or bandages
  • After blowing your nose, coughing, or sneezing

Should family members or other close contacts of patients be tested for CRAB?

CDPH does not recommend family members or otherwise healthy close contacts of patients with CRAB infection or colonization be tested for CRAB. In general, healthy people are not at risk of CRAB and do not need to be tested.

What can healthcare facilities and public health departments do to prevent CRAB transmission?

Preventing the spread of CRAB and other antibiotic-resistant bacteria is essential to patient safety and making sure antibiotics continue to work in the future. Healthcare providers and public health practitioners can visit the CDPH webpage for Carbapenem-resistant and Carbapenemase-producing Organisms to learn more about how healthcare facilities and public health departments can prevent transmission of multidrug-resistant pathogens like CRAB. Local health departments can view the CDPH Carbapenem-Resistant Pseudomonas and Acinetobacter Quicksheet (PDF) when working with facilities to prevent CRAB transmission in their jurisdiction.

Additional CRAB Resources

For additional information contact the HAI Program at​​

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