Safe Care



Gram-negative Infections

Educational Media

Gram-negative bacteria are drug-resistant superbugs that are increasing in frequency in hospitals, and once found are nearly impossible to treat.


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.  CDC’s 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.The biggest concern with gram-negative bacteria is that we have virtually no drugs to effectively treat them.


One drug, Colistin, is the only option that sometimes works, but it is extremely toxic to the body and may cause kidney damage.


Acinetobacter is often found in U.S. servicemen. A. baumannii forms opportunistic infections. There have been many reports of A. baumannii infections among American soldiers wounded in Iraq, earning it the nickname "Iraqibacter". Multi-drug resistant Acinetobacter baumannii is abbreviated as MDRAB. Multidrug-resistant Acinetobacter is not new; it has always been inherently resistant to multiple antibiotics. Veterans often have wound infections. Other people that are at risk are ICU patients, very young or old patients, people with a lot of other health problems who are already immunocompromised.

How do Gram-negative Infections Spread?

Gram-negative infections are spread almost exclusively in hospitals. Doctors see gram-negative infections among patients who are already very ill. Babies in the NICU, elderly patients, people who've just had surgery and burn patients are at risk. Gram-negative bacteria can enter the body by way of catheters, IVs, ventilators or wounds, but most commonly, bacteria is transmitted by the hands of caregivers.

How common are Gram-negative Infections?

Gram-negative infections are clearly on the rise and one day could be as troublesome as MRSA is now.

If there are no drugs to battle these infections, then how will the medical community address them?

Organizations like the Infectious Diseases Society of America (IDSA) are encouraging drug companies to research and develop new drugs to battles these kinds of infections. But also, hospitals need to practice infection control and prevention - especially compulsive hand hygiene.  Patients found to be infected with MRSA should be isolated. Physicians need to take care not to overprescribe antibiotics or prescribe the wrong antibiotic.


IDSA advocates a three-pronged strategy for fighting these gram negative infections:


☛ Infection control: prevent people from getting an infection in first place.

☛ Prudent use of antibiotics: not overusing antibiotics.

☛ Developing new antibiotics: generating interest at NIH, CDC, private industry. Get all key stakeholders more involved with developing effective antibiotics to stem infections.

Gram-negative Infection: One Family's Story

Antimicrobial resistance is one of the scariest prospects patients and their families now face. We should know: We lost our 27-year-old son Josh to a deadly antibiotic-resistant bacterial infection in October 2006.


Josh was a healthy, active skydiving instructor, attending college with passionate dreams of becoming a child psychologist. He was financing his own education by teaching other enthusiasts at a local skydiving school in Colorado.

During Labor Day weekend in 2006, Josh was enjoying the holiday doing what he loved best: jumping out of airplanes, something he had done more than 5,000 times before. But during a jump that weekend, he landed wrong, hitting the ground at around 55 miles an hour. The impact jackknifed his body, breaking his left femur and fracturing his skull. Amazingly, he survived these terrible injuries.


During his almost six-week stay in the intensive care unit (ICU) that followed, Josh developed a hospital-associated infection, methicillin-resistant Staphyloccus aureus (MRSA), which the doctors were able to treat with antibiotics. Eventually, he was doing well enough to be transferred to a nearby rehabilitation facility to continue his progress.


Just as Josh was recuperating and on a hopeful path to a good recovery, he began to run a fever of 103 degrees. An infection caused by enterobacter aerogenes, a gram-negative bacteria, was discovered in his cerebral spinal fluid. From there, despite doctors’ efforts to treat the infection, it spread rapidly, causing unbelievable pressure around his brain. The pressure eventually pushed part of his brain into his spinal column, paralyzing him, making him a permanent quadriplegic dependent on a ventilator to breathe.


Josh died two weeks later. He was just 27.


The tragic, unnecessary, and lasting impact of the loss of our son continues to this day. Our family has never recovered from Josh’s death.  We feel overwhelming sadness and a great sense of loss. No holiday dinner or special family celebration ever passes without the haunting reminder of a lone chair that remains empty.


Since Josh’s death, we have devoted our lives to bringing attention to the serious problem of health-care acquired infections and the need for better practices, education, and solutions. We’ve learned that antibiotic-resistant gram-negative bacterial infections are a serious problem. Because they are resistant to virtually every antibiotic we have, they are one of our greatest public health threats.

Looking to the future, we hope patients and their families educate themselves on how to safely receive medical care before being admitted to a hospital to help prevent infections. Everyone who comes into contact with patients should practice appropriate hand hygiene. Lastly, we hope drug companies will invest in more research to fight these dangerous and sometimes deadly bacteria to prevent more people from suffering.


We look forward to a time when these infections no longer threaten to cut short the lives of the ones we love so much.

- Victoria and Armando Nahum