**3. Clinical importance — Infections and outbreaks**

Acinetobacter spp. can cause infections in both hospital settings and in community. They are the second most commonly isolated non-fermenters in human specimens, after Pseudomonas aeruginosa. About 1-3% of health care-associated infections are caused by Acientobacter spp.

Acinetobacter poses little risk to healthy people. However, people who have weakened immune systems, chronic lung disease, or diabetes may be more susceptible to infections with Acinetobacter. Most infections caused by this multiresistant bacteria involve organ systems, which have a high fluid content (the respiratory tract, peritoneal fluid, and the urinary tract) and are associated with usage of indwelling devices. The distribution of the different types of hospital acquired infections is variable between hospitals and it depends on the hospital population and the type of performed procedures and interventions. Rates of mortality from Acinetobacter infections have a wide range from 5% in general wards to 54% in intensive care units (Kempf & Rolain, 2012).

One important feature of A. baumannii is its ability to cause outbreaks, which is in relation to antimicrobial resistance and resistance to desiccation (D'Agata et al., 2000; Villegas et Hart‐ stein, 2003). Acinetobacter spp. cause a wide range of health care-associated infections such as: ventilator-associated pneumonia, bloodstream infections, urinary tract infections, surgical site infections, meningitis, cholangitis, peritonitis, skin and wound infections, ventriculitis, and infective endocarditis. Suppuration is common feature in infections caused by Aciento‐ bacter (abscesses of the brain, lung and the thyroid; secondary infections of wounds or surgical trauma, and purulent lesions of the eye).

Acinetobacter can also cause infections in the community (Falagas et al., 2007). The predomi‐ nant community-acquired infections are: pneumonia, meningitis, cellulitis and bacteremia. High fatality rates in community were correlated to underlying conditions and risk factors, such as : alcoholism, diabetes and cancer.

Acinetobacter infections were also frequently reported during the natural disasters and wars (Iraq, Kuwait and Afghanistan wars). Pathogenic Acinetobacter infections were encountered in military personnel during the wars in Afghanistan and Iraq (O'Shea, 2012).Therefore it was named by media as Iraqibacter.

Recent disasters suggested that Acinetobacter infections should be taken in consideration in differential diagnosis of soft-tissue infections (Asia tsunami on 2004).

Many Acinetobacter infections have a seasonal variation with 50% infection rates higher from July to October than at other times of the year. This variation was explained by warmer, more humid ambient air, which favors growth of Acinetobacter and potentially preventable environmental contaminants, such as condensate from air-conditioners.
