1. Date of download: 7/8/2016 Copyright © 2016 American Medical Association. All rights reserved. From: An Outbreak of Multidrug-Resistant Acinetobacter baumannii Associated With Pulsatile Lavage Wound Treatment JAMA. 2004;292(24):3006-3011. doi:10.1001/jama.292.24.3006 The outbreak period was in September and October 2003, when a markedincrease in the number of cases was noted. The patterns indicate various strainsof multidrug-resistant Acinetobacter baumannii (MDR-Ab)as defined by pulsed-field gel electrophoresis. After the outbreak was haltedin late October, the number of cases of MDR-Ab remained somewhat elevatedin November because of an increase in the number of patients admitted withMDR-Ab. These cases were unrelated to pulsatile lavage therapy and the strainsdid not match the outbreak strain. Figure Legend:

2. Date of download: 7/8/2016 Copyright © 2016 American Medical Association. All rights reserved. From: An Outbreak of Multidrug-Resistant Acinetobacter baumannii Associated With Pulsatile Lavage Wound Treatment JAMA. 2004;292(24):3006-3011. doi:10.1001/jama.292.24.3006 Strain A was isolated from blood, urine, sputum, or wound specimensfrom 6 patients who were treated with pulsatile lavage therapy and from multiplesurfaces in the wound care treatment room. Strains B and C were isolated fromsputum or wound specimens from 2 patients who were not treated with pulsatilelavage therapy. ETS indicates endotracheal suction. MDR-Ab, multidrug-resistant Acinetobacter baumannii; MW, molecular weight. Figure Legend:

3. Date of download: 7/8/2016 Copyright © 2016 American Medical Association. All rights reserved. From: An Outbreak of Multidrug-Resistant Acinetobacter baumannii Associated With Pulsatile Lavage Wound Treatment JAMA. 2004;292(24):3006-3011. doi:10.1001/jama.292.24.3006 This timeline depicts the 11 patients identified as infected or colonizedwith multidrug-resistant Acinetobacter baumannii (MDR-Ab)at Johns Hopkins Hospital during September and October 2003. Eight of the11 patients had pulsatile lavage therapy, as indicated by the bars. Circlesdenote cultures that grew MDR-Ab. During the outbreak investigation, it wasdiscovered retrospectively that patient 11 had a urine culture that grew MDR-Abin July 2003. This isolate was not available for pulsed-field gel electrophoresisanalysis. Figure Legend: