Last March, when I fi rst wrote about acinetobacter on this page, it was bad news. Today, it looks like worse news. The organism that still has not entered the journalist’s lexicon alongside meticillin-resistant Staphylococcus aureus (MRSA) and Clostridium diffi cile could prove to be an even more intractable cause of hospital infections. The latest blow is that a key element in the battle against nosocomial infection—alcohol-based handrubs—may make matters worse rather than better. A year ago (Lancet Infect Dis 2007; 7: 181), Acinetobacter baumannii was attracting attention for three reasons. First, it is a formidable opportunistic pathogen, especially in critically ill patients needing mechanical ventilation. Second, the bacterium has evolved extraordinarily effi cient mechanisms for acquiring and over-expressing resistance genes. Finally, it is highly refractory to both vigorous cleaning and to disinfectants.