Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 17, Number 6—June 2011
Letter

Extended-Spectrum β-Lactamase–producing Escherichia coli in Neonatal Care Unit

Cite This Article

To the Editor: Tschudin-Sutter et al. provide convincing evidence of transfer of an extended-spectrum β-lactamase–producing Escherichia coli strain from a mother to her vaginally delivered twins, then from the neonates to a health care worker and other neonates in a neonatal care unit (1). This finding advances our understanding of how extended-spectrum β-lactamase–positive (and, by extension, other antimicrobial drug–resistant or virulent strains) E. coli can spread within the community.

However, the authors’ use of the term infection for the asymptomatic colonization that was observed, including in the mother (who had asymptomatic bacteriuria), is potentially misleading. This term could perpetuate a line of thinking that is all too common among clinicians and leads to unnecessary antimicrobial drug use, thereby ironically aggravating the problem of antimicrobial drug resistance.

Although the first paragraph of their report implicitly acknowledges the distinction between infection and colonization, the rest of the report (including the abstract) uses the terms infection or infected interchangeably with colonization or colonized. Examples include “Subsequently, infection spread by healthcare worker contact with other neonates,” “a healthcare worker also was infected,” and “a urinary tract infection developed....”

One wonders why, in the absence of genitourinary symptoms, the (postpartum) mother’s urine was cultured and why the positive culture prompted antimicrobial drug therapy. This seeming misinterpretation by the mother’s providers of what probably was a harmless colonization state as representing acute disease, and their all too typical response (i.e., antimicrobial drug therapy), are to be discouraged (2). More cautious use of terminology, to emphasize the distinction between colonization and infection (which have radically different therapeutic implications), may help refine clinicians’ thinking and practice in this regard, thereby promoting improved antimicrobial drug stewardship and slowing the antimicrobial drug resistance epidemic.

Top

James R. Johnson
Author affiliation: Author affilation: Veterans Affairs Medical Center, Minneapolis, Minnesota, USA

Top

References

  1. Tschudin-Sutter  S, Frei  R, Battegay  M, Hoesli  I, Widmer  AF. Extended-spectrum β-lactamase–producing Escherichia coli in neonatal care unit. Emerg Infect Dis. 2010;16:175860.PubMedGoogle Scholar
  2. Nicolle  LE, Bradley  S, Colgan  R, Rice  JC, Schaeffer  A, Hooton  TM. Infectious Diseases Society of America Guidelines for the diagnosis and treatment of asymptomatic bacteriuria. Clin Infect Dis. 2005;40:64354. DOIPubMedGoogle Scholar

Top

Cite This Article

DOI: 10.3201/eid1706.101868

Related Links

Top

In Response: We thank James Johnson for the issue that he has raised in his letter (1). We agree that distinction of the terms colonization and infection is crucial to prevent misinterpretation of clinical findings and subsequently unnecessary antimicrobial drug use. The outbreak occurred in the hospital; therefore, definitions of nosocomial infections were used throughout the article (2).

Nosocomial urinary tract infection is defined by the Centers for Disease Control and Prevention as asymptomatic bacteriuria or symptomatic infection (urinary tract infection–symptomatic urinary tract infection; www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf) (3,4). Therefore, the term nosocomial urinary tract infection in our report is correct. However, we agree with the author that the term asymptomatic bacteriuria is less than optimal and it was removed when we submitted our report. We agree that the term infection is misleading for describing spread to health care workers and that colonization should have been used. However, the article clearly states that invasive infection did not occur in any of the neonates or health care workers found to be colonized. In addition, the focus of the article was to describe the mode of transmission rather than the distinction between colonization and infection.

References

  1. Johnson  JR. Extended-spectrum β-lactamase–producing Escherichia coli in neonatal care unit. Emerg Infect Dis. 2011;17:11534. DOIPubMedGoogle Scholar
  2. Tschudin-Sutter  S, Frei  R, Battegay  M, Hoesli  I, Widmer  AF. Extended-spectrum β-lactamase–producing Escherichia coli in neonatal care unit. Emerg Infect Dis. 2010;16:175860.PubMedGoogle Scholar
  3. Garner  JS, Jarvis  WR, Emori  TG, Horan  TC, Hughes  JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:12840. DOIPubMedGoogle Scholar
  4. Horan  TC, Andrus  M, Dudeck  MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:30932. DOIPubMedGoogle Scholar

Table of Contents – Volume 17, Number 6—June 2011

Page created: September 01, 2011
Page updated: September 01, 2011
Page reviewed: September 01, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external