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Published Date: 2011-11-28 09:11:08
Subject: PRO/EDR> Antibiotic resistance, E. coli - UK (02): (Wales) ESBL
Archive Number: 20111128.3471

ANTIBIOTIC RESISTANCE, E. COLI - UK (02): (WALES) ESBL
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Date: Sat 26 Nov 2011
Source: Daily Mail, MailOnline [edited]
http://www.dailymail.co.uk/news/article-2066515/Third-baby-suspected-having-potentially-fatal-E-coli-hospital-died.html

A 3rd baby at a hospital where 2 babies died in an _Escherichia coli_
outbreak is suspected of having the potentially fatal infection. The
latest case is a baby who is carrying the bacteria without any signs
of infection, health chiefs confirmed last night [25 Nov 2011].

The maternity unit at Singleton Hospital, in Swansea, south Wales,
continues to be restricted to full-term babies following the deaths.
Hopes that it could reopen in full to all pregnancies yesterday were
put on hold.

'A 3rd case of ESBL [extended spectrum beta-lactamase] _E. coli_ cross
infection is unfortunately suspected at the maternity/neonatal unit at
Singleton Hospital,' a spokeswoman said. 'This latest case involves
another baby who is carrying the bacteria without any signs of
infection. The baby has been a patient in the neonatal unit at the
hospital within the past month. Further tests are now under way to
confirm the cross infection.'

Abertawe Bro Morgannwg (ABM) University Health Board, which runs the
hospital, announced that 2 babies had died from an ESBL _E. coli_
infection on Tuesday [22 Nov 2011]. [One of the 2 infants who died],
described as 'very premature' by hospital officials, died of the ESBL
_E. coli_ infection after being born at the unit. The 2nd case
involved a baby whose mother is suspected of contracting the infection
at the hospital.

Health chiefs have stressed that ESBL _E. coli_ is not the same as _E.
coli_ O157, which causes food poisoning. In most people ESBL _E. coli_
does not cause harm but in vulnerable individuals, such as premature
babies and the elderly, it can cause serious infections.

An investigation into how the _E. coli_ bug was transmitted is
continuing. It is looking at a total of 5 ESBL _E. coli_ infections, 3
among adults. Of the 5 cases 3 were contracted outside the hospital.
An independent investigation, reviewing the hospital's response to the
outbreak, is to be carried out by Healthcare Inspectorate Wales. Extra
precautions have been put in place at the hospital's maternity unit.
'We are also taking additional precautions, including restricting
visitors to the maternity unit, and we are continuing to ask visitors
to wash their hands and use hand hygiene gel,' the health board
spokeswoman said. She said that checks of equipment and the
environment in the maternity and neonatal unit have all been negative
for the bug. 'Despite stringent hygiene controls these cross infection
incidents have occurred, which we very much regret,' she said.

'Our investigations into the cross infection have not yet identified
how the ESBL _E. coli_ was transmitted, but we continue to do all we
can to determine the cause. However, in other similar instances of
this kind elsewhere in the UK the cause of transmission was never
identified. We would like to again reassure mothers-to-be that the
maternity unit remains open as usual for full term births.'

A helpline number for mothers-to-be who have queries or concerns is
available via 0800 952 0090.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Neonatal infections caused by _Escherichia coli_, a Gram-negative
bacillus that is normally found in the lower intestinal tract, can be
acquired either from the mother during vaginal delivery or from the
environment, for example on the hands of caregivers.

Neonatal infections due to extended-spectrum beta-lactamase
(ESBL)-producing _E. coli_ have been described previously, where the
infections were believed to have been acquired from the hospital
environment (Jain A, Roy I, Gupta MK, et al: Prevalence of
extended-spectrum beta-lactamase-producing Gram-negative bacteria in
septicaemic neonates in a tertiary care hospital. J Med Microbiol
2003; 52(5), 421-5. Available at
http://jmm.sgmjournals.org/content/52/5/421.full). However, in a
region of Spain where infections due to ESBL-producing _E. coli_
isolates have been community-acquired and a significant number of
community fecal carriers have been detected, ESBL-producing _E. coli_
was believed to have spread from a mother to child and caused
community-acquired neonatal sepsis (Lopez-Cerero L, De Cueto M, Saenz
C, et al: Neonatal sepsis caused by a CTX-M-32-producing _Escherichia
coli_ isolate. J Med Microbiol October 2008; 57 (10): 1303-05.
Available at http://jmm.sgmjournals.org/content/57/10/1303.full).

There are multiple types of ESBLs, such as, TEM, SHV, CTX-M, OXA, each
with multiple subtypes. More than 80 CTX-M enzyme types are currently
known. No CTX-M-15 were recorded in the UK prior to 2000; but since
2003 they have spread rapidly
(http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1274090495083).

CTX-M-15 is currently the most widespread type in _E. coli_ the UK and
is reported to be widely prevalent in the community (Woodford N, Ward
ME, Kaufmann ME, et al: Community and hospital spread of _Escherichia
coli_ producing CTX-M extended-spectrum beta-lactamases in the UK. J
Antimicrob Chemother 2004; 54(4): 735-43. Available at
http://jac.oxfordjournals.org/content/54/4/735.full.)

The types of ESBL involved in the Swansea outbreak are not stated in
the news report above. If ESBL-producing _E. coli_ are common in the
Swansea community, these neonatal infections in Swansea could have
been community-acquired from the mothers, which may explain both why
the environment in the maternity and neonatal units of Singleton
Hospital in Swansea has been negative for ESBL-producing _E. coli_ and
the 3 community-acquired cases.

Infection control interventions in healthcare facilities aimed at
preventing transmission of multi-drug resistant isolates include their
rapid recognition by the microbiology laboratory when cultured from
clinical specimens, placement of patients colonized or infected with
these isolates on contact precautions, and in some circumstances,
conducting point prevalence surveys or active-surveillance testing
among high-risk patients (CDC, Healthcare Infection Control Practices
Advisory Committee. Management of multidrug-resistant organisms in
healthcare settings, 2006. Atlanta, GA: US Department of Health and
Human Services, CDC, Healthcare Infection Control Practices Advisory
Committee; 2007. Available at
http://www.cdc.gov/hicpac/pdf/guidelines/MDROGuideline2006.pdf).

Swansea is a coastal city and county in south west Wales. It can be
located on the map at
http://en.wikipedia.org/wiki/File:Swansea_UK_location_map.svg. A
HealthMap/ProMED-mail interactive map of the UK can be seen at
http://healthmap.org/r/1tu2. - Mod.ML]

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