Two infant fatalities in Wales as a result of E. coli

Five cases of ESBL-producing E. coli have been reported in South Wales.  Of these, two involved babies, with the infection proving fatal in both infant cases.

One of the infants, a premature-born baby girl is confirmed to have contracted the infection at the neo-natal unit of the Singleton Hospital in Swansea.  The child’s mother is also understood to have tested positive for the bacteria, although she is reported not to have suffered any adverse symptoms.  It is suspected that the mother also caught the bug in the hospital but test results to confirm this are awaited.

The other baby who died is understood to have contracted the infection in the community.  It is thought that this second infant was also born at Singleton Hospital.  The hospital believes that the three cases mentioned, together with two other adult cases of infection, are all linked but it has not elaborated on what the suspected connection is.  Authorities have also refused to speculate on how the infection could have been spread.

Molecular fingerprinting techniques should eventually establish where the infection emanated from.  The investigation will then most likely entail an examination of the history of contact between all five people infected, whether this was in the community or in the local hospital environment.

As a precaution in the meantime, hospital managers have closed the maternity and neo-natal unit to premature babies but it remains open to full-term births.

ESBL (Extended-Spectrum Beta-Lactamases)-producing E. coli are strains of the bactieria which produce enzymes that have the effect of making them resistant to most beta-lactam antibiotics (such as penicillins and cephalosporins), in common with other so-called ‘super bugs’.

While they are from the same family of bacteria, ESBL-producing E. coli and E. coli O157 are entirely distinct strains.  Unlike E. coli O157, which is a regular culprit in cases of foodborne illness, ESBL-producing E. coli infection is not contracted due to food poisoning.

The most common ailments caused by ESBL-producing E. coli (which is typically found in the gut) are urinary tract infections which normally respond well to treatment in otherwise healthy individuals.

In the case of certain vulnerable groups, however, these infections can sometimes progress to cause more serious infections, such as bacteraemia, which can be life threatening.  Those most at risk are very young babies, people with other underlying medical conditions, and the elderly.

Infection is regularly reported in hospital environments and may usually be attributed to colonised carriers (healthy individuals who carry the bug without showing any symptoms) or infected patients.  The bacterium is often spread from patient to patient on the hands of healthcare workers.  However, it can persist in the environment for hours or even longer, and may therefore be transmitted without direct person-to-person contact.  Mothers can pass it on to their babies during or after birth, but not in utero.

ESBL-producing E. coli is treatable with a reduced range of antibiotics to which a resistance has not been developed.  Figures available from the HSPC suggest that of the cases of E. coli bloodstream infections reported in Ireland each year the percentage of those involving ESBL-producing E. coli is in single digits.

Stringent hand hygiene practices and effective environmental cleaning in hospitals are seen as the most effective means of reducing the risk of ESBL-producing E. coli being spread from patient to patient.  It will be important for the investigation which is to take place to establish whether appropriate infection control measures were in force in the hospital during the relevant period or whether the strain in question is one which can thwart the prevention techniques which are presently in line with clinical best practice.