Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Water as a Source of Health Care–Associated Infections—Reply

Water as a Source of Health Care–Associated Infections—Reply In reply We greatly appreciate the interest and commentary by Cervia et al in response to our article. We agree that the reemergence of gram-negative organisms as increasingly common causes of health care–acquired bloodstream infections is very troubling, particularly given the dearth of new antibiotic development in the past several years.1 Recent work has underscored the unique challenges of developing new agents effective against some of the most worrisome gram-negative pathogens such as Pseudomonas aeruginosa and Acinetobacter baumanii.2 The urgency of this issue is highlighted even more by the continued increases in multidrug resistance among these organisms. More clearly elucidating the epidemiology of gram-negative infections, particularly resistant gram-negative infections, is paramount in developing interventions to effectively curb these infections in the health care setting. Cervia et al note recent data showing that gram-negative organisms associated with health care infections can frequently be cultured from hospital water sources. Their own data show that this is not an isolated finding but is widespread across institutions. That approximately one third of organisms isolated from such sources are pathogens commonly associated with health care infections is of clear concern. While these data are ecologic in nature, they emphasize the importance of more rigorously assessing possible water sources in future studies seeking to identify patient level risk factors for the emergence of gram-negative infections. We believe that the findings by Cervia et al in fact point to the broader lack of understanding of the epidemiologic characteristics of health care–associated gram-negative infections. Among gram-positive organisms, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus, clinical and molecular epidemiology studies have ably demonstrated the high degree of transmissibility of these pathogens in the health care setting. These data have helped to inform the development of guidelines regarding possible approaches to curbing the emergence of these organisms. The epidemiologic characteristics of gram-negative infections in the hospital is less clear. How often these organisms (particularly resistant phenotypes) originate de novo in the individual patient, are passed from person to person, or are obtained from the hospital environment (including water sources) or other sources (such as the food supply) has not been well described. Indeed, the very importance of infection control interventions in addressing emerging gram-negative organisms, particularly resistant pathogens, has recently been debated.3 The conclusion of these debates is primarily that more data are needed. The studies required to answer these questions are complicated and time consuming, requiring longitudinal follow-up with colonization surveillance of both patients and environment to determine more clearly the epidemiologic features of new and prolonged colonization as well as the relationship between colonization and subsequent infection. Given the findings of our study, these data are urgently needed to better elucidate the epidemiologic characteristics of health care–acquired gram-negative infections. Correspondence: Dr Lautenbach, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 825 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021 (elautenb@cceb.med.upenn.edu). References 1. Spellberg BPowers JHBrass EPMiller LGEdwards JE Jr Trends in antimicrobial drug development: implications for the future. Clin Infect Dis 2004;381279- 1286PubMedGoogle ScholarCrossref 2. Rice LB Challenges in identifying new antimicrobial agents effective for treating infections with Acinetobacter baumannii and Pseudomonas aeruginosa. Clin Infect Dis 2006;43 ((suppl 2)) S100- S105PubMedGoogle ScholarCrossref 3. Harris ADMcGregor JCFuruno JP What infection control interventions should be undertaken to control multidrug-resistant gram-negative bacteria? Clin Infect Dis 2006;43 ((suppl 2)) S57- S61PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Water as a Source of Health Care–Associated Infections—Reply

Loading next page...
 
/lp/american-medical-association/water-as-a-source-of-health-care-associated-infections-reply-LYgx0051y4
Publisher
American Medical Association
Copyright
Copyright © 2007 American Medical Association. All Rights Reserved.
ISSN
0003-9926
DOI
10.1001/archinte.167.1.92-b
Publisher site
See Article on Publisher Site

Abstract

In reply We greatly appreciate the interest and commentary by Cervia et al in response to our article. We agree that the reemergence of gram-negative organisms as increasingly common causes of health care–acquired bloodstream infections is very troubling, particularly given the dearth of new antibiotic development in the past several years.1 Recent work has underscored the unique challenges of developing new agents effective against some of the most worrisome gram-negative pathogens such as Pseudomonas aeruginosa and Acinetobacter baumanii.2 The urgency of this issue is highlighted even more by the continued increases in multidrug resistance among these organisms. More clearly elucidating the epidemiology of gram-negative infections, particularly resistant gram-negative infections, is paramount in developing interventions to effectively curb these infections in the health care setting. Cervia et al note recent data showing that gram-negative organisms associated with health care infections can frequently be cultured from hospital water sources. Their own data show that this is not an isolated finding but is widespread across institutions. That approximately one third of organisms isolated from such sources are pathogens commonly associated with health care infections is of clear concern. While these data are ecologic in nature, they emphasize the importance of more rigorously assessing possible water sources in future studies seeking to identify patient level risk factors for the emergence of gram-negative infections. We believe that the findings by Cervia et al in fact point to the broader lack of understanding of the epidemiologic characteristics of health care–associated gram-negative infections. Among gram-positive organisms, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus, clinical and molecular epidemiology studies have ably demonstrated the high degree of transmissibility of these pathogens in the health care setting. These data have helped to inform the development of guidelines regarding possible approaches to curbing the emergence of these organisms. The epidemiologic characteristics of gram-negative infections in the hospital is less clear. How often these organisms (particularly resistant phenotypes) originate de novo in the individual patient, are passed from person to person, or are obtained from the hospital environment (including water sources) or other sources (such as the food supply) has not been well described. Indeed, the very importance of infection control interventions in addressing emerging gram-negative organisms, particularly resistant pathogens, has recently been debated.3 The conclusion of these debates is primarily that more data are needed. The studies required to answer these questions are complicated and time consuming, requiring longitudinal follow-up with colonization surveillance of both patients and environment to determine more clearly the epidemiologic features of new and prolonged colonization as well as the relationship between colonization and subsequent infection. Given the findings of our study, these data are urgently needed to better elucidate the epidemiologic characteristics of health care–acquired gram-negative infections. Correspondence: Dr Lautenbach, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 825 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021 (elautenb@cceb.med.upenn.edu). References 1. Spellberg BPowers JHBrass EPMiller LGEdwards JE Jr Trends in antimicrobial drug development: implications for the future. Clin Infect Dis 2004;381279- 1286PubMedGoogle ScholarCrossref 2. Rice LB Challenges in identifying new antimicrobial agents effective for treating infections with Acinetobacter baumannii and Pseudomonas aeruginosa. Clin Infect Dis 2006;43 ((suppl 2)) S100- S105PubMedGoogle ScholarCrossref 3. Harris ADMcGregor JCFuruno JP What infection control interventions should be undertaken to control multidrug-resistant gram-negative bacteria? Clin Infect Dis 2006;43 ((suppl 2)) S57- S61PubMedGoogle ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 8, 2007

References