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The acquisition of escherichia coli by new-born babies

Die Neugeborenenbesiedlung mit Escherichia coli

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Summary

In discussing the background of these studies the importance of faecal carriage of Gram negative organisms by hospital patients is stressed. In many instances it was shown that transmission is by an oral route. This discussion leads on to an assessment of the dose required forEscherichia coli to implant in the bowel. The difficulties of studying the spread ofE. coli within a faecal specimen are discussed. A number of papers are quoted which show that E. coli are present in the vagina of women and that the acquisition of theseE. coli by babies is related to the length of time that the birth takes, and that there is a relationship between theE. coli found in the faeces of the mothers, the mucus swallowed by the babies at birth and subsequently in the faeces of the babies. Most of the earlier studies quoted deal predominantly with enteropathogenic serotypes, but it was later shown that other serotypes can be similarly acquired by the babies. Although this appears to be the general method by which babies acquire their faecalE. coli, it is well established that they can also be obtained from the environment, hence ward outbreaks of infantile gastroenteritis. Studies on normally delivered babies show that generally two thirds obtain their faecalE. coli from their mothers while the rest appear to pick up environmental strains. Very detailed biochemical and serological studies need to be performed to assess this. Caesarian section babies are generally not likely to become colonized by their mothers' faecalE. coli and studies are described which show that the babies faeces or rectal swabs are usually the first areas colonized and that theE. coli are spread from there. Extensive environmental studies suggest that contaminated hands and uniforms of the nursing staff may be the main vector for transmittingE. coli. There is a wide variety ofE. coli serotypes present in a maternity ward at any time and these are related to the presence of the babies excreting them. A variation in the ability of strains to spread was noted.

Zusammenfassung

Die Bedeutung der Ausscheidung von gramnegativen Keimen durch Krankenhauspatienten zeichnet sich auf dem Hintergrund der Diskussion ab. In vielen Beispielen wurde gezeigt, daß es zu einer oralen Aufnahme kam. Die Diskussion geht darauf hinaus, die für das Angehen im Rektum erforderliche Bakterienmenge zu erfassen. Die methodischen Schwierigkeiten, um dieE.-coli-Menge im Stuhl zu beurteilen, werden erwähnt. Eine Anzahl von Arbeiten werden zitiert, bei denen demonstriert wurde, daßE. coli in der Vagina von Frauen vorhanden sind, und daß die Aufnahme vonE. coli durch Neugeborene mit der Dauer der Geburt in Relation steht. Es werden die gleichen Coli-Typen zuerst im mütterlichen Stuhl, dann im Vaginalschleim und, nachdem dieser von den Säuglingen bei der Geburt geschluckt wurde, bis zum Stuhl der Säuglinge verfolgt. Die Mehrzahl der älteren zitierten Arbeiten befassen sich mit enteropathogenen Serotypen, aber es wurde in neueren Publikationen gezeigt, daß andere Serotypen von den Neugeborenen in ähnlicher Weise erworben werden können. Obgleich dies der normale Weg der Besiedlung von Säuglingen zu sein scheint, ist es klar, daß sie auch durch die Umgebung erworben werden können, wie bei Kleinraumepidemien von infantiler Gastroenteritis nachgewiesen wurde. Säuglinge mit einem normalen Geburtsablauf zeigen, daß sie ca. zwei Drittel ihrer Stuhl-Coli-Flora von der Mutter erhalten, der Rest hingegen nimmt die Stämme von der Umgebung auf. Sorgfältige biochemische und serologische Untersuchungen sind nötig, um dies festzustellen. Bei Säuglingen, die durch eine Sectio entbunden werden, ist es unwahrscheinlich, daß sie durch die mütterlichen fäkalen Coli-Typen besiedelt werden. Bei diesen Kindern zeigten Untersuchungen, daß sie zuerst anal besiedelt werden, undE. coli sich von dort aus weiterverbreitet. Ausgiebige Umgebungsuntersuchungen lassen vermuten, daß kontaminierte Hände und Bekleidung des Pflegepersonals der Hauptüberträger vonE. coli sind. In der Entbindungsstation ist eine große Zahl verschiedener Coli-Typen zu jeder Zeit nachweisbar, und sie stehen zu den im gleichen Zeitraum ausgeschiedenen Bakterien in enger Beziehung. Unterschiedliche Ausbreitungstendenzen konnten bei den verschiedenen Stämmen beobachtet werden.

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Authors and Affiliations

  1. Department of Medical Microbiology, Medical College of St. Bartholomew's Hospital, West Smithfield, ECl, London, Great Britain

    K. Bettelheim &  S. Lennox-King

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  1. K. Bettelheim
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  2. S. Lennox-King
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Bettelheim, K., Lennox-King, S. The acquisition of escherichia coli by new-born babies. Infection 4, 174–179 (1976). https://doi.org/10.1007/BF01638945

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