ESBL

Question

My son was born 2 months premature and he was coloniaed ESBL whilst in the NICCU ICU. He has since been moved to a regional hospital where he isolated from the other babies in the nursery.

I was told today by infections control that I have most likely contracted ESBL from my son as I breast feed him. I was my hands when I enter and leave the nursery and wash my clothes after every wear.

Just wondering how it's possible to catch is through breast feeding??

Answer

Dear Questionner

Thank you for your question. For various reasons it's not a good idea for health care professionals to comment on specific individual cases online, but some facts and general opinions may be helpful here:

1. We all have millions of bacteria living on and in our bodies - all of us, without exception within a day or two after birth. In fact there are more bacterial cells in our bodies than human ones.

2. These bacteria usually do us no harm and infection specialists call them "colonisers" and this is what is happening when a patient is said to be "colonised". Actually some bugs are actually good for us, as they help make vitamins and help stop other bad bugs like the meningitis bacteria living in our mouths.

3. E Coli is a bacteria which lives in all our guts and faeces - everyone's.

4. Although it is a colonizer, usually living harmlessly in everyone's faeces, if it travels to another part of our body for example our urine or blood it can make us ill and we are then said to be infected, rather than colonised .

5. ESBL is a "brand" of E coli which is more resistant to antibiotics than the average E coli bug. It is more common in people who have had repeated courses of antibiotics, but like ordinary E coli it usually "colonises" people and most people who have it are not harmed by it. However, on occasion, when it does cause infection, it is more difficult to treat with antibiotics as it is resistant to many of the standard antibiotics and needs to be treated with special, more powerful , more "broad spectrum" antibiotics.

6. In hospital we try to put patients "colonised" or infected with bacteria that are more resistant than average, like ESBL into a separate room with precautions to stop these bacteria spreading to other patients whose immune systems are weak.

7. Good hand hygiene is the best way to prevent bacteria spreading from one patient to another.

8. Although it is always a good idea to practice good hand hygiene, despite this, young families especially mothers and young babies often share or swap the same bacteria. The baby will pick up some of his or her normal bacteria from the mother during a normal vaginal delivery, but at many other times it's not clear as to who has picked up bacteria from whom - it's a "chicken and egg" situation. Good hygiene can minimise the transfer of bacteria, but with close skin to skin contact it's impossible to prevent all bacteria moving between mother and child. This should not be used as a reason to stop breast feeding, except sometimes when there was an actual breast infection* diagnosed by a doctor, for example a breast abscess. This is because breast feeding is the best kind of feeding to build up a young baby's immune system to protect against infections and most bacteria that transfer between mother and child are harmless.


*Even then it may still be possible to continue breast feeding after expressing and discarding breast milk for a period of time but this depends on specific medical advice for each mother.

Kind regards
Dr Colin Goldsmith
Consultant in Medical Microbiology

11.12.2012

The answer is edited by: Prof Judy Bradley