Correspondence

Sepsis in a Newborn Due to Pseudomonas aeruginosa from a Contaminated Tub Bath

N Engl J Med 2001; 345:378-379August 2, 2001

Article

To the Editor:

During labor at term, a 23-year-old woman took a 30-minute tub bath for relaxation in the morning, in water with a temperature of 37°C. She gave birth to a 3170-g boy later that day. Mother and child left the clinic three days later. At day 11, the infant had poor suckling, lethargy, and seizures. Meningitis with bacteremia was diagnosed by the isolation of Pseudomonas aeruginosa from cerebrospinal fluid, blood, and a conjunctival swab. In spite of immediate antipseudomonal chemotherapy (ampicillin, cefotaxime, and gentamicin), acute hydrocephalus developed. Ventriculostomy with external drainage and a ventriculoperitoneal shunt were required. Over the course of the next six months, 10 revisions of the shunt were necessary because of dysfunction or infection. At nine months, the psychomotor development of the patient is appropriate.

Genotyping by means of pulsed-field gel electrophoresis revealed clonal identity of the isolate from the patient's blood with two isolates from the shower tubing used to clean the bathtub used for relaxation (Figure 1Figure 1Pulsed-Field Gel Electrophoresis of DNA Cut by SpeI from Isolates of Pseudomonas aeruginosa.). Eight other isolates of P. aeruginosa from the drain traps of the delivery bathtub (which the woman had used briefly although she did not deliver in it), a washbasin, and two showers in the hospital were different strains. The strain found on the shower tubing was also isolated from the skin cream used on the infant at home. Thus, it is likely that the strain found on the shower tubing was responsible for the infection.

Warm tub baths for relaxation during labor are commonly used in many hospitals throughout the world.1 P. aeruginosa is found in many water reservoirs within and outside hospitals. It can cause severe infections in immunocompromised adults and neonates.2 Plastic tubing is a perfect environment for the growth of P. aeruginosa in biofilms that increase the bacteria's resistance to disinfectants and promote its persistence.2 Neonatal pseudomonas sepsis was linked to contaminated tub systems used for births that actually took place in the water; however, the source of the strain in those cases was not identified.3,4 Although one study found that bathing during delivery did not increase perinatal mortality or morbidity,5 our case demonstrates that there is a risk of serious waterborne infection from contaminated bathing equipment.

Matthias Vochem, M.D.
St. Elisabeth-Krankenhaus, D-56564 Neuwied, Germany

Manfred Vogt, M.D.
Landesuntersuchungsamt Koblenz, 56068 Koblenz, Germany

Gerd Döring, Ph.D.
University of Tübingen, D-72074 Tübingen, Germany
gerd.doering@uni-tuebingen.de

5 References

1. 1

   Odent M. Birth under water. Lancet 1983;2:1476-1477
   CrossRef | Web of Science | Medline

2. 2

   Botzenhart K, Döring G. Ecology and epidemiology of Pseudomonas aeruginosa. In: Campa M, Bendinelli M, Freidman H, eds. Pseudomonas aeruginosa as an opportunistic pathogen. New York: Plenum Press, 1993:1-18.
   

3. 3

   Rawal J, Shah A, Stirk F, Mehtar S. Water birth and infection in babies. BMJ 1994;309:511-511
   CrossRef | Web of Science | Medline

4. 4

   Parker PC, Boles RG. Pseudomonas otitis media and bacteremia following a water birth. Pediatrics 1997;99:653-653
   CrossRef | Web of Science | Medline

5. 5

   Gilbert RE, Tookey PA. Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey. BMJ 1999;319:483-487
   CrossRef | Web of Science | Medline

Citing Articles (10)

Citing Articles

1. 1

   Shigeru Fujimura, Yoshihisa Nakano, Hidenari Takane, Toshiaki Kikuchi, Akira Watanabe. (2011) Risk factors for health care-associated pneumonia: Transmission of multidrug-resistant Pseudomonas aeruginosa isolates from general hospitals to nursing homes. American Journal of Infection Control 39:2, 173-175
   CrossRef

2. 2

   Susan E. Coffin, Theoklis E. Zaoutis. 2011. HealthCare–Associated Infections in the Nursery. , 1126-1143.
   CrossRef

3. 3

   Matthias Trautmann, S. Halder, P. M. Lepper, M. Exner. (2009) Reservoire von Pseudomonas aeruginosa auf der Intensivstation. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 52:3, 339-344
   CrossRef

4. 4

   Naomi KOMADA-SAKURAI, Kazuko A. KOIKE. (2008) Japanese Journal of Environmental Infections 23:1, 1-7
   CrossRef

5. 5

   (2007) Empfehlung zur Prävention nosokomialer Infektionen bei neonatologischen Intensivpflegepatienten mit einem Geburtsgewicht unter 1500 g. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 50:10, 1265-1303
   CrossRef

6. 6

   Rosanna A. Zanetti-Daellenbach, Sibil Tschudin, Xiao Yan Zhong, Wolfgang Holzgreve, Olav Lapaire, Irene Hösli. (2007) Maternal and neonatal infections and obstetrical outcome in water birth. European Journal of Obstetrics & Gynecology and Reproductive Biology 134:1, 37-43
   CrossRef

7. 7

   Joan A. Heath, Danielle M. Zerr. 2006. Infections Acquired in the Nursery: Epidemiology and Control. , 1179-1205.
   CrossRef

8. 8

   Michael G Pinette, Joseph Wax, Elizabeth Wilson. (2004) The risks of underwater birth. American Journal of Obstetrics and Gynecology 190:5, 1211-1215
   CrossRef

9. 9

   KS Oláh. (2004) Neonatal death caused by intrauterine infection with Pseudomonas aeruginosa. Journal of Obstetrics & Gynaecology 24:5, 581-582
   CrossRef

10. 10

    (2001) Sepsis in a Newborn Due to Pseudomonas aeruginosa from a Contaminated Tub Bath. New England Journal of Medicine 345:22, 1644-1645
    Full Text