The acquisition of Escherichia coli by new-born babies.
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 for Escherichia coli to implant in the bowel. The difficulties of studying the spread of E. 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 these E. coli by babies is related to the length of time that the birth takes, and that there is a relationship between the E. 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 eralier 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 faecal E. 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 faecal E. 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' faecal E. coli and studies are described which show that the babies faeces or rectal swabs are usually the first areas colonized and that the E. coli are spread from there. Extensive environmental studies suggest that contaminated hands and uniforms of the nursing staff may be the main vector for transmitting E. coli. There is a wide variety of E. 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.