Water as a Source of Health Care–Associated Infections

The timely analysis by Albrecht and colleagues¹ sheds appropriate light on the disturbing reemergence of gram-negative bacteria as agents of health care–associated bloodstream infections. As the authors aptly describe, such infections exact a devastating toll in morbidity and mortality and add substantially to the cost of patient care. Interestingly, some of the most frequently isolated gram-negative bacteria, including Pseudomonas and Enterobacter, have been found to persist in hospital water for extended periods and have been responsible for nosocomial outbreaks.² In fact, a recent review of prospective studies published between 1998 and 2005 indicated that between 9.7% and 68.1% of random intensive care unit water samples were positive for Pseudomonas aeruginosa, and between 14.2% and 50% of patient infections were due to genotypes found in intensive care unit water.³