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In reply

With our article, my colleagues and I intended to start a healthy debate on this important and yet underappreciated health care issue.¹ We are thus very pleased to see the response by Dr Hunter, one of the leading experts in the field of waterborne infections, and particularly encouraged that he shares our opinion on 2 key points:

1. That a waterborne transmission route for nosocomial infections (including Pseudomonas) is likely ("some of the outbreaks quoted by Anaissie and colleagues are reasonably convincing"); and
   
2. That there is a need to develop a critical approach to reporting waterborne nosocomial infections and to develop proper prospective epidemiological studies to determine the real contribution that water supplies make to disease burden.
   

Elias J. Anaissie, MD
Little Rock, Ark

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