Point: Should All Stools Be Screened for Shiga Toxin-producing Escherichia Coli?

Overview

Journal J Clin Microbiol

Specialty Microbiology

Date 2011 May 6

PMID 21543568

Citations 5

Authors

Mario J Marcon

Affiliations

Soon will be listed here.

Abstract

In October 2009, the Centers for Disease Control and Prevention recommended that clinical laboratories test all stools submitted for the detection of enteric bacterial pathogens for the presence of Shiga toxin-producing Escherichia coli (STEC). In order to do this, it is recommended that all stools be cultured for Escherichia coli O157:H7 on selective medium as well as that testing for the presence of Shiga toxin be done by immunoassay to detect non-O157 STEC (3). There are a variety of products that are FDA approved for detection of Shiga toxin. Further, it is recommended that Shiga toxin detection be done by testing overnight enrichment broth cultures of stools rather than directly examining stools for this toxin. This recommendation was made approximately 18 months ago. We have asked Mario Marcon of Nationwide's Children Hospital in Columbus, OH, to explain the rationale for his decision to follow this recommendation, while we have asked Deanna Kiska and Scott Riddell of Upstate University Hospital in Syracuse, NY, why these guidelines have not been adopted by their laboratory.

Citing Articles

Clinical Evaluation and Cost Analysis of Great Basin Shiga Toxin Direct Molecular Assay for Detection of Shiga Toxin-Producing Escherichia coli in Diarrheal Stool Specimens.

Faron M, Ledeboer N, Connolly J, Granato P, Alkins B, Bard J J Clin Microbiol. 2016; 55(2):519-525.

PMID: 27927919 PMC: 5277522. DOI: 10.1128/JCM.01939-16.

Estimating true incidence of O157 and non-O157 Shiga toxin-producing Escherichia coli illness in Germany based on notification data of haemolytic uraemic syndrome.

Kuehne A, Bouwknegt M, Havelaar A, Gilsdorf A, Hoyer P, Stark K Epidemiol Infect. 2016; 144(15):3305-3315.

PMID: 27468812 PMC: 9150202. DOI: 10.1017/S0950268816001436.

Recent advances in understanding enteric pathogenic Escherichia coli.

Croxen M, Law R, Scholz R, Keeney K, Wlodarska M, Finlay B Clin Microbiol Rev. 2013; 26(4):822-80.

PMID: 24092857 PMC: 3811233. DOI: 10.1128/CMR.00022-13.

Clinical evaluation of a real-time PCR assay for identification of Salmonella, Shigella, Campylobacter (Campylobacter jejuni and C. coli), and shiga toxin-producing Escherichia coli isolates in stool specimens.

Buchan B, Olson W, Pezewski M, Marcon M, Novicki T, Uphoff T J Clin Microbiol. 2013; 51(12):4001-7.

PMID: 24048539 PMC: 3838069. DOI: 10.1128/JCM.02056-13.

Incidence and virulence determinants of verocytotoxin-producing Escherichia coli infections in the Brussels-Capital Region, Belgium, in 2008-2010.

Buvens G, De Gheldre Y, Dediste A, de Moreau A, Mascart G, Simon A J Clin Microbiol. 2012; 50(4):1336-45.

PMID: 22238434 PMC: 3318570. DOI: 10.1128/JCM.05317-11.

References

Lathrop S, Edge K, Bareta J . Shiga toxin-producing Escherichia coli, New Mexico, USA, 2004-2007. Emerg Infect Dis. 2009; 15(8):1289-91. PMC: 2815966. DOI: 10.3201/eid1508.081616. View

Voetsch A, Angulo F, Rabatsky-Ehr T, Shallow S, Cassidy M, Thomas S . Laboratory practices for stool-specimen culture for bacterial pathogens, including Escherichia coli O157:H7, in the FoodNet sites, 1995-2000. Clin Infect Dis. 2004; 38 Suppl 3:S190-7. DOI: 10.1086/381586. View

Park C, Kim H, Hixon D . Importance of testing stool specimens for Shiga toxins. J Clin Microbiol. 2002; 40(9):3542-3. PMC: 130793. DOI: 10.1128/JCM.40.9.3542-3543.2002. View

Paton J, Paton A . Pathogenesis and diagnosis of Shiga toxin-producing Escherichia coli infections. Clin Microbiol Rev. 1998; 11(3):450-79. PMC: 88891. DOI: 10.1128/CMR.11.3.450. View

. Importance of culture confirmation of shiga toxin-producing Escherichia coli infection as illustrated by outbreaks of gastroenteritis--New York and North Carolina, 2005. MMWR Morb Mortal Wkly Rep. 2006; 55(38):1042-5. View

Gould L, Bopp C, Strockbine N, Atkinson R, Baselski V, Body B . Recommendations for diagnosis of shiga toxin--producing Escherichia coli infections by clinical laboratories. MMWR Recomm Rep. 2009; 58(RR-12):1-14. View

Gavin P, Peterson L, Pasquariello A, Blackburn J, Hamming M, Kuo K . Evaluation of performance and potential clinical impact of ProSpecT Shiga toxin Escherichia coli microplate assay for detection of Shiga Toxin-producing E. coli in stool samples. J Clin Microbiol. 2004; 42(4):1652-6. PMC: 387566. DOI: 10.1128/JCM.42.4.1652-1656.2004. View

Panos G, Betsi G, Falagas M . Systematic review: are antibiotics detrimental or beneficial for the treatment of patients with Escherichia coli O157:H7 infection?. Aliment Pharmacol Ther. 2006; 24(5):731-42. DOI: 10.1111/j.1365-2036.2006.03036.x. View

. University outbreak of calicivirus infection mistakenly attributed to Shiga toxin-producing Escherichia coli O157:H7--Virginia, 2000. MMWR Morb Mortal Wkly Rep. 2001; 50(23):489-91. View

10.

. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food - 10 states, 2009. MMWR Morb Mortal Wkly Rep. 2010; 59(14):418-22. View

11.

Martin D, MacDonald K, White K, Soler J, Osterholm M . The epidemiology and clinical aspects of the hemolytic uremic syndrome in Minnesota. N Engl J Med. 1990; 323(17):1161-7. DOI: 10.1056/NEJM199010253231703. View

12.

Tarr P, Gordon C, Chandler W . Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet. 2005; 365(9464):1073-86. DOI: 10.1016/S0140-6736(05)71144-2. View

13.

Parry S, Palmer S . The public health significance of VTEC O157. Symp Ser Soc Appl Microbiol. 2000; (29):1S-9S. DOI: 10.1111/j.1365-2672.2000.tb05326.x. View

14.

Ake J, Jelacic S, Ciol M, Watkins S, Murray K, Christie D . Relative nephroprotection during Escherichia coli O157:H7 infections: association with intravenous volume expansion. Pediatrics. 2005; 115(6):e673-80. DOI: 10.1542/peds.2004-2236. View

15.

. Laboratory-confirmed non-O157 Shiga toxin-producing Escherichia coli--Connecticut, 2000-2005. MMWR Morb Mortal Wkly Rep. 2007; 56(2):29-31. View

16.

Cohen M . Shiga toxin-producing E coli: two tests are better than one. J Pediatr. 2002; 141(2):155-6. DOI: 10.1067/mpd.2002.126920. View

17.

Pollock K, Stewart A, Beattie T, Andrew Todd W, Ahn C, Tarr P . From diarrhoea to haemolytic uraemic syndrome - when to seek advice. J Med Microbiol. 2009; 58(Pt 4):397-398. DOI: 10.1099/jmm.0.007179-0. View

18.

Brooks J, Sowers E, Wells J, Greene K, Griffin P, Hoekstra R . Non-O157 Shiga toxin-producing Escherichia coli infections in the United States, 1983-2002. J Infect Dis. 2005; 192(8):1422-9. DOI: 10.1086/466536. View

19.

Johnson K, Thorpe C, Sears C . The emerging clinical importance of non-O157 Shiga toxin-producing Escherichia coli. Clin Infect Dis. 2006; 43(12):1587-95. DOI: 10.1086/509573. View

20.

Safdar N, Said A, Gangnon R, Maki D . Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis: a meta-analysis. JAMA. 2002; 288(8):996-1001. DOI: 10.1001/jama.288.8.996. View