Escherichia coli O157: H7 Diarrhea in the United States: Clinical and Epidemiologic Features
| Autor: | Patricia M. Griffin, Laurence Slutsker, Lori Hutwagner, Joy G. Wells, Katherine D. Greene, Allen A. Ries |
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| Rok vydání: | 1997 |
| Předmět: |
Diarrhea
Salmonella Escherichia coli O157 medicine.disease_cause Microbiology Feces Leukocyte Count Campylobacter Infections Prevalence Internal Medicine medicine Humans Mass Screening Shigella Child Escherichia coli Escherichia coli Infections Dysentery Bacillary business.industry Campylobacter General Medicine Middle Aged United States Geographic distribution Logistic Models Bacterial diarrhea Salmonella Infections Bloody diarrhea medicine.symptom business |
| Zdroj: | Annals of Internal Medicine. 126:505 |
| ISSN: | 0003-4819 |
| Popis: | Escherichia coli O157:H7 is increasingly recognized as a cause of bacterial diarrhea in the United States, but the frequency of its isolation and the clinical and epidemiologic features of E. coli O157:H7 infection in a large, geographically diverse population of patients have not been well described.To determine the frequency of isolation of E. coli O157:H7 relative to that of other bacterial enteric pathogens in a nationwide sample of patients and to identify the clinical and epidemiologic features of E. coli O157:H7 infection.Population prevalence study from October 1990 to October 1992.10 U.S. hospitals.Both inpatients and outpatients who had stool samples submitted to 1 of 10 laboratories for routine pathogen identification.Clinical, epidemiologic, and laboratory information was collected for infected and uninfected patients. Isolates of E. coli O157:H7 were tested for production of Shiga toxin. Patient charts were then reviewed.Escherichia coli O157:H7 was isolated from 118 (0.39%) of the 30463 fecal specimens tested. The proportion of fecal specimens with isolates was higher at northern sites (0.57%) than at southern sites (0.13%) (P0.001). Escherichia coli O157:H7 was more likely to be isolated from visibly bloody stool specimens than from specimens without visible blood (odds ratio [OR], 59.2 [95% CI, 36.6 to 96.0) and was the pathogen most commonly isolated from visibly bloody stool specimens that yielded a bacterial enteric pathogen (39% of such specimens). The highest age-specific isolation proportions from fecal specimens for E. coli O157:H7 were in patients 5 to 9 years of age (0.90%) and 50 to 59 years of age (0.89%). Clinical features independently associated with E. coli O157:H7 infection compared with the other enteric pathogens included a history of bloody diarrhea (OR, 18.6 [CI, 7.4 to 48.6]), visibly bloody stool specimens (OR, 8.1 [CI, 3.6 to 18.3]), no reported fever (OR, 8.3 [CI, 1.6 to 50.0]), leukocyte count greater than 10 x 10(9)/L (OR, 4.0 [CI, 1.7 to 9.5]), and abdominal tenderness on physical examination (OR, 2.9 [CI, 1.2 to 7.2]).In some geographic areas and some age groups, isolation proportions from fecal specimens for E. coli O157:H7 surpassed those of other common enteric pathogens. One third of isolates of this organism came from nonbloody specimens. Because person-to-person transmission of E. coli O157:H7 is not uncommon and infection with this organism may cause severe disease, stool specimens from all patients with a history of acute bloody diarrhea should be cultured for E. coli O157:H7. |
| Databáze: | OpenAIRE |
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