A longitudinal study of Vero cytotoxin producing Escherichia coli in cattle calves in Sri Lanka.

Two cohorts of 10 and 16 calves were followed at weekly or fortnightly intervals from 4-28 and 1-9 weeks respectively to determine whether natural infection by Vero cytotoxin (VT) producing Escherichia coli (VTEC) occurred. Ninety-one of 171 (53%) faecal specimens were VTEC positive and 20-80% of animals at any given time excreted VTEC. Of 104 VTEC strains studied further, 6 different serogroups (O 22.H16; O 25.H5; O 49.H-; O 86.H26; O 88.H25; O 153.H12) and an untypable strain (O? .H21) were identified. All strains belonging to the same serotype had identical profiles of reactivity with DNA probes to toxins VT1 or 2, LTI or II and a probe (CVD419) derived from a plasmid carried by enterohaemorrhagic Escherichia coli O 157.H7. Four of these serotypes were found in the faecal flora of the calves, taken as a group, throughout the 4-month study period. Sixty percent of the strains hybridized with the probe for VT1, 4% with the probe for VT2, and 36% with both probes. Faecal VTEC were significantly associated with overt diarrhoeal illness in animals < 10 weeks of age, but no characteristic profile of markers (serotype or hybridization pattern) in E. coli isolates was associated with diarrhoea. A serological response to VT1 was detected in some animals, but faecal VT1 VTEC excretion persisted in spite of seroconversion. VT1 seroconversion was not associated with diarrhoea. A serological response to VT2 was not detected even in those animals excreting VT2 VTEC in the faeces.     

Transmission of Vero cytotoxin producing Escherichia coli O157 infection from farm animals to humans in Cornwall and west Devon

A study of Vero cytotoxin producing Escherichia coli (VTEC) O157 infections in Cornwall and West Devon was conducted to identify associations between human infection and contact with farm animals. In three years from November 1994 to October 1997, 63,000 stool specimens were submitted to four participating microbiology laboratories and screened for E. coli O157. Sixty-nine confirmed cases were interviewed to assess the extent of any direct or indirect contact with farm animals. Nine out of 22 investigations conducted on farms--in which animal rectal swabs, faecal specimens, fore-stream milk samples (first draw-off from teats), and various environmental samples were tested--yielded VTEC O157. In seven incidents one or more isolates from animals were indistinguishable from the isolate(s) from the human case(s) using phenotypic and genotypic subtyping. Cases associated with animal contact included farm visitors, holidaymakers, and members of farming families and farm workers.     

Guidelines for the control of infection with Vero cytotoxin producing Escherichia coli (VTEC). Subcommittee of the PHLS Advisory Committee on Gastrointestinal Infections

Increasing numbers of cases of Vero cytotoxin producing Escherichia coli (VTEC) O157 infection, well published incidents, and new scientific evidence make it appropriate to produce new guidelines for their control. This document reviews the clinical and epidemiological features of VTEC O157 infection, describes the principles of microbiological investigation and laboratory safety, and presents recommendations for the prevention of spread of VTEC) O157. The recommendations consider direct spread of infection from animals, foodborne spread, the institutions in which spread is more likely to occur (nursing homes, schools, and children's day nurseries), and groups at particular risk of acquiring and transmitting infection (in essence, food handlers, and those unable to maintain high standards of hygiene for themselves and their carers).     

Risk factors for sporadic Shiga toxin-producing Escherichia coli infections in children, Argentina

We evaluated risk factors for sporadic Shiga toxin-producing Escherichia coli (STEC) infection among children in Argentina. We conducted a prospective case-control study in 2 sites and enrolled 150 case-patients and 299 controls. The median age of case-patients was 1.8 years; 58% were girls. Serotype O157:H7 was the most commonly isolated STEC. Exposures associated with infection included eating undercooked beef, living in or visiting a place with farm animals, and contact with a child <5 years of age with diarrhea. Protective factors included the respondent reporting that he or she always washed hands after handling raw beef and the child eating more than the median number of fruits and vegetables. Many STEC infections in children could be prevented by avoiding consumption of undercooked beef, limiting exposure to farm animals and their environment, not being exposed to children with diarrhea, and washing hands after handling raw beef.     

Verotoxin producing Escherichia coli O 157 infections associated with the consumption of yoghurt.

Sixteen cases of verotoxin producing Escherichia coli (VTEC) O 157:H7 Phage Type 49 infection were identified in the North West of England from 1 September to 1 November 1991, eight of whom lived in or around the same large town. Eleven of the cases were aged 10 years or less, and five of the affected children developed haemolytic uraemic syndrome. A case control study demonstrated a strong association between VTEC O 157:H7 PT 49 infection and the consumption of a locally produced live yoghurt. This is the first time that an outbreak of VTEC O 157 infection has been linked to the consumption of yoghurt and this vehicle of infection should be considered when investigating such outbreaks in future.     

Transmission pathways for sporadic Shiga-toxin producing E. coli infections: A systematic review and meta-analysis

Background

Shiga-toxin E. coli infections remain a public health concern because of the severity of the gastrointestinal illness and associated complications. Transmission pathways are typically elucidated from outbreaks, with foodborne transmission the primary source. However, most STEC cases are sporadic. This systematic review aimed to identify the most common pathways for sporadic STEC transmission and quantify their importance.

老年患者医院感染产超广谱β-内酰胺酶大肠埃希菌的检测与耐药性研究

目的了解老年患者医院感染产超广谱β-内酰胺酶(ESBLs)大肠埃希菌(ESBLs-ECO)的检出和耐药性,为临床合理用药提供依据。方法 2011年7月-2013年12月临床分离的423株ECO采用AST-GN13药敏卡检测耐药性。结果产ESBLs-ECO 238株检出率为56.3%;主要分离自尿液标本,占33.2%,其余依次为痰液占20.6%、血液占13.4%、引流液占8.8%、胆汁占7.6%、胸腔积液占6.3%和分泌物占4.6%;ICU分离出的产ESBLs-ECO最高,占25.6%,其余依次为急诊科占16.4%、肿瘤科占13.4%、普外科占11.3%、呼吸内科占9.2%、神经外科占7.6%、消化内科占3.8%和神经内科占2.9%;产ESBLs-ECO对哌拉西林、头孢唑林、头孢孟多、头孢西丁、头孢曲松、头孢他啶、头孢塞肟、头孢哌酮、氨曲南、环丙沙星和氧氟沙星的耐药率均明显高于非ESBLs-ECO,差异有统计学意义(P<0.05);而对阿米卡星和亚胺培南耐药率差异无统计学意义;产ESBLs-ECO对哌拉西林、头孢唑林、头孢孟多、头孢曲松、头孢塞肟、头孢哌酮耐药率较高,均达80.0%以上;对头孢西丁、头孢他啶、阿米卡星和亚胺培南耐药率较低,均在20.0%以下。结论产ESBLs-ECO主要分离自尿液标本,科室以ICU为主,耐药严重,临床应合理用药,控制耐药菌株的出现及传播。     

Spatial and temporal epidemiology of sporadic human cases of Escherichia coli O157 in Scotland, 1996-1999

In Scotland, between 1995 and 2000 there were between 4 and 10 cases of illness per 100000 population per year identified as being caused by Escherichia coli O157, whereas in England and Wales there were between 1 and 2 cases per 100000 population per year. Within Scotland there is significant regional variation. A cluster of high rate areas was identified in the Northeast of Scotland and a cluster of low rate areas in central-west Scotland. Temporal trends follow a seasonal pattern whilst spatial effects appeared to be distant rather than local. The best-fit model identified a significant spatial trend with case rate increasing from West to East, and from South to North. No statistically significant spatial interaction term was found. In the models fitted, the cattle population density, the human population density, and the number of cattle per person were variously significant. The findings suggest that rural/urban exposures are important in sporadic infections.     

Continuous surveillance of Shiga toxin-producing Escherichia coli infections by pulsed-field gel electrophoresis shows that most infections are sporadic

The purpose of this study was to evaluate the value of real-time molecular typing of Shiga toxin (Verocytotoxin)-producing Escherichia coli (STEC) infections in order to detect possible outbreaks of infections. All laboratory confirmed STEC infections in Denmark from 2003 to mid 2005 were routinely characterized by serotyping, virulence genes characterization, and subtyping by pulsed-field gel electrophoresis (PFGE) using the PulseNet protocol for STEC O157. The study included 312 STEC isolates representing 50 different O groups and 75 O:H-serotypes, and 68% of the isolates belonged to the eight most common O-groups: O157 (26%), O103 (13%), O146 (8%), O26 (8%), O117 (4%), O145 (3%), O128 (3%), and O111 (2%). The remaining O-groups constituted less than 2% each, and 8.1% of the isolates were O-rough. The eae gene was found in 60% of all isolates, and detection of the two main Shiga toxin genes showed that 40% had stx1 only, 31% had stx2 only, and 29% had both stx1 and stx2. A high diversity was seen within all O groups, and for most of the rare O groups, the number of PFGE profiles equaled the number of isolates. However, one outbreak of E. coli O157 was detected by the routine PFGE typing. The value of "real-time' PFGE typing of the infrequent serotypes is limited if the full scheme for O-grouping or O:H-serotyping is used routinely for all STEC isolates. Possible outbreaks can then be detected by the increased number of isolates within a particular serotype. PFGE typing would then be valuable in subsequent steps of the outbreak investigation. However, routine PFGE typing of the three to five most common O groups will enable early recognition of possible outbreaks.     

Contact with farming environment as a major risk factor for Shiga toxin (Vero cytotoxin)-producing Escherichia coli O157 infection in humans.

In a prospective, unmatched case-control study of sporadic Shiga toxin (Vero cytotoxin)-producing Escherichia coli O157 (STEC O157) infection in England, exposure to the farming environment emerged strongly as a risk factor (adjusted odds ratio = 2.45; 95% confidence intervals = 1.49-4.02; p=0.0004) posing further challenges and opportunities for prevention.     

抗菌药物对肝硬化患者感染产超广谱β-内酰胺酶大肠埃希菌的治疗分析

目的分析抗菌药物对肝硬化患者感染产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的疗效。方法选择2006-2013年收治的3 600例肝硬化患者临床资料,对其抗感染治疗疗效进行回顾性分析。结果 3 600例患者发生感染803例,感染率为22.30%,其中产ESBLs大肠埃希菌感染100例,感染率为12.45%;首用喹诺酮类抗菌药物和肝硬化分级ChildpughA在死亡组和生存组感染患者之间差异有统计学意义(P<0.05);在抗感染中,有效与无效的单因素分析显示肝硬化分级Child-pugh C与菌血症差异有统计学意义(P<0.05);而上消化道出血和肝性脑病在生存和死亡组间差异无统计学意义。结论肝硬化患者产ESBLs大肠埃希菌感染使用抗菌药物的疗效较低,其中喹诺酮类药物比三代头孢更适合作为一线用药,抗感染并积极进行保肝治疗,同时及时提供细菌鉴定以及药敏报告,为临床靶向治疗提供重要依据。     

Vero cytotoxin-producing Escherichia coli, particularly serogroup O157, associated with human infections in England and Wales: 1992-4.

Investigations were performed by the Laboratory of Enteric Pathogens on Vero cytotoxin-producing Escherichia coli (VTEC) in England and Wales from 1992-4. Bacterial isolates, faeces and sera obtained from patients with diarrhoea, bloody diarrhoea and haemolytic uraemic syndrome were examined. Using serotyping, Vero cytotoxin gene probing and serodiagnostic tests for E. coli O157, evidence of infection was detected in 543, 434 and 491 individuals in 1992, 1993 and 1994 respectively; VTEC of serogroup O157 were isolated from 470, 385 and 411 cases. The O157 VTEC strains belonged to at least 19 different phage types (PT) although 84% belonged to PT2, PT49, PT8, PT1 or PT4. Antibodies to E. coli O157 lipopolysaccharide were detected in 13% of the cases. The average annual rate of infection with O157 VTEC was 0.83/100000 and 12% of the 1458 individuals with evidence of infection with VTEC or E. coli O157 developed haemolytic uraemic syndrome. There were at least 18 general outbreaks and many family outbreaks.     

医院感染产ESBLs大肠埃希菌危险因素分析

目的分析某三级甲等医院产超广谱β-内酰胺酶(ESBLs)大肠埃希菌医院感染的现状及危险因素,为预防和控制该菌的医院感染提供参考依据。方法回顾性研究2013年1月1日-2015年12月31日检出大肠埃希菌病例848例,分析产ESBLs大肠埃希菌感染因素,采用单因素及多因素logistic回归分析。结果共调查848例检出大肠埃希菌医院感染病例,其中527例为产ESBLs大肠埃希菌感染,感染率为62.15%;多因素logistic回归分析结果显示:使用第三代头孢菌素、尿管插管、抗菌药物联用、年龄及住院天数是其感染的危险因素(P<0.05);趋势χ~2分析发现随着年龄的增大,发生产ESBLs的大肠埃希菌医院感染的风险高。结论加强重点人群监测,合理使用抗菌药物,有利于预防和控制该菌的医院感染。     

Risk factors for sporadic Shiga toxin-producing Escherichia coli O157 infections in FoodNet sites, 1999-2000

To monitor risk factors for illness, we conducted a case-control study of sporadic Shiga toxin-producing Escherichia coli O157 (STEC O157) infections in 1999-2000. Laboratory-confirmed cases of STEC O157 infection were identified through active laboratory surveillance in all or part of seven states. Patients and age-matched controls were interviewed by telephone using a standard questionnaire. Information was collected on demographics, clinical illness, and exposures to food, water, and animals in the 7 days before the patient's illness onset. During the 12-month study, 283 patients and 534 controls were enrolled. STEC O157 infection was associated with eating pink hamburgers, drinking untreated surface water, and contact with cattle. Eating produce was inversely associated with infection. Direct or indirect contact with cattle waste continues to be a leading identified source of sporadic STEC O157 infections.     

产超广谱β-内酰胺酶大肠埃希菌β-内酰胺酶基因研究

目的检测20株产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的β-内酰胺酶基因,以便了解该20株产ESBLs大肠埃希菌β-内酰胺酶基因亚型携带存在状况。方法收集医院2013年分离到的20株产ESBLs大肠埃希菌,采用聚合酶链反应(PCR)方法分析16种A类β-内酰胺酶基因、6种C类β-内酰胺酶基因、3种D类β-内酰胺酶基因。结果 20株产ESBLs大肠埃希菌对头孢呋辛、头孢噻肟、头孢吡肟的耐药率均为100.0%;共检出4种A类β-内酰胺酶基因,其中检出blaTEM16株、blaSHV1株、blaCTX-M-1 cluster 3株、blaCTX-M-9 cluster 14株,检出率分别为80.0%、5.0%、15.0%、70.0%,C类β-内酰胺酶基因检出blaDHA2株,检出率为10.0%,D类β-内酰胺酶基因检出blaOXA-1 cluster 3株,检出率为15.0%;20株产ESBLs大肠埃希菌每一株均有β-内酰胺酶基因检出,少者检出1种,多者同时检出2⁴种,且该组菌株blaCTX-M总检出率85.0%。结论产β-内酰胺酶基因是该组大肠埃希菌对β-酰胺类抗菌药物产生耐药的重要原因。     

Vero cytotoxin-producing Escherichia coli, particularly serogroup O 157, associated with human infections in the United Kingdom: 1989-91.

This survey reports the results of investigations performed by the Laboratory of Enteric Pathogens (LEP), to identify evidence of human infection with Vero cytotoxin-producing Escherichia coli (VTEC) in the UK during the period 1989-91. Bacterial isolates, faecal specimens and serum samples were received from patients suffering from diarrhoea, bloody diarrhoea and haemolytic uraemic syndrome. Using serotyping, Vero cytotoxin gene probing and an ELISA for serum antibodies to E. coli O 157, evidence of infection was detected in 232, 428 and 615 individuals in 1989, 1990 and 1991 respectively. Of these individuals, 15% were reported as having HUS. Vero cytotoxin-producing E. coli O 157 was the most frequently encountered serogroup, with isolations from a total of 1092 individuals over the 3-year period. The incidence of VTEC infection increased from 0.41/100,000 in 1989 to 1.07/100,000 in 1991. The area with the highest rate of infection in each year was Scotland, increasing from 1.37/100,000 in 1989 to 3.97/100,000 in 1991.     

泌尿外科泌尿系感染大肠埃希菌耐药性临床调查分析

目的 了解医院泌尿外科泌尿道感染的主要病原菌及其耐药性,以指导临床合理用药.方法 回顾性调查2011年1-12月所有门诊与住院泌尿外科泌尿道感染病原学检测患者,对调查结果进行统计分析.结果 2011年.1-12月中段尿标本共培养分离109株病原菌,以大肠埃希菌为主,62株占56.9％;62株大肠埃希菌中产ESBLs菌株为24株占38.7％、非产ESBLs菌株为38株占61.3％;产与非产ESBLs大肠埃希菌对氨苄西林、庆大霉素、左氧氟沙星、磺胺甲噁唑/甲氧苄啶、妥布霉素、环丙沙星的耐药率均≥50.0％.结论 根据泌尿系感染的病原菌分布及耐药性,有针对性地选择用药,规范抗菌药物合理使用,降低泌尿道感染的发生.