Shiga toxin-producing Escherichia coli in children with diarrhea: a prospective point-of-care study.
OBJECTIVE
To conduct a prospective cohort study to determine the frequency and characteristics of Shiga toxin (Stx)-producing Escherichia coli (STEC) infections in children with diarrhea attending an emergency department and a private clinic in Seattle, Washington.


METHODS
Between November 1998 and October 2001, 1851 stools were processed for STEC by sorbitol-MacConkey (SMAC) agar screening and a commercial Stx enzyme immunoassay (EIA).


RESULTS
STEC belonging to serotypes O157:H7 (n = 28), O103:H2 (n = 4), O118:H16 (n = 2), O26:H11, O111:nonmotile, O111:H8, O121:H19, and O rough:H11 (n = 1 each) were recovered from 39 (2.1%) stools. EIA and SMAC agar detected 89% and 100% of the patients with E coli O157:H7, respectively. E coli O157:H7-infected patients had significantly higher frequencies of bloody stools, fecal leukocytes, and abdominal tenderness and shorter symptom duration. Hemolytic uremic syndrome developed in 5 (18%) and none of the children infected with E coli O157:H7 and non-O157:H7 STEC, respectively (P =.30).


CONCLUSIONS
E coli O157:H7 is the predominant STEC in this population. Children infected with E coli O157:H7 have clinical presentations different from those whose stools contain non-O157:H7 STEC. Culture and Stx detection are needed to optimally detect STEC of all serotypes in stools. SMAC agar screening should not be replaced by EIA.
Klein
Eileen J
EJ
Department of Pediatrics, University of Washington and Children's Hospital and Regional Medical Center, Seattle, Washington, 98105, USA.
Stapp
Jennifer R
JR
Clausen
Carla R
CR
Boster
Daniel R
DR
Wells
Joy G
JG
Qin
Xuan
X
Swerdlow
David L
DL
Tarr
Phillip I
PI
D000293:Adolescent; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D015331:Cohort Studies; D003967:Diarrhea / Q000382:microbiology* / Q000628:therapy; D004636:Emergency Service, Hospital; D004926:Escherichia coli / Q000145:classification / Q000302:isolation & purification / Q000378:metabolism; D004927:Escherichia coli Infections / Q000382:microbiology / Q000628:therapy; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D008297:Male; D019095:Point-of-Care Systems; D011446:Prospective Studies; D022621:Shiga Toxin / Q000009:adverse effects* / Q000096:biosynthesis*; D013223:Statistics as Topic; D014861:Washington
D022621:Shiga Toxin