title: Prevalence, characterisation and clinical profiles of Shiga toxin-producing Escherichia coli in The Netherlands.
abstract: Detection of Shiga toxin-producing Escherichia coli (STEC) in The Netherlands is traditionally limited to serogroup O157. To assess the relative importance of STEC, including non-O157 serogroups, stool samples submitted nationwide for investigation of enteric pathogens or diarrhoea were screened with real-time PCR for the presence of the Shiga toxin genes. Patients were selected if their stool contained blood upon macroscopic examination, if they had a history of bloody diarrhoea, were diagnosed with haemolytic uraemic syndrome, or were aged <6 years (irrespective of the bloody aspect of the stool). PCR-positive stools were forwarded to a central laboratory for STEC isolation and typing. In total, 4069 stools were examined, with 68 (1.7%) positive PCR results. The highest prevalence was for stools containing macroscopic blood (3.5%), followed by stools from patients with a history of bloody diarrhoea (2.4%). Among young children, the prevalence (1.0%) was not significantly higher than among random, non-bloody, stool samples from diarrhoeal patients (1.4%). STEC strains were isolated from 25 (38%) PCR-positive stools. Eleven O-serogroups were detected, including five STEC O157 strains. As serogroup O157 represented only 20% of the STEC isolates, laboratories should be encouraged to use techniques enabling them to detect non-O157 serogroups, in parallel with culture, for isolation and subsequent characterisation of STEC strains for public health surveillance and detection of outbreaks.
authors.affiliation: Centre for Infectious Disease Control Netherlands, National Institute of Public Health and the Environment RIVM, Bilthoven, The Netherlands. y.van.duynhoven@rivm.nl
authors.forename: Y T H P
authors.initials: YT
authors.lastname: van Duynhoven
authors.forename: I H M
authors.initials: IH
authors.lastname: Friesema
authors.forename: T
authors.initials: T
authors.lastname: Schuurman
authors.forename: A
authors.initials: A
authors.lastname: Roovers
authors.forename: A A
authors.initials: AA
authors.lastname: van Zwet
authors.forename: L J M
authors.initials: LJ
authors.lastname: Sabbe
authors.forename: W K
authors.initials: WK
authors.lastname: van der Zwaluw
authors.forename: D W
authors.initials: DW
authors.lastname: Notermans
authors.forename: B
authors.initials: B
authors.lastname: Mulder
authors.forename: E J
authors.initials: EJ
authors.lastname: van Hannen
authors.forename: F G C
authors.initials: FG
authors.lastname: Heilmann
authors.forename: A
authors.initials: A
authors.lastname: Buiting
authors.forename: R
authors.initials: R
authors.lastname: Jansen
authors.forename: A M D
authors.initials: AM
authors.lastname: Kooistra-Smid
mesh_terms: D002675:Child, Preschool; D003967:Diarrhea / Q000382:microbiology; D004927:Escherichia coli Infections / Q000453:epidemiology*; D019453:Escherichia coli O157 / Q000145:classification* / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D006801:Humans; D007223:Infant; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence