Prevalence, characterisation and clinical profiles of Shiga toxin-producing Escherichia coli in The Netherlands.
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.
van Duynhoven
Y T H P
YT
Centre for Infectious Disease Control Netherlands, National Institute of Public Health and the Environment RIVM, Bilthoven, The Netherlands. y.van.duynhoven@rivm.nl
Friesema
I H M
IH
Schuurman
T
T
Roovers
A
A
van Zwet
A A
AA
Sabbe
L J M
LJ
van der Zwaluw
W K
WK
Notermans
D W
DW
Mulder
B
B
van Hannen
E J
EJ
Heilmann
F G C
FG
Buiting
A
A
Jansen
R
R
Kooistra-Smid
A M D
AM
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