title: Recommendations for diagnosis of shiga toxin--producing Escherichia coli infections by clinical laboratories.
abstract: Shiga toxin--producing Escherichia coli (STEC) are a leading cause of bacterial enteric infections in the United States. Prompt, accurate diagnosis of STEC infection is important because appropriate treatment early in the course of infection might decrease the risk for serious complications such as renal damage and improve overall patient outcome. In addition, prompt laboratory identification of STEC strains is essential for detecting new and emerging serotypes, for effective and timely outbreak responses and control measures, and for monitoring trends in disease epidemiology. Guidelines for laboratory identification of STEC infections by clinical laboratories were published in 2006. This report provides comprehensive and detailed recommendations for STEC testing by clinical laboratories, including the recommendation that all stools submitted for routine testing from patients with acute community-acquired diarrhea (regardless of patient age, season of the year, or presence or absence of blood in the stool) be simultaneously cultured for E. coli O157:H7 (O157 STEC) and tested with an assay that detects Shiga toxins to detect non-O157 STEC. The report also includes detailed procedures for specimen selection, handling, and transport; a review of culture and nonculture tests for STEC detection; and clinical considerations and recommendations for management of patients with STEC infection. Improving the diagnostic accuracy of STEC infection by clinical laboratories should ensure prompt diagnosis and treatment of these infections in patients and increase detection of STEC outbreaks in the community.
authors.affiliation: Division of Foodborne, Bacterial, and Mycotic Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, CDC, Atlanta, Georgia 30333, USA. lgould@cdc.gov
authors.forename: L Hannah
authors.initials: LH
authors.lastname: Gould
authors.forename: Cheryl
authors.initials: C
authors.lastname: Bopp
authors.forename: Nancy
authors.initials: N
authors.lastname: Strockbine
authors.forename: Robyn
authors.initials: R
authors.lastname: Atkinson
authors.forename: Vickie
authors.initials: V
authors.lastname: Baselski
authors.forename: Barbara
authors.initials: B
authors.lastname: Body
authors.forename: Roberta
authors.initials: R
authors.lastname: Carey
authors.forename: Claudia
authors.initials: C
authors.lastname: Crandall
authors.forename: Sharon
authors.initials: S
authors.lastname: Hurd
authors.forename: Ray
authors.initials: R
authors.lastname: Kaplan
authors.forename: Marguerite
authors.initials: M
authors.lastname: Neill
authors.forename: Shari
authors.initials: S
authors.lastname: Shea
authors.forename: Patricia
authors.initials: P
authors.lastname: Somsel
authors.forename: Melissa
authors.initials: M
authors.lastname: Tobin-D'Angelo
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Griffin
authors.forename: Peter
authors.initials: P
authors.lastname: Gerner-Smidt
mesh_terms: D001431:Bacteriological Techniques; D004196:Disease Outbreaks; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000453:epidemiology; D019453:Escherichia coli O157 / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D005243:Feces / Q000382:microbiology; D005506:Food Contamination; D006463:Hemolytic-Uremic Syndrome / Q000382:microbiology; D006801:Humans; D007118:Immunoassay / Q000379:methods; D007753:Laboratories; D016133:Polymerase Chain Reaction; D022603:Shiga Toxins / Q000032:analysis / Q000235:genetics; D054323:Shiga-Toxigenic Escherichia coli / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D013048:Specimen Handling; D014481:United States / Q000453:epidemiology
chemical_list: D022603:Shiga Toxins