title: Laboratory practices for the identification of Shiga toxin-producing Escherichia coli in the United States, FoodNet sites, 2007.
abstract: Clinical laboratory practices affect patient care and disease surveillance. It is recommended that laboratories routinely use both culture for Escherichia coli O157 and a method that detects Shiga toxins (Stx) to identify all Stx-producing E. coli (STEC) and that labs send broths or isolates to a public health laboratory. In 2007, we surveyed laboratories serving Foodborne Diseases Active Surveillance Network sites that performed on-site enteric disease diagnostic testing to determine their culture and nonculture-based testing practices for STEC identification. Our goals were to measure changes over time in laboratory practices and to compare reported practices with published recommendations. Overall, 89% of laboratories used only culture-based methods, 7% used only Stx enzyme immunoassay (EIA), and 4% used both Stx EIA and culture-based methods. Only 2% of laboratories reported simultaneous culture for O157 STEC and use of Stx EIA. The proportion that ever used Stx EIA increased from 6% in 2003 to 11% in 2007. The proportion that routinely tested all specimens with at least one method was 66% in 2003 versus 71% in 2007. Reference laboratories were less likely than others to test all specimens routinely by one or more of these methods (48% vs. 73%, p=0.03). As of 2007, most laboratories complied with recommendations for O157 STEC testing by culture but not with recommendations for detection of non-O157 STEC. The proportion of laboratories that culture stools for O157 STEC has changed little since 2003, whereas testing for Stx has increased.
authors.affiliation: New York State Department of Health, Bureau of Communicable Disease Control, Albany, New York 12237, USA. dxh13@health.state.ny.us
authors.forename: Dina
authors.initials: D
authors.lastname: Hoefer
authors.forename: Sharon
authors.initials: S
authors.lastname: Hurd
authors.forename: Carlota
authors.initials: C
authors.lastname: Medus
authors.forename: Alicia
authors.initials: A
authors.lastname: Cronquist
authors.forename: Samir
authors.initials: S
authors.lastname: Hanna
authors.forename: Julie
authors.initials: J
authors.lastname: Hatch
authors.forename: Tameka
authors.initials: T
authors.lastname: Hayes
authors.forename: Kirsten
authors.initials: K
authors.lastname: Larson
authors.forename: Cyndy
authors.initials: C
authors.lastname: Nicholson
authors.forename: Katie
authors.initials: K
authors.lastname: Wymore
authors.forename: Melissa
authors.initials: M
authors.lastname: Tobin-D'Angelo
authors.forename: Nancy
authors.initials: N
authors.lastname: Strockbine
authors.forename: Paula
authors.initials: P
authors.lastname: Snippes
authors.forename: Robyn
authors.initials: R
authors.lastname: Atkinson
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Griffin
authors.forename: L Hannah
authors.initials: LH
authors.lastname: Gould
mesh_terms: D015373:Bacterial Typing Techniques / Q000639:trends; D002487:Centers for Disease Control and Prevention, U.S.; D004751:Enteritis / Q000382:microbiology*; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D019453:Escherichia coli O157 / Q000145:classification / Q000302:isolation & purification / Q000378:metabolism; D005243:Feces / Q000382:microbiology; D019983:Guideline Adherence; D006801:Humans; D018571:Sentinel Surveillance; D022621:Shiga Toxin / Q000378:metabolism; D054323:Shiga-Toxigenic Escherichia coli / Q000145:classification* / Q000302:isolation & purification* / Q000378:metabolism; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
chemical_list: D022621:Shiga Toxin