title: Assessment of physician knowledge and practices concerning Shiga toxin-producing Escherichia coli infection and enteric illness, 2009, Foodborne Diseases Active Surveillance Network (FoodNet).
abstract: BACKGROUND
  Shiga toxin-producing Escherichia coli (STEC) infections cause acute diarrheal illness and sometimes life-threatening hemolytic uremic syndrome (HUS). Escherichia coli O157 is the most common STEC, although the number of reported non-O157 STEC infections is growing with the increased availability and use of enzyme immunoassay testing, which detects the presence of Shiga toxin in stool specimens. Prompt and accurate diagnosis of STEC infection facilitates appropriate therapy and may improve patient outcomes.
  
  
  METHODS
  We mailed 2400 surveys to physicians in 8 Foodborne Diseases Active Surveillance Network (FoodNet) sites to assess their knowledge and practices regarding STEC testing, treatment, and reporting, and their interpretation of Shiga toxin test results.
  
  
  RESULTS
  Of 1102 completed surveys, 955 were included in this analysis. Most (83%) physicians reported often or always ordering a culture of bloody stool specimens; 49% believed that their laboratory routinely tested for STEC O157, and 30% believed that testing for non-O157 STEC was also included in a routine stool culture. Forty-two percent of physicians were aware that STEC, other than O157, can cause HUS, and 34% correctly interpreted a positive Shiga toxin test result. All STEC knowledge-related factors were strongly associated with correct interpretation of a positive Shiga toxin test result.
  
  
  CONCLUSIONS
  Identification and management of STEC infection depends on laboratories testing for STEC and physicians ordering and correctly interpreting results of Shiga toxin tests. Although overall knowledge of STEC was low, physicians who had more knowledge were more likely to correctly interpret a Shiga toxin test result. Physician knowledge of STEC may be modifiable through educational interventions.
authors.affiliation: Emerging Infections Program, Yale University School of Public Health, One Church St, 7th Fl, New Haven, CT 06510, USA. paula.clogher@yale.edu
authors.forename: Paula
authors.initials: P
authors.lastname: Clogher
authors.forename: Sharon
authors.initials: S
authors.lastname: Hurd
authors.forename: Dina
authors.initials: D
authors.lastname: Hoefer
authors.forename: James L
authors.initials: JL
authors.lastname: Hadler
authors.forename: Lauren
authors.initials: L
authors.lastname: Pasutti
authors.forename: Shaun
authors.initials: S
authors.lastname: Cosgrove
authors.forename: Suzanne
authors.initials: S
authors.lastname: Segler
authors.forename: Melissa
authors.initials: M
authors.lastname: Tobin-D'Angelo
authors.forename: Cindy
authors.initials: C
authors.lastname: Nicholson
authors.forename: Hillary
authors.initials: H
authors.lastname: Booth
authors.forename: Katie
authors.initials: K
authors.lastname: Garman
authors.forename: Rajal K
authors.initials: RK
authors.lastname: Mody
authors.forename: L Hannah
authors.initials: LH
authors.lastname: Gould
mesh_terms: D003967:Diarrhea / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005517:Foodborne Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010818:Practice Patterns, Physicians'; D011933:Reagent Kits, Diagnostic; D054323:Shiga-Toxigenic Escherichia coli / Q000302:isolation & purification*
chemical_list: D011933:Reagent Kits, Diagnostic