title: Duration of fecal shedding of Shiga toxin-producing Escherichia coli O104:H4 in patients infected during the 2011 outbreak in Germany: a multicenter study.
abstract: BACKGROUND
  In May-July 2011, Germany experienced a large food-borne outbreak of Shiga toxin 2-producing Escherichia coli (STEC O104:H4) with 3842 cases, including 855 cases with hemolytic uremic syndrome (HUS) and 53 deaths.
  
  
  METHODS
  A multicenter study was initiated in 5 university hospitals to determine pathogen shedding duration. Diagnostics comprised culture on selective media, toxin enzyme-linked immunosorbent assay, and polymerase chain reaction. Results were correlated with clinical and epidemiologic findings. Testing for pathogen excretion was continued after discharge of the patient.
  
  
  RESULTS
  A total of 321 patients (104 male, 217 female) were included (median age, 40 years [range, 1-89 days]). Median delay from onset of symptoms to hospitalization was 4 days (range, 0-17 days). Two hundred nine patients presented with HUS. The estimate for the median duration of shedding was 17-18 days. Some patients remained STEC O104:H4 positive until the end of the observation time (maximum observed shedding duration: 157 days). There was no significant influence of sex on shedding duration. Patients presenting with HUS had a significantly shortened shedding duration (median, 13-14 days) compared to non-HUS patients (median, 33-34 days). Antimicrobial treatment was also significantly associated with reduced shedding duration. Children (age≤15 years) had longer shedding durations than adults (median, 35-41 vs 14-15 days).
  
  
  CONCLUSIONS
  STEC O104:H4 is usually eliminated from the human gut after 1 month, but may sometimes be excreted for several months. Proper follow-up of infected patients is important to avoid further pathogen spread.
authors.affiliation: Institute for Medical Microbiology and Hospital Epidemiology, Department of Nephrology, Hannover Medical School, Germany.
authors.forename: Ralf P
authors.initials: RP
authors.lastname: Vonberg
authors.forename: Michael
authors.initials: M
authors.lastname: Höhle
authors.forename: Martin
authors.initials: M
authors.lastname: Aepfelbacher
authors.forename: Franz C
authors.initials: FC
authors.lastname: Bange
authors.forename: Cristina
authors.initials: C
authors.lastname: Belmar Campos
authors.forename: Katja
authors.initials: K
authors.lastname: Claussen
authors.forename: Martin
authors.initials: M
authors.lastname: Christner
authors.forename: Jakob P
authors.initials: JP
authors.lastname: Cramer
authors.forename: Hermann
authors.initials: H
authors.lastname: Haller
authors.forename: Mathias
authors.initials: M
authors.lastname: Hornef
authors.forename: Helmut
authors.initials: H
authors.lastname: Fickenscher
authors.forename: Katharina
authors.initials: K
authors.lastname: Fraedrich
authors.forename: Johannes K
authors.initials: JK
authors.lastname: Knobloch
authors.forename: Tanja
authors.initials: T
authors.lastname: Kühbacher
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.forename: Martin
authors.initials: M
authors.lastname: Nitschke
authors.forename: Georg
authors.initials: G
authors.lastname: Peters
authors.forename: Matthias
authors.initials: M
authors.lastname: Pulz
authors.forename: Holger
authors.initials: H
authors.lastname: Rohde
authors.forename: Rahel T
authors.initials: RT
authors.lastname: Roseland
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Sayk
authors.forename: Frieder
authors.initials: F
authors.lastname: Schaumburg
authors.forename: Harald O
authors.initials: HO
authors.lastname: Schöcklmann
authors.forename: Sabine
authors.initials: S
authors.lastname: Schubert
authors.forename: Werner
authors.initials: W
authors.lastname: Solbach
authors.forename: Helge
authors.initials: H
authors.lastname: Karch
authors.forename: Sebastian
authors.initials: S
authors.lastname: Suerbaum
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D057138:Bacterial Shedding; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D054324:Enterohemorrhagic Escherichia coli; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012737:Sex Factors; D018709:Statistics, Nonparametric; D055815:Young Adult