title: Shiga toxin-producing Escherichia coli: a single-center, 11-year pediatric experience.
abstract: The aim of this study was to identify the best practices for the detection of Shiga toxin-producing Escherichia coli (STEC) in children with diarrheal illness treated at a tertiary care center, i.e., sorbitol-MacConkey (SMAC) agar culture, enzyme immunoassay (EIA) for Shiga toxin, or the simultaneous use of both methods. STEC was detected in 100 of 14,997 stool specimens submitted for enteric culture (0.7%), with 65 cases of E. coli O157. Among E. coli O157 isolates, 57 (88%) were identified by both SMAC agar culture and EIA, 6 (9%) by SMAC agar culture alone, and 2 (3%) by EIA alone. Of the 62 individuals with diarrheal hemolytic uremic syndrome (HUS) seen at our institution during the study period, 16 (26%) had STEC isolated from cultures at our institution and 15 (24%) had STEC isolated at other institutions. No STEC was recovered in 31 cases (50%). Of the HUS cases in which STEC was isolated, 28 (90%) were attributable to E. coli O157 and 3 (10%) were attributable to non-O157 STEC. Consistent with previous studies, we have determined that a subset of E. coli O157 infections will not be detected if an agar-based method is excluded from the enteric culture workup; this has both clinical and public health implications. The best practice would be concomitant use of an agar-based method and a Shiga toxin EIA, but a Shiga toxin EIA should not be considered to be an adequate stand-alone test for detection of E. coli O157 in clinical samples.
authors: Barnes Jewish Hospital, St. Louis, Missouri, USA Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors: Emily I
authors: EI
authors: Schindler
authors: St. Louis Children's Hospital, St. Louis, Missouri, USA.
authors: Patricia
authors: P
authors: Sellenriek
authors: Division of Infectious Diseases, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.
authors: Gregory A
authors: GA
authors: Storch
authors: Division of Gastroenterology, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors: Phillip I
authors: PI
authors: Tarr
authors: Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA cburnham@path.wustl.edu.
authors: Carey-Ann D
authors: http://orcid.org/0000-0002-1137-840X
authors: CA
authors: Burnham
mesh_terms: D000293:Adolescent; D001431:Bacteriological Techniques / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003470:Culture Media / Q000737:chemistry; D003967:Diarrhea / Q000175:diagnosis* / Q000382:microbiology; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007124:Immunoenzyme Techniques; D007223:Infant; D008297:Male; D012680:Sensitivity and Specificity; D022621:Shiga Toxin / Q000032:analysis; D054323:Shiga-Toxigenic Escherichia coli / Q000302:isolation & purification*; D062606:Tertiary Care Centers
chemical_list: D003470:Culture Media; D022621:Shiga Toxin