Risk factors for and prevention of sporadic infections with vero cytotoxin (shiga toxin) producing Escherichia coli 0157

Abstract Shiga toxin-producing Escherichia coli (STEC) infection can cause serious illness including haemolytic uraemic syndrome. The role of socio-economic status (SES) in differential clinical presentation and exposure to potential risk factors amongst STEC cases has not previously been reported in England. We conducted an observational study using a dataset of all STEC cases identified in England, 2010–2015. Odds ratios for clinical characteristics of cases and foodborne, waterborne and environmental risk factors were estimated using logistic regression, stratified by SES, adjusting for baseline demographic factors. Incidence was higher in the highest SES group compared to the lowest (RR 1.54, 95% CI 1.19–2.00). Odds of Accident and Emergency attendance (OR 1.35, 95% CI 1.10–1.75) and hospitalisation (OR 1.71, 95% CI 1.36–2.15) because of illness were higher in the most disadvantaged compared to the least, suggesting potential lower ascertainment of milder cases or delayed care-seeking behaviour in disadvantaged groups. Advantaged individuals were significantly more likely to report salad/fruit/vegetable/herb consumption (OR 1.59, 95% CI 1.16–2.17), non-UK or UK travel (OR 1.76, 95% CI 1.40–2.27; OR 1.85, 95% CI 1.35–2.56) and environmental exposures (walking in a paddock, OR 1.82, 95% CI 1.22–2.70; soil contact, OR 1.52, 95% CI 2.13–1.09) suggesting other unmeasured risks, such as person-to-person transmission, could be more important in the most disadvantaged group.

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Risk Factors of Sporadic Human Infection of Shiga Toxin Producing Escherichia coli O157 and Non-O157 in Australia

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2008.05.539 ◽

2008 ◽

Vol 12 ◽

pp. e217

Author(s):

M. McPherson ◽

M. Kirk ◽

J. Raupach ◽

A. Koehler

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Shiga Toxin ◽

Human Infection ◽

Escherichia Coli O157

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Shiga Toxin-producing Escherichia coli Infection in Germany--Different Risk Factors for Different Age Groups

American Journal of Epidemiology ◽

10.1093/aje/kwk023 ◽

2006 ◽

Vol 165 (4) ◽

pp. 425-434 ◽

Cited By ~ 65

Author(s):

D. Werber ◽

S. C. Behnke ◽

A. Fruth ◽

R. Merle ◽

S. Menzler ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Shiga Toxin ◽

Age Groups ◽

Escherichia Coli Infection

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Hemolytic uremic syndrome caused by Shiga toxin–producing Escherichia coli in children: incidence, risk factors, and clinical outcome

Pediatric Nephrology ◽

10.1007/s00467-020-04560-0 ◽

2020 ◽

Vol 35 (9) ◽

pp. 1749-1759 ◽

Cited By ~ 1

Author(s):

Elisa Ylinen ◽

Saara Salmenlinna ◽

Jani Halkilahti ◽

Timo Jahnukainen ◽

Linda Korhonen ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Clinical Outcome ◽

Hemolytic Uremic Syndrome ◽

Shiga Toxin ◽

Incidence Risk ◽

Uremic Syndrome

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Predicting Hemolytic Uremic Syndrome and Renal Replacement Therapy in Shiga Toxin–producing Escherichia coli–infected Children

Clinical Infectious Diseases ◽

10.1093/cid/ciz432 ◽

2019 ◽

Vol 70 (8) ◽

pp. 1643-1651 ◽

Cited By ~ 4

Author(s):

Ryan S McKee ◽

David Schnadower ◽

Phillip I Tarr ◽

Jianling Xie ◽

Yaron Finkelstein ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Renal Replacement Therapy ◽

Serum Sodium ◽

Shiga Toxin ◽

Leukocyte Count ◽

Lower Serum ◽

Younger Age ◽

Intravenous Fluid Administration ◽

Uremic Syndrome

Abstract Background Shiga toxin–producing Escherichia coli (STEC) infections are leading causes of pediatric acute renal failure. Identifying hemolytic uremic syndrome (HUS) risk factors is needed to guide care. Methods We conducted a multicenter, historical cohort study to identify features associated with development of HUS (primary outcome) and need for renal replacement therapy (RRT) (secondary outcome) in STEC-infected children without HUS at initial presentation. Children aged <18 years who submitted STEC-positive specimens between January 2011 and December 2015 at a participating study institution were eligible. Results Of 927 STEC-infected children, 41 (4.4%) had HUS at presentation; of the remaining 886, 126 (14.2%) developed HUS. Predictors (all shown as odds ratio [OR] with 95% confidence interval [CI]) of HUS included younger age (0.77 [.69–.85] per year), leukocyte count ≥13.0 × 103/μL (2.54 [1.42–4.54]), higher hematocrit (1.83 [1.21–2.77] per 5% increase) and serum creatinine (10.82 [1.49–78.69] per 1 mg/dL increase), platelet count <250 × 103/μL (1.92 [1.02–3.60]), lower serum sodium (1.12 [1.02–1.23 per 1 mmol/L decrease), and intravenous fluid administration initiated ≥4 days following diarrhea onset (2.50 [1.14–5.46]). A longer interval from diarrhea onset to index visit was associated with reduced HUS risk (OR, 0.70 [95% CI, .54–.90]). RRT predictors (all shown as OR [95% CI]) included female sex (2.27 [1.14–4.50]), younger age (0.83 [.74–.92] per year), lower serum sodium (1.15 [1.04–1.27] per mmol/L decrease), higher leukocyte count ≥13.0 × 103/μL (2.35 [1.17–4.72]) and creatinine (7.75 [1.20–50.16] per 1 mg/dL increase) concentrations, and initial intravenous fluid administration ≥4 days following diarrhea onset (2.71 [1.18–6.21]). Conclusions The complex nature of STEC infection renders predicting its course a challenge. Risk factors we identified highlight the importance of avoiding dehydration and performing close clinical and laboratory monitoring.

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Shiga toxin-producing escherichia coli infections in Norway, 1992–2012: characterization of isolates and identification of risk factors for haemolytic uremic syndrome

BMC Infectious Diseases ◽

10.1186/s12879-015-1017-6 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 46

Author(s):

Lin T. Brandal ◽

Astrid L. Wester ◽

Heidi Lange ◽

Inger Løbersli ◽

Bjørn-Arne Lindstedt ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Shiga Toxin ◽

Haemolytic Uremic Syndrome ◽

Uremic Syndrome

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Microbial Safety and Sanitary Quality of Strawberry Primary Production in Belgium: Risk Factors for Salmonella and Shiga Toxin-Producing Escherichia coli Contamination

Applied and Environmental Microbiology ◽

10.1128/aem.03930-14 ◽

2015 ◽

Vol 81 (7) ◽

pp. 2562-2570 ◽

Cited By ~ 16

Author(s):

Stefanie Delbeke ◽

Siele Ceuppens ◽

Claudia Titze Hessel ◽

Irene Castro ◽

Liesbeth Jacxsens ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Shiga Toxin ◽

Irrigation Water ◽

Multivariable Logistic Regression Analysis ◽

Content Type ◽

E Coli ◽

Production And Consumption

ABSTRACTStrawberries are an important fruit in Belgium in both production and consumption, but little information is available about the presence ofSalmonellaand Shiga toxin-producingEscherichia coli(STEC) in these berries, the risk factors in agricultural production, and possible specific mitigation options. In 2012, a survey was undertaken of three soil and three soilless cultivation systems in Belgium. NoSalmonellaspp. were isolated. No STEC was detected in the strawberry samples (0 of 72), but STEC was detected by PCR in 11 of 78 irrigation water and 2 of 24 substrate samples. Culture isolates were obtained for 2 of 11 PCR-positive irrigation water samples and 2 of 2 substrate samples. Multivariable logistic regression analysis revealed elevated genericE. colinumbers (the odds ratio [OR] for a 1 log increase being 4.6) as the most important risk factor for STEC, together with the berry-picking season (elevated risk in summer). The presence of genericE. coliin the irrigation water (≥1 CFU per 100 ml) was mainly influenced by the type of irrigation water (collected rainfall water stored in ponds was more often contaminated than groundwater pumped from boreholes [OR = 5.8]) and the lack of prior treatment (untreated water versus water subjected to sand filtration prior to use [OR = 19.2]). The follow-up study in 2013 at one of the producer locations indicated cattle to be the most likely source of STEC contamination of the irrigation water.

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