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Cited by 282Escherichia coli research studiesSalmonella and Campylobacter epidemiologyClostridium difficile and Clostridium perfringens research

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Escherichia coli O157: H7 Diarrhea in the United States: Clinical and Epidemiologic Features

Slutsker, Laurence, Ries, Allen A., Greene, Katherine D., Wells, Joy G., Hutwagner, Lori, Griffin, Patricia M.·1997·Annals of Internal Medicine
DOI 10.7326/0003-4819-126-7-199704010-00002
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Abstract

BACKGROUND: Escherichia coli O157:H7 is increasingly recognized as a cause of bacterial diarrhea in the United States, but the frequency of its isolation and the clinical and epidemiologic features of E. coli O157:H7 infection in a large, geographically diverse population of patients have not been well described. OBJECTIVE: To determine the frequency of isolation of E. coli O157:H7 relative to that of other bacterial enteric pathogens in a nationwide sample of patients and to identify the clinical and epidemiologic features of E. coli O157:H7 infection. DESIGN: Population prevalence study from October 1990 to October 1992. SETTING: 10 U.S. hospitals. PATIENTS: Both inpatients and outpatients who had stool samples submitted to 1 of 10 laboratories for routine pathogen identification. MEASUREMENTS: Clinical, epidemiologic, and laboratory information was collected for infected and uninfected patients. Isolates of E. coli O157:H7 were tested for production of Shiga toxin. Patient charts were then reviewed. RESULTS: Escherichia coli O157:H7 was isolated from 118 (0.39%) of the 30463 fecal specimens tested. The proportion of fecal specimens with isolates was higher at northern sites (0.57%) than at southern sites (0.13%) (P < 0.001). Escherichia coli O157:H7 was more likely to be isolated from visibly bloody stool specimens than from specimens without visible blood (odds ratio [OR], 59.2 [95% CI, 36.6 to 96.0) and was the pathogen most commonly isolated from visibly bloody stool specimens that yielded a bacterial enteric pathogen (39% of such specimens). The highest age-specific isolation proportions from fecal specimens for E. coli O157:H7 were in patients 5 to 9 years of age (0.90%) and 50 to 59 years of age (0.89%). Clinical features independently associated with E. coli O157:H7 infection compared with the other enteric pathogens included a history of bloody diarrhea (OR, 18.6 [CI, 7.4 to 48.6]), visibly bloody stool specimens (OR, 8.1 [CI, 3.6 to 18.3]), no reported fever (OR, 8.3 [CI, 1.6 to 50.0]), leukocyte count greater than 10 x 10(9)/L (OR, 4.0 [CI, 1.7 to 9.5]), and abdominal tenderness on physical examination (OR, 2.9 [CI, 1.2 to 7.2]). CONCLUSIONS: In some geographic areas and some age groups, isolation proportions from fecal specimens for E. coli O157:H7 surpassed those of other common enteric pathogens. One third of isolates of this organism came from nonbloody specimens. Because person-to-person transmission of E. coli O157:H7 is not uncommon and infection with this organism may cause severe disease, stool specimens from all patients with a history of acute bloody diarrhea should be cultured for E. coli O157:H7.

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Metadata

Authors
Slutsker, L., Ries, A. A., Greene, K. D., Wells, J. G., Hutwagner, L., & Griffin, P. M.
Affiliations
for the Escherichia coli O157:H7 Study Group.
Corresponding author
Slutsker, Laurence
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
1997-04-01
Volume
126
Issue
7
Pages
505-513
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/0003-4819-126-7-199704010-00002
OpenAlex
W2008738343
Cited by
282
References
0
Citations by year
2025: 3 · 2024: 1 · 2023: 6 · 2022: 5 · 2021: 3 · 2020: 5 · 2019: 5 · 2018: 2 · 2017: 10 · 2016: 10 · 2015: 13 · 2014: 16 · 2013: 8 · 2012: 10
FWCI
9.23
Type
journal article
Language
en
Open access
closed
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Immunology and Microbiology › Microbiology › Escherichia coli research studies
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Salmonella and Campylobacter epidemiology
  • Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
Keywords
Escherichia coli O157:H7, bloody diarrhea, Shiga toxin-producing Escherichia coli, bacterial enteric pathogens, prevalence, hematochezia, clinical features, age distribution, regional variation, Shiga toxin, hemolytic uremic syndrome, hospitalized patients, fecal samples, United States hospitals, food poisoning, waterborne outbreaks
MeSH terms
Campylobacter Infections, Child, Diarrhea, Dysentery, Bacillary, Escherichia coli Infections, Feces, Humans, Leukocyte Count, Mass Screening, Middle Aged, Salmonella Infections, United States, Prevalence, Logistic Models, Escherichia coli O157

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