• Media type: E-Article
  • 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
  • Contributor: Vonberg, Ralf P.; Höhle, Michael; Aepfelbacher, Martin; Bange, Franz C.; Campos, Cristina Belmar; Claussen, Katja; Christner, Martin; Cramer, Jakob P.; Haller, Hermann; Hornef, Mathias; Fickenscher, Helmut; Fraedrich, Katharina; Knobloch, Johannes K.; Kühbacher, Tanja; Manns, Michael P.; Nitschke, Martin; Peters, Georg; Pulz, Matthias; Rohde, Holger; Roseland, Rahel T.; Sayk, Friedhelm; Schaumburg, Frieder; Schöcklmann, Harald O.; Schubert, Sabine; [...]
  • Published: Oxford University Press, 2013
  • Published in: Clinical Infectious Diseases
  • Extent: 1132-1140
  • Language: English
  • DOI: 10.1093/cid/cis1218
  • ISSN: 1058-4838
  • Keywords: ARTICLES AND COMMENTARIES
  • Abstract: <p>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.</p>
  • Description: <p>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.</p>
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  • Access State: Open Access