R M Pedersen1, M T K Nielsen2, S Möller3, S Ethelberg4, M N Skov2, H J Kolmos5, F Scheutz6, H M Holt2, F S Rosenvinge7. 1. Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark. Electronic address: rmpedersen@health.sdu.dk. 2. Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark. 3. OPEN - Odense Patient Data Explorative Network, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark. 4. Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark. 5. Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark. 6. The International Collaborating Centre for Reference and Research on Escherichia and Klebsiella, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark. 7. Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark.
Abstract
OBJECTIVES: Shiga toxin-producing Escherichia coli (STEC) causes diarrhoeal disease, bloody diarrhoea, and haemolytic uraemic syndrome. The aim of this study was to describe the incidence of STEC and the clinical features of STEC patients from a well-defined Danish population in which all fecal samples of patients with suspected infective gastroenteritis were analysed for STEC. METHODS: In this population-based cohort study, all stool samples referred to two clinical microbiology laboratories were screened for STEC by culture and/or PCR. Epidemiological (n=170) and clinical (n=209) characteristics were analysed using data from local and national registries. RESULTS: Overall, 75,132 samples from 30,073 patients were screened resulting in 217 unique STEC-isolates. The epidemiological analysis showed an incidence of 10.1 cases per 100,000 person-years, which was more than twofold higher than the incidence in the rest of Denmark (3.4 cases per 100,000 person-years, p <0.001). Three groups were associated with a higher incidence: age <5 years (n=28, p <0.001), age ≥65 years (n=38, p 0.045), and foreign ethnicity (n=27, p 0.003). In the clinical analysis, patients with STEC harbouring only the Shiga toxin 1 gene (stx1-only isolates) showed a lower frequency of acute (n=11, p <0.05) and bloody diarrhoea (n=5, p <0.05) and a higher frequency of gastrointestinal symptoms for ≥3 months (n=8, p <0.05) than the other STEC patients. CONCLUSIONS: We report a more than twofold higher incidence in the project area compared with the rest of Denmark, indicating that patients remain undiagnosed when selective STEC screening is used. We found an association between patients with stx1-only isolates and long-term gastrointestinal symptoms.
OBJECTIVES: Shiga toxin-producing Escherichia coli (STEC) causes diarrhoeal disease, bloody diarrhoea, and haemolytic uraemic syndrome. The aim of this study was to describe the incidence of STEC and the clinical features of STEC patients from a well-defined Danish population in which all fecal samples of patients with suspected infective gastroenteritis were analysed for STEC. METHODS: In this population-based cohort study, all stool samples referred to two clinical microbiology laboratories were screened for STEC by culture and/or PCR. Epidemiological (n=170) and clinical (n=209) characteristics were analysed using data from local and national registries. RESULTS: Overall, 75,132 samples from 30,073 patients were screened resulting in 217 unique STEC-isolates. The epidemiological analysis showed an incidence of 10.1 cases per 100,000 person-years, which was more than twofold higher than the incidence in the rest of Denmark (3.4 cases per 100,000 person-years, p <0.001). Three groups were associated with a higher incidence: age <5 years (n=28, p <0.001), age ≥65 years (n=38, p 0.045), and foreign ethnicity (n=27, p 0.003). In the clinical analysis, patients with STEC harbouring only the Shiga toxin 1 gene (stx1-only isolates) showed a lower frequency of acute (n=11, p <0.05) and bloody diarrhoea (n=5, p <0.05) and a higher frequency of gastrointestinal symptoms for ≥3 months (n=8, p <0.05) than the other STEC patients. CONCLUSIONS: We report a more than twofold higher incidence in the project area compared with the rest of Denmark, indicating that patients remain undiagnosed when selective STEC screening is used. We found an association between patients with stx1-only isolates and long-term gastrointestinal symptoms.
Authors: Anika Penzel; Katrin Schützler; Jana Dröge; Alexander Mellmann; Ralf Ehricht; Ines Engelmann; Sascha D Braun; Benjamin T Schleenvoigt; Bettina Löffler; Jürgen Rödel Journal: Eur J Clin Microbiol Infect Dis Date: 2019-09-16 Impact factor: 3.267