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Duration of Fecal Shedding of Shiga Toxin–Producing Escherichia coli O104:H4 in Patients Infected During the 2011 Outbreak in Germany: A Multicenter Study

2013; Oxford University Press; Volume: 56; Issue: 8 Linguagem: Inglês

10.1093/cid/cis1218

1537-6591

R.-P. Vonberg, Michael Höhle, Martin Aepfelbacher, Franz Bange, Cristina Belmar Campos, K Claußen, Martin Christner, Jakob P. Cramer, Hermann Haller, Mathias W. Hornef, Helmut Fickenscher, Katharina Fraedrich, Johannes K.‐M. Knobloch, Tanja Kühbacher, Michael P. Manns, Martin Nitschke, Georg Peters, M Pulz, Holger Rohde, Rahel Tabea Roseland, Friedhelm Sayk, Frieder Schaumburg, Harald O. Schöcklmann, Sabine Schubert, Werner Solbach, Helge Karch, Sebastian Suerbaum,

Clostridium difficile and Clostridium perfringens research

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.