Assessment of Physician Knowledge and Practices Concerning Shiga Toxin–Producing Escherichia coli Infection and Enteric Illness, 2009, Foodborne Diseases Active Surveillance Network (FoodNet)

Clogher, Paula; Hurd, Sharon; Hoefer, Dina; Hadler, James L.; Pasutti, Lauren; Cosgrove, Shaun; Segler, Suzanne; Tobin-D’Angelo, Melissa; Nicholson, Cindy; Booth, Hillary; Garman, Katie; Mody, Rajal K.; Gould, L. Hannah

doi:10.1093/cid/cis246

Cited by 18 publications

(13 citation statements)

References 8 publications

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“…8 Although there was much media attention around this and other E. coli O157 outbreaks, few of the GPs surveyed in this study routinely asked about farm visits, or mentioned bloody painful diarrhoea in children in the open questions; this compares with 81% of GPs in the present study and 83-99% of US clinicians who would send a sample of bloody diarrhoea when directly questioned about this symptom. 5,9 In a recent prospective, multicentre cohort study, over 9 years across five US states, of children infected with E. coli O157:H7, 14% of 259 children developed HUS. 10 Multivariable analysis shows antibiotic exposure early in the illness is associated with a threefold risk of HUS, 10 therefore it is concerning that 45% of GPs in the present study would consider antibiotics for this condition.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…US clinicians also lack knowledge regarding diagnostic testing and management of this condition. 9 In a similar survey of US emergency physicians, 11 only one-half reported that they would submit a diarrhoeal specimen from a chef or care centre worker and 20% said that a chef may return to work as long as he observes strict hand hygiene. This is similar to the number in the present survey who would advise that food handlers could return to work in under 48 hours of cessation of symptoms, contrary to public health guidelines.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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Management of suspected infectious diarrhoea by English GPs: are they right?

et al. 2013

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Section: Comparison With Existing Literaturementioning

confidence: 99%

Section: Comparison With Existing Literaturementioning

confidence: 99%

Management of suspected infectious diarrhoea by English GPs: are they right?

et al. 2013

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“…Additionally, a recent assessment of physician knowledge and practices regarding STEC found that only 6% of the surveyed physicians specifically ordered testing for non-O157 STEC, while 30% believed that the test is included in a stool test panel and 60% did not consider testing for non-O157 STEC at all (13). These findings indicate that proper diagnosis and management of non-O157 STEC infections depend on improved physician awareness as well as improved laboratory practices for detection of STEC.…”

mentioning

confidence: 99%

A Sensitive Multiplex, Real-Time PCR Assay for Prospective Detection of Shiga Toxin-Producing Escherichia coli from Stool Samples Reveals Similar Incidences but Variable Severities of Non-O157 and O157 Infections in Northern California

et al. 2013

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dRapid and accurate detection of Shiga toxin-producing Escherichia coli (STEC) of all serotypes from patients with diarrhea is critical for medical management and for the prevention of ongoing transmission. In this prospective study, we assessed the performance of a multiplex, real-time PCR assay targeting stx 1 and stx 2 for the detection of O157 and non-O157 STEC in diarrheal stool samples enriched in Gram-negative broth. We show that the assay is 100% sensitive (95% confidence interval [CI], 89.1% to 100%) and 98.5% specific (95% CI, 90.6% to 99.9%) based on a panel of 40 known STEC-positive specimens and 65 known negative specimens. During a 2-year postvalidation period, the assay detected more positive samples from patients in northern California than did culture and PCR testing performed at a public health reference laboratory, with a positive predictive value of 95.6% (95% CI, 87.6% to 99.1%). Serotyping data showed an incidence rate of 51.2% for non-O157 STEC strains, with 5.8% of patients (1/17) with non-O157 strains and 42.9% (6/14) with O157 strains (P ‫؍‬ 0.03) developing hemolytic-uremic syndrome. The findings from this study underscore the recommendations of the CDC for laboratories to test all diarrheal stool samples from patients with acute community-acquired diarrhea for non-O157 STEC in addition to the O157 serotype by using a sensitive assay. Additionally, a survey of 17 clinical laboratories in northern California demonstrated that nearly 50% did not screen all stool specimens for the presence of Shiga toxins, indicating that many clinical microbiology laboratories still do not routinely screen all stool specimens for the presence of Shiga toxins as recommended in the 2009 CDC guidelines. Shiga toxin-producing Escherichia coli (STEC) infections are a major cause of bacterial gastroenteritis throughout the world and can be complicated by hemorrhagic colitis and hemolyticuremic syndrome (HUS) (1, 2). Although previously the majority of reported cases were attributed to E. coli O157:H7 and many recent studies indicate higher incidence rates of HUS associated with E. coli O157:H7 (3, 4), non-O157 STEC serotypes are emerging as important etiological agents of both sporadic cases and community outbreaks of diarrhea (3-8). Most notably, in May and June 2011, a large outbreak of E. coli O104:H4-associated diarrheal illness in Germany led to HUS in over 800 patients, many of whom were adults, and ultimately resulted in 54 deaths (5, 9). This outbreak and others have underscored the fact that severe disease and HUS can occur in cases related to non-O157 or O157 E. coli strains and that adults as well as children are susceptible to these complications (8-10). Timely laboratory identification of STEC has important implications for outbreak containment and patient management, including prompt parenteral hydration, monitoring for development of HUS, and avoidance of antibiotics and antidiarrheal agents, which can exacerbate disease (1). Importantly, a number of studies have shown that STECrelated illnesses...

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“…Given a scenario of a child with classic features of STEC infection, only 88% of PEM physicians indicated they would perform a culture, that is, one in eight PEM physicians would not perform a stool culture. This is similar to the proportion that indicated they would submit a culture (83%) in a survey of 995 physicians who work in the Foodborne Diseases Active Surveillance Network sites . This may relate to an underestimation of the risk of developing HUS in children with STEC infection as 57% of PEM participants estimated the overall proportion to be ≤5% (the question did not specify an age range).…”

Section: Discussionmentioning

confidence: 99%