Comparison of a Commercial Reversed Passive Latex Agglutination Assay to an Enzyme Immunoassay for the Detection of Shiga Toxin-Producing Escherichia coli

Carroll, Karen C.; Adamson, Katy; Korgenski, Kent; Croft, Ann; Hankemeier, R.; Daly, Judy A.; Park, C. H.

doi:10.1007/s10096-003-1053-9

Cited by 23 publications

(14 citation statements)

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“…One-quarter of the infections would have been missed if STEC screening had been restricted to the summer months, a strategy proposed by some groups (33). Importantly, the EIA failed to detect six cases of E. coli O157, the most clinically actionable serotype of STEC, emphasizing the shortcomings of using this assay as a stand-alone test (14,(17)(18)(19)(20)(21)34).…”

Section: Discussionmentioning

confidence: 99%

“…These complementary methods are recommended because of the increasing recognition that non-O157:H7 STEC strains cause disease and the lack of evidence that STEC enzyme immunoassays (EIAs) are as good as or better than sorbitol-MacConkey (SMAC) agar screening for the detection of E. coli O157, which remains the most clinically actionable STEC serotype. Furthermore, some studies suggest that a toxin EIA is inferior to SMAC agar screening for detecting E. coli O157:H7 (14,(17)(18)(19)(20)(21)(22)(23)(24).…”

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confidence: 99%

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Shiga Toxin-Producing Escherichia coli: a Single-Center, 11-Year Pediatric Experience

et al. 2014

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The aim of this study was to identify the best practices for the detection of Shiga toxin-producing Escherichia coli (STEC) in children with diarrheal illness treated at a tertiary care center, i.e., sorbitol-MacConkey (SMAC) agar culture, enzyme immunoassay (EIA) for Shiga toxin, or the simultaneous use of both methods. STEC was detected in 100 of 14,997 stool specimens submitted for enteric culture (0.7%), with 65 cases of E. coli O157. Among E. coli O157 isolates, 57 (88%) were identified by both SMAC agar culture and EIA, 6 (9%) by SMAC agar culture alone, and 2 (3%) by EIA alone. Of the 62 individuals with diarrheal hemolytic uremic syndrome (HUS) seen at our institution during the study period, 16 (26%) had STEC isolated from cultures at our institution and 15 (24%) had STEC isolated at other institutions. No STEC was recovered in 31 cases (50%). Of the HUS cases in which STEC was isolated, 28 (90%) were attributable to E. coli O157 and 3 (10%) were attributable to non-O157 STEC. Consistent with previous studies, we have determined that a subset of E. coli O157 infections will not be detected if an agar-based method is excluded from the enteric culture workup; this has both clinical and public health implications. The best practice would be concomitant use of an agar-based method and a Shiga toxin EIA, but a Shiga toxin EIA should not be considered to be an adequate stand-alone test for detection of E. coli O157 in clinical samples. Shiga toxin-producing Escherichia coli (STEC) causes a spectrum of disease, with manifestations ranging from mild selflimited diarrhea to the life-threatening hemolytic uremic syndrome (HUS) (1-7). The incidence and severity of STEC infections are highest in children, with disproportionate numbers of HUS cases being reported for this group (7-10). E. coli O157:H7 is the serotype most often implicated in HUS worldwide (1,9,(11)(12)(13)(14)(15).In 2009, the US Centers for Disease Control and Prevention (CDC) published guidelines indicating that laboratories should simultaneously perform a selective and differential agar-based test to detect E. coli O157 and a test to detect Shiga toxins or Shiga toxin genes for all stool samples submitted for bacterial culture (16). These complementary methods are recommended because of the increasing recognition that non-O157:H7 STEC strains cause disease and the lack of evidence that STEC enzyme immunoassays (EIAs) are as good as or better than sorbitol-MacConkey (SMAC) agar screening for the detection of E. coli O157, which remains the most clinically actionable STEC serotype. Furthermore, some studies suggest that a toxin EIA is inferior to SMAC agar screening for detecting E. coli O157:H7 (14, 17-24).Infections with STEC are rare (FoodNet data suggest that approximately 4,000 cases of E. coli O157:H7 infections per year occur in the United States) (25) but, for the individuals infected, there are considerable benefits to making a timely diagnosis. Specifically, the earlier a microbiological diagnosis is attained, the better the clinical outc...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Shiga Toxin-Producing Escherichia coli: a Single-Center, 11-Year Pediatric Experience

et al. 2014

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“…This latter group of organisms is considerably less likely to cause HUS or to be associated with outbreaks, and the value of their detection to clinicians and disease control authorities is nowhere near as great as is the value of detecting E. coli O157:H7. Furthermore, for unexplained reasons, Stx assays are not always as sensitive as SMAC agar screening for the detection of E. coli O157:H7 (Fey, Wickert et al 2000;Klein, Stapp et al 2002;Carroll, Adamson et al 2003;Park, Kim et al 2003;Teel, Daly et al 2007). More specifically, SMAC agar can sometimes detect E. coli O157:H7 when simultaneously performed toxin assays do not.…”

Section: Diagnostic Considerations For Pathogenic Stecmentioning

confidence: 99%

“…FACT: SMAC agar screening is more accurate and quicker at detecting E. coli O157:H7 than toxin assays. If you have to choose one detection method, choose SMAC agar (Fey, Wickert et al 2000;Klein, Stapp et al 2002;Carroll, Adamson et al 2003;Park, Kim et al 2003;Teel, Daly et al 2007).…”

Section: Pathophysiology Of Husmentioning

confidence: 99%

Shiga-Toxin Producing Escherichia coli and the Hemolytic Uremic Syndrome: What Have We Learned in the Past 25 Years?

Ahn

Holt

Tarr³

2008

Advances in Experimental Medicine and Biology

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“…Hence, the presence of a colorless colony on sorbitolMacConkey agar that agglutinates with an appropriate serologic reagent enables the microbiologist to make a confident and timely presumptive diagnosis. For inexplicable reasons, E. coli O157:H7 is more easily detected by sorbitol-MacConkey agar plating than by toxin testing of broth cultures of stool (1,16,(52)(53)(54)(55)(56). Because of the greater sensitivity of agar plating, the critical importance of making a diagnosis of E. coli O157:H7 infection as rapidly as possible, and the recognition that a small subset of non-O157:H7 STEC/VTEC infections can be severe, we agree with the guidance of the Centers for Disease Control and Prevention that advises the simultaneous testing for E. coli O157:H7 (on agar plates) and non-O157:H7 STEC/VTEC (using, in most cases, a toxin enzyme immunoassay [EIA]) (57).…”

Section: Distinction Between Stec/vtec Belonging To Serotype O157:h7 mentioning

confidence: 99%

Shiga Toxin/Verocytotoxin-Producing Escherichia coli Infections: Practical Clinical Perspectives

2014

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Escherichia coli strains that produce Shiga toxins/verotoxins are rare, but important, causes of human disease. They are responsible for a spectrum of illnesses that range from the asymptomatic to the life-threatening hemolyticuremic syndrome; diseases caused by E. coli belonging to serotype O157:H7 are exceptionally severe. Each illness has a fairly predictable trajectory, and good clinical practice at one phase can be inappropriate at other phases. Early recognition, rapid and definitive microbiology, and strategic selection of tests increase the likelihood of good outcomes. The best management of these infections consists of avoiding antibiotics, antimotility agents, and narcotics and implementing aggressive intravenous volume expansion, especially in the early phases of illness.

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Comparison of a Commercial Reversed Passive Latex Agglutination Assay to an Enzyme Immunoassay for the Detection of Shiga Toxin-Producing Escherichia coli

Cited by 23 publications

References 13 publications

Shiga Toxin-Producing Escherichia coli: a Single-Center, 11-Year Pediatric Experience

Shiga Toxin-Producing Escherichia coli: a Single-Center, 11-Year Pediatric Experience

Shiga-Toxin Producing Escherichia coli and the Hemolytic Uremic Syndrome: What Have We Learned in the Past 25 Years?

Shiga Toxin/Verocytotoxin-Producing Escherichia coli Infections: Practical Clinical Perspectives

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