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Shiga toxin-producing Escherichia coli: a single-center, 11-year pediatric experience

Emily I Schindler1, Patricia Sellenriek2, Gregory A Storch3

  • 1Barnes Jewish Hospital, St. Louis, Missouri, USA Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA.

Journal of Clinical Microbiology
|August 1, 2014
PubMed

Insights

Detecting Shiga toxin-producing E. coli (STEC) in children requires both sorbitol-MacConkey (SMAC) agar culture and enzyme immunoassay (EIA). Relying solely on EIA misses some STEC infections, impacting clinical and public health.

Area of Science:

  • Microbiology
  • Clinical Diagnostics
  • Infectious Diseases

Background:

  • Shiga toxin-producing Escherichia coli (STEC) causes diarrheal illness, sometimes leading to hemolytic uremic syndrome (HUS).
  • Accurate detection of STEC is crucial for timely clinical management and public health surveillance.

Purpose of the Study:

  • To evaluate the optimal methods for detecting STEC in pediatric diarrheal illness.
  • To compare sorbitol-MacConkey (SMAC) agar culture, enzyme immunoassay (EIA), and their combined use for STEC detection.

Main Methods:

  • Retrospective analysis of stool specimens from children with diarrhea.
  • Comparison of STEC detection rates using SMAC agar culture, Shiga toxin EIA, and both methods concurrently.

Main Results:

  • STEC was detected in 0.7% of specimens; E. coli O157 was the most common serotype.
  • Combined SMAC agar and EIA detected 88% of E. coli O157 cases; EIA alone missed 9% of cases.
  • In HUS cases, STEC was isolated in 50% of patients, with E. coli O157 being predominant.

Conclusions:

  • A subset of E. coli O157 infections are missed if agar-based methods are excluded.
  • Concomitant use of SMAC agar culture and Shiga toxin EIA is the best practice for STEC detection.
  • Shiga toxin EIA alone is insufficient for detecting E. coli O157 in clinical samples.

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