[Evaluation of immunochromatography-based rapid detection kit for fecal Escherichia coli O157]

"Quix" is an immunochromatography-based direct detection kit for the E. coli O157 LPS antigen in the patient's stool. The present study was conducted to evaluate the efficacy of the kit for rapid diagnosis of enterohemorrhagic Escherichia coli (EHEC) O157 infection. Sensitivity of the kit was determined using a pure culture of a clinical isolate of E. coli O157. Analytical sensitivity was found to be 5 x 10(5) CFU/ml. When compared with the culture method using fecal samples of 64 patients and with bloody diarrhea, sensitivity and specificity were 95.0% (19/20) and 86.4% (38/44), respectively, and overall agreement to culture method was 89.1% (57/64). One patient was found positive by culture method while negative in the present method, where the sample contained a low number of the cells less than the detection limit. Four of the six patients with a negative result by culture method and positive in the present method, were confirmed E. coli O157 infection by positive IgM antibody response against the E. coli O157 LPS. The discrepancy between the two methods seemed to be attributable to antibiotic administration. In one patient, Salmonella urbana (O30(1)30(2)) was detected. The O30(1) antigen of this bacterium is well known to be identical to the E. coli O157 antigen. When the present method was compared with an ELISA-based E. coli O157 LPS antigen detection kit, sensitivity and specificity were 100% (11/11) and 82.1% (23/28), and overall agreement to ELISA method was 87.2% (34/39). From these findings, Quix is useful as a rapid diagnostic kit in the primary clinics, outpatient or bedside use. E. coli O157 LPS antigen in patient's fecal samples can be detected in about five minutes with this simple procedure. Early diagnosis using such a simple kit will largely contribute for the early treatment and prevention of severe complications of the E. coli O157 infection.