Denno Donna M, Keene William E, Hutter Carolyn M, Koepsell Jennifer K, Patnode Marianne, Flodin-Hursh Denny, Stewart Laurie K, Duchin Jeffrey S, Rasmussen Laurette, Jones Robert, Tarr Phillip I
Department of Pediatrics and Global Health, University of Washington, Public Health-Seattle and King County, Seattle, Washington, USA.
J Infect Dis. 2009 Feb 15;199(4):467-76. doi: 10.1086/596555.
The aim of this study was to determine risk factors for childhood sporadic reportable enteric infection (REI) caused by bacteria, specifically Campylobacter, Salmonella, Escherichia coli O157, or Shigella (REI-B).
Matched case-control study. Case patients aged <19 years who were reported to 3 Washington State county health departments and matched control subjects were interviewed from November 2003-November 2005. Matched odds ratios (ORs) were calculated by using conditional logistic regression. Population attributable risk percentages were calculated for exposures associated with infection.
Two hundred ninety-six case patients were matched to 580 control subjects. Aquatic recreation was the most important factor associated with all REI-Bs studied (beach water exposure [OR for Salmonella infection, 28.3 {CI, 7.2-112.2}; OR for Shigella infection, 14.5 {CI 1.5-141.0} or any recreational water exposure [OR for Campylobacter infection, 2.7 {CI, 1.5-4.8}; OR for Escherichia coli O157 infection, 7.4 {CI, 2.1-26.1}]). Suboptimal kitchen hygiene after preparation of raw meat or chicken (OR, 7.1 [CI, 2.1-24.1]) and consumption of food from restaurants were additional risks for Campylobacter infection. Infection with Salmonella was associated with the use of private wells as sources of drinking water (OR, 6.5 [CI, 1.4-29.7]), and the use of residential septic systems was a risk for both Salmonella (OR, 3.2 [CI, 1.3-7.8]) and E. coli (OR, 5.7 [CI, 1.2-27.2]) O157 infection.
Overall, non-food exposures were as important as food-related exposures with regard to their contributions to the proportion of cases. Infection prevention efforts should address kitchen hygiene practices and non-food exposures, such as recreational water exposure, in addition to food-consumption risks.
本研究旨在确定儿童散发性可报告肠道感染（REI）由细菌引起的危险因素，具体为弯曲杆菌、沙门氏菌、大肠杆菌O157或志贺氏菌（REI - B）。
配对病例对照研究。对2003年11月至2005年11月期间向华盛顿州3个县卫生部门报告的年龄<19岁的病例患者及配对的对照对象进行访谈。使用条件逻辑回归计算配对比值比（OR）。计算与感染相关暴露的人群归因风险百分比。
296例病例患者与580名对照对象配对。水上娱乐是所有研究的REI - B相关的最重要因素（接触滩涂水[沙门氏菌感染的OR为28.3{CI，7.2 - 112.2}；志贺氏菌感染的OR为14.5{CI 1.5 - 141.0}]或任何娱乐用水接触[弯曲杆菌感染的OR为2.7{CI，1.5 - 4.8}；大肠杆菌O157感染的OR为7.4{CI，2.1 - 26.1}]）。生肉或鸡肉制备后厨房卫生欠佳（OR为7.1[CI，2.1 - 24.1]）以及食用餐馆食物是弯曲杆菌感染的额外风险因素。沙门氏菌感染与使用私人井水作为饮用水源有关（OR为6.5[CI，1.4 - 29.7]），使用住宅化粪池系统是沙门氏菌（OR为3.2[CI，1.3 - 7.8]）和大肠杆菌O157感染（OR为5.7[CI，1.2 - 27.2]）的风险因素。
总体而言，非食物暴露对病例比例的贡献与食物相关暴露同样重要。除了食物消费风险外，感染预防措施应涉及厨房卫生习惯和非食物暴露，如娱乐用水接触。
