Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany ; Berlin School of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
PLoS One. 2013 Nov 14;8(11):e78180. doi: 10.1371/journal.pone.0078180. eCollection 2013.
The clinical spectrum following infection with Shiga toxin-producing Escherichia coli (STEC) is wide ranging and includes hemorrhagic colitis and life-threatening hemolytic uremic syndrome (HUS). Severity of STEC illness depends on patients' age and strongly on the infecting strains' virulence. Serogroup O157 is often assumed to be more virulent than others. Age-adjusted population-based data supporting this view are lacking thus far. We conducted a large retrospective cohort study among patients of community-acquired gastroenteritis or HUS diagnosed with STEC infection, reported in Germany January 2004 through December 2011. Age-adjusted risks for reported hospitalization and death, as proxies for disease severity, were estimated for STEC serogroups separately, and compared with STEC O157 (reference group) using Poisson regression models with robust error estimation. A total of 8,400 case-patients were included in the analysis; for 2,454 (29%) and 30 (0.4%) hospitalization and death was reported, respectively. Highest risks for hospitalization, adjusted for age and region of residence, were estimated for STEC O104 (68%; risk ratio [RR], 1.33; 95% confidence interval [CI], 1.19-1.45), followed by STEC O157 (46%). Hospitalization risks for the most prevalent non-O157 serogroups (O26, O103, O91, O145, O128, O111) were consistently and markedly lower than for O157, with the highest RR for O145 (0.54; 95% CI, 0.41-0.70) and the lowest for O103 (0.27; 95% CI, 0.20-0.35). Mortality risk of O104 was similar to O157 (1.2% each), but the group of all other non-O157 STEC had only 1/10 the risk (RR, 0.09; 95% CI, 0.02-0.32) compared to O157. The study provides population-based and age-adjusted evidence for the exceptional high virulence of STEC O157 in relation to non-O157 STEC other than O104. Timely diagnosis and surveillance of STEC infections should prioritize HUS-associated E. coli, of which STEC O157 is the most important serogroup.
产志贺毒素大肠杆菌（STEC）感染后的临床谱广泛，包括出血性结肠炎和危及生命的溶血性尿毒综合征（HUS）。STEC 疾病的严重程度取决于患者的年龄，并且强烈取决于感染菌株的毒力。血清群 O157 通常被认为比其他血清群更具毒力。但到目前为止，还缺乏支持这一观点的基于人群的年龄调整数据。我们对德国 2004 年 1 月至 2011 年 12 月报告的社区获得性胃肠炎或 STEC 感染诊断为 HUS 的患者进行了一项大型回顾性队列研究。使用泊松回归模型和稳健误差估计，分别估计 STEC 血清群的住院和死亡报告风险（作为疾病严重程度的替代指标），并与 STEC O157（参考组）进行比较。共纳入 8400 例病例患者；分别有 2454 例（29%）和 30 例（0.4%）报告住院和死亡。调整年龄和居住地后，估计 STEC O104 的住院风险最高（68%；风险比 [RR]，1.33；95%置信区间 [CI]，1.19-1.45），其次是 STEC O157（46%）。最常见的非 O157 血清群（O26、O103、O91、O145、O128、O111）的住院风险始终明显低于 O157，O145 的 RR 最高（0.54；95%CI，0.41-0.70），O103 的 RR 最低（0.27；95%CI，0.20-0.35）。O104 的死亡率与 O157 相似（各为 1.2%），但所有其他非 O157 STEC 组的风险仅为 O157 的十分之一（RR，0.09；95%CI，0.02-0.32）。该研究提供了基于人群和年龄调整的证据，证明 STEC O157 相对于非 O157 STEC （除 O104 外）具有异常高的毒力。及时诊断和监测 STEC 感染应优先考虑与 HUS 相关的大肠杆菌，其中 STEC O157 是最重要的血清群。
