National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5AT, UK.
Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
J Med Microbiol. 2022 Aug;71(8). doi: 10.1099/jmm.0.001579.
Shiga toxin-producing (STEC) O157:H7 has been the most clinically significant STEC serotype in the UK for over four decades. Over the last 10 years we have observed a decrease in STEC O157:H7 and an increase in non-O157 STEC serotypes, such as O145:H28. Little is known about the microbiology and epidemiology of STEC belonging to CC32 (including O145:H28) in the UK. The aim of this study was to integrate genomic data with patient information to gain a better understanding of the virulence, disease severity, epidemic risk assessment and population structure of this clinically significant clonal complex. Isolates of belonging to CC32 (=309) in the archives of public health agencies in the UK and Ireland were whole-genome-sequenced, virulence-profiled and integrated with enhanced surveillance questionnaire (ESQ) data, including exposures and disease severity. Overall, diagnoses of STEC belonging to CC32 (290/309, 94 %) in the UK have increased every year since 2014. Most cases were female (61 %), and the highest proportion of cases belonged to the 0-4 age group (53/211,25 %). The frequency of symptoms of diarrhoea (92 %), abdominal pain (84 %), blood in stool (71 %) and nausea (51 %) was similar to that reported in cases of STEC O157:H7, although cases of STEC CC32 were more frequently admitted to hospital (STEC CC32 48 % vs O157:H7 34 %) and/or developed haemolytic uraemic syndrome (HUS) (STEC CC32 9 % vs O157:H7 4 %).The majority of STEC isolates (268/290, 92 %) had the / virulence gene combination, most commonly associated with progression to STEC HUS. There was evidence of person-to-person transmission and small, temporally related, geographically dispersed outbreaks, characteristic of foodborne outbreaks linked to nationally distributed products. We recommend more widespread use of polymerase chain reaction (PCR) for the detection of all STEC serogroups, the development of consistent strategies for the follow-up testing of PCR-positive faecal specimens, the implementation of more comprehensive and standardized collection of epidemiological data, and routine sharing of sequencing data between public health agencies worldwide.
产志贺毒素（STEC）O157:H7 四十多年来一直是英国最具临床意义的 STEC 血清型。在过去的 10 年中，我们观察到 STEC O157:H7 的数量减少，而非 O157 STEC 血清型（如 O145:H28）的数量增加。关于英国属于 CC32（包括 O145:H28）的 STEC 的微生物学和流行病学知之甚少。本研究的目的是整合基因组数据和患者信息，以更好地了解这种具有临床意义的克隆复合体的毒力、疾病严重程度、流行病学风险评估和种群结构。来自英国和爱尔兰公共卫生机构档案的属于 CC32（=309）的分离株进行了全基因组测序、毒力分析，并与增强监测问卷（ESQ）数据（包括暴露和疾病严重程度）整合。总体而言，自 2014 年以来，英国每年诊断出的属于 CC32（290/309，94%）的 STEC 病例均有所增加。大多数病例为女性（61%），比例最高的病例属于 0-4 岁年龄组（53/211，25%）。腹泻（92%）、腹痛（84%）、粪便带血（71%）和恶心（51%）的症状频率与 O157:H7 报告的 STEC 病例相似，尽管 STEC CC32 病例更频繁地住院（STEC CC32 48%比 O157:H7 34%）和/或发展溶血性尿毒综合征（HUS）（STEC CC32 9%比 O157:H7 4%）。大多数 STEC 分离株（268/290，92%）具有 / 毒力基因组合，最常见于进展为 STEC HUS。有证据表明人与人之间的传播以及与全国分布产品有关的食源性暴发相关的小型、时间相关、地理分散的暴发。我们建议更广泛地使用聚合酶链反应（PCR）检测所有 STEC 血清群，制定一致的策略对 PCR 阳性粪便标本进行后续检测，更全面和标准化地收集流行病学数据，并在全球公共卫生机构之间例行共享测序数据。
