Over a 9-day period in February 1995, 16 newborn babies (age range 2–11 days) and 3 infants (24, 47 and 180 days of age) in a neonatal nursery ward developed diarrhoea accompanied by pyrexia and ...weight loss. Known enteropathogens were not detected in their stools but Escherichia coli displaying aggregative adherence to HEp-2 cells (enteroaggregative E. coli) were found in 12 (63%) ill infants and in none of 5 well neonates (P = 0·02). The illness lasted 3–9 days (mean 5·2) in 16 babies, whereas in 3 neonates it showed a protracted course of 18–20 days. The source of infection and the mode of transmission remained unclear. The outbreak isolates manifested properties common in this new group of diarrhoeagenic E. coli: mannose-resistant haemagglutination, haemolysis on blood agar, and clump formation in liquid culture medium. They belonged to the O4 E. coli serogroup and expressed multiple antibiotic resistance.
Nosocomial bloodstream infections (BSI) create a serious health problem in hospitals all over the world. The objectives of our study were to explore putative disease markers and potential risk ...factors with nosocomial BSI in patients in intensive care units (ICU) and non-ICU patients and to determine risk factors associated with increased 28-day mortality rate in patients with nosocomial BSI acquired in combined medical-surgical ICU. However, the major purposes of this report were to identify epidemiologic differences between nosocomial BSI acquired in ICU and non-ICU, as well as analyses outcomes for patients with nosocomial BSI acquired in ICU.
A 1-year prospective cohort study was performed to determine the incidence of nosocomial BSI in hospitalized patients. Patient characteristics, risk factors related to health care, and source of infection of patients with BSI acquired in non-ICU were compared with those patient with BSI acquired in ICU. Also, nested case-control study of patients to nosocomial BSI acquired in ICU was performed to evaluate outcome. Patients were identified by active surveillance and positive blood culture during the study period.
The incidence of nosocomial BSI was 2.2 per 1000 admission in non-ICU patients and 17.4 per 1000 admission in ICU patients. The 28-day crude mortality rate was 69% in ICU patients. A multivariate model showed that nasogastric tube (RR, 25.1; 95% CI: 3.845-163.85;
P
=
.001), mechanical ventilation (RR, 13.04; 95% CI: 1.974-96.136;
P
=
.008), and H2 blockers (RR, 12.16; 95% CI: 1.748-84.623;
P
=
.012) were more prevalent among patients with BSI acquired in ICU, and aggressive procedures (RR, 8.65; 95% CI: 1.70-44.00;
P
=
.009) were more prevalent among patients with BSI acquired in non-ICU patients. Risk factors independently associated with increased 28-day mortality rate in ICU patients were mechanical ventilation (OR, 8.63; 95% CI: 1.5-49.8;
P
=
.016) and SAPS II >40 (OR, 6.0; 95% CI: 1.0-35.7;
P
=
.049). The most common isolated nosocomial BSI pathogens (in both groups of patients) were coagulase-negative
staphylococci (21%),
Staphylococcus aureus (14%), and
Klebsiella species (13%).
Klebsiella species was the only organism independently influencing the poor outcome of nosocomial BSI in ICU patients (OR, 4.3; 95% CI: 1.2-15.3;
P
=
.022).
Our results show epidemiologic differences between non-ICU and ICU BSI. Also, this study suggests that severity of underlying host conditions, mechanical ventilation, and microbial agents (
Klebsiella species) affect the outcome of NBI in patients in ICU.
Faecal samples of 2660 domestic animals from 116 farms and 956 samples of food were examined for the presence of Shiga toxin-producing Escherichia coli (STEC). STEC was recovered from 126 (15·3%) ...cattle, 135 (11·3%) pigs, 135 (66·8%) sheep, 31 (73·8%) goats, 4 (1%) chicken, and 15 (1·6%) food samples. Of all STEC isolates, 21·5, 25·8 and 15% produced enterohaemolysin, α-haemolysin, and aerobactin respectively, 1·6% displayed localized adherence (LA) to HEp-2 cells, 27·6% were sorbitol negative, and 30% were resistant to antibiotics. Only 14 (3·1%) of the STEC isolates belonged to human infection-associated serogroups (O26, O55, O111, O128 and O157), designated as enterohaemorrhagic E. coli (EHEC). This study revealed that STEC are prevalent in domestic animals, and to a lesser extent in food of animal origin in Serbia, but the absence of a EHEC phenotypic profile (characteristic serogroup, LA, enterohaemolysin production) in most animal STEC strains may explain the low incidence of human STEC infection in this part of the world.
Rifampin-resistant Escherichia coli are known to be poor colonizers of the animal intestine. In this report, we show that the colonizing ability of rifampin-resistant E. coli cells is increased ...dramatically in the presence of the aerobactin-mediated iron(III) uptake system. In contrast, the colonization by nalidixic acid-resistant E. coli does neither depend on the aerobactin-iron(III) nor on the dicitrate-iron(III) uptake system. Likewise, it does not depend on the production of the siderophore enterochelin.
The presence of enterotoxigenic and enteropathogenic Escherichia coli (ETEC and EPEC, respectively) was investigated in stool specimens of 1082 preschool children with diarrhoea and in stools of 335 ...healthy controls in localities in southern Yugoslavia, as well as in 566 children with diarrhoea and in 231 controls living in northern part of the country, during the seasonal peak (August-November) of enteric diseases in 1986. ETEC were found in 114 (10·5%) children with diarrhoea and in 14 (4·2%) controls (P < 0·001) in the southern part, and in 26 (4·6%) ill children and one (0·4%) well child (P < 0·005) in the northern part of Yugoslavia. EPEC were isolated from stools of 85 (7·9%) children with diarrhoea and of 14 (4·2%) well children (P < 0·05) in localities of southern Yugoslavia, and from 22 (3·9%) ill children and from 10 (4·3%) controls in northern Yugoslavia. Nineteen EPEC strains expressed localized adherence to HEp-2 tissue culture cells; all were isolated from stools of ill children. In southern Yugoslavia, where other enteropathogens were sought, the most commonly found agents in ill children were shigellae (17·5%), rotavirus (11·8%), ETEC, and EPEC. Potential pathogens were detected in 44·5% cases of sporadic diarrhoea and in 15·8% controls. This study revealed that ETEC were associated with acute diarrhoeal disease in Yugoslav preschool children. On the other hand, the diagnosis of EPEC-diarrhoea by routine determination of serogroup established the association of these agents with sporadic diarrhoea only in the 0-2 years age categories in all investigated localities. In the less developed southern part of Yugoslavia bacteria were the predominant causative agents of enteric illness during the seasonal peak of this disease.
Stool specimens from 631 children with acute diarrhoea and from 277 healthy controls were tested for the presence of non-enteropathogenic, non-enterotoxigenic Escherichia coli strains which mediated ...mannose-resistant haemagglutination of human erythrocytes (MRHA + ). Fifty-nine (34·9%) of 169 isolated MRHA + strains but none of 210 MRHA - strains exhibited diffuse adherence (DA+) to HEp–2 cells. DA+ strains were found in 37 (5·9%) children with diarrhoea and in 22 (7·9%) controls. MRHA + /DA + strains in comparison to MRHA + /DA - strains significantly less frequently expressed P fimbriae (10·7 vs. 73·6%), haemolysin production (12·5 vs. 63·2%), and MRHA of other species erythrocytes (21·4 vs. 84%). These data demonstrate that E. coli which exhibit the diffuse pattern of adherence to HEp–2 cells also cause MRHA of human erythrocytes. Since these strains were found with similar frequencies in children with and without diarrhoea it seems that DA is not a marker of enteropathogenicity of E. coli.
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