Guidance for public health laboratories : isolation and characterization of Shiga toxin-producing Escherichia coli (STEC) from clinical specimens
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Guidance for public health laboratories : isolation and characterization of Shiga toxin-producing Escherichia coli (STEC) from clinical specimens

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      Clinical laboratories are the front line in detecting Shiga toxin-producing Escherichia coli (STEC) disease. They are responsible for the initial detection of suspect cases by testing primary specimens. In October 2009, a report entitled “Recommendations for Diagnosis of Shiga toxin-producing Escherichia coli Infections by Clinical Laboratories” stated that clinical laboratories should simultaneously test all stools submitted for the routine diagnosis of acute, community-acquired diarrhea for E. coli O157:H7 by culture and for non-O157 STEC by an assay that detects Shiga toxins or the genes encoding these toxins regardless of patient age, time of year, or presence or absence of blood in the stool (see below). As part of these recommendations, clinical laboratories should forward, as soon as possible, all confirmed and presumptive O157 STEC isolates and Shiga toxin-positive broths that do not yield O157 STEC to a public health laboratory for organism isolation and characterization. These recommendations are based on evidence which indicates that the use of enzyme immunoassays (EIA) for screening, in conjunction with culture, followed by molecular characterization of isolates at the public health laboratory, provides increased diagnostic sensitivity compared with the use of either method alone.

      As a companion piece to the clinical laboratory recommendations, this document provides recommendations to public health laboratories for the isolation of STEC from Shiga toxin-positive stools/specimens and for the characterization of isolates including verification, virulence gene detection, and PFGE analysis. These public health recommendations, in conjunction with the recommendations for clinical laboratories, provide a solid framework for the efficient and rapid diagnosis of this important group of pathogens.

      These recommendations are the result of a collaborative effort of public health microbiologists from ten states, the Association of Public Health Laboratories, and the Centers for Disease Control and Prevention.

      Prepared by the APHL STEC Work Group.

      This publication was supported by Cooperative Agreement Number #1U60HM000803 from CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

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