Treatment of Shiga Toxin–Producing Escherichia coli Infections

Real-Time PCR Assay for Detection and Differentiation of Shiga Toxin-Producing Escherichia coli from Clinical Samples

“…This increased sensitivity is a clear advantage, as bacterial loads decrease rapidly during infection, particularly if cultures are not performed early in the illness (7,14). Low EIA sensitivity was also reported in other studies when PCR was used as the gold standard (10), as well as in comparison to culture (9). The isolation of either STEC O186 or STEC O111 (both isolates negative for rfbE O157 ) from two specimens that were reproducibly positive for all three targets, including rfbE O157 (Table 1), indicates possible mixed STEC infections.…”

“…Most other STEC serotypes ferment sorbitol (as do most commensal E. coli strains) and have few unifying phenotypes other than toxin production; therefore, toxin assays of overnight broth cultures are used to detect these agents in stools. The Centers for Disease Control and Prevention (CDC) recommends routine laboratory testing for Shiga toxin-producing bacteria (8), but toxin assays are inexplicably suboptimal for the detection of toxin-producing E. coli O157:H7 (9).…”

Protection against Shiga-Toxigenic Escherichia coli by Non-Genetically Modified Organism Receptor Mimic Bacterial Ghosts

“…Antibiotic therapy is contraindicated in cases of human STEC infection, owing to the risk of induction of phage stx gene expression by the bacterial SOS response and/or increased release of Stx into the gut lumen due to antibiotic-induced bacterial lysis (26). Management of patients is principally supportive, and early intravenous blood volume expansion is recommended, as it may provide protection against anuric HUS (26).…”

“…Management of patients is principally supportive, and early intravenous blood volume expansion is recommended, as it may provide protection against anuric HUS (26). During the 2011 European outbreak, the anti-C5 monoclonal antibody eculizumab, which has been used for treating atypical (non-Stx-related) HUS, was used empirically in some patients but without clear evidence of benefit (26).…”

“…Management of patients is principally supportive, and early intravenous blood volume expansion is recommended, as it may provide protection against anuric HUS (26). During the 2011 European outbreak, the anti-C5 monoclonal antibody eculizumab, which has been used for treating atypical (non-Stx-related) HUS, was used empirically in some patients but without clear evidence of benefit (26). More encouragingly, intravenous administration of mouse-human chimeric monoclonal antibodies to Stx1 and Stx2 has been shown to protect mice against intraperitoneal injection of purified Stx or oral challenge with Stx2-producing STEC (27).…”