Shiga Toxin-Producing E. coli Infections Associated with Flour.
Shiga Toxin-Producing E. coli Infections Associated with Flour.
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DOI：
10.1056/nejmoa1615910
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发表时间：
2017-11-23
期刊：
影响因子：
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通讯作者：
Neil KP
中科院分区：
文献类型：
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作者：
Crowe SJ;Bottichio L;Shade LN;Whitney BM;Corral N;Melius B;Arends KD;Donovan D;Stone J;Allen K;Rosner J;Beal J;Whitlock L;Blackstock A;Wetherington J;Newberry LA;Schroeder MN;Wagner D;Trees E;Viazis S;Wise ME;Neil KP
2016 年，一个跨辖区小组调查了一次产志贺毒素大肠杆菌 (STEC) 血清群 O121 和 O26 感染的爆发，该感染与一家大型国内生产商受污染的面粉有关。病例被定义为发病时间为2015年12月21日至2016年9月5日之间的暴发菌株感染。为了确定与暴发相关的暴露情况，将暴发病例与非STEC肠道疾病病例进行了比较，并根据年龄组、性别和居住州进行了匹配。收集疑似与疫情相关的产品进行 STEC 检测，并寻找共同污染点。对临床和食品样本中的分离株进行了全基因组测序。 24个州共发现56例病例。 22 组匹配组的单变量精确条件逻辑回归模型显示，感染与使用一种品牌面粉（比值比，21.04；95% 置信区间 [CI]，4.69 至 94.37）以及品尝未烘烤的自制面团或面糊（比值比，36.02；95% CI，4.63 至 280.17）显着相关。实验室测试从面粉样本中分离出了爆发菌株，全基因组测序显示，从临床和食品样本中分离出的菌株在基因上彼此密切相关。追溯调查发现了一个常见的面粉生产设施。这项调查表明生面粉是 STEC 感染爆发的来源。尽管生面粉是一种低水分食品，但它可能是食源性病原体的传播媒介。
In 2016, a multijurisdictional team investigated an outbreak of Shiga toxin–producing Escherichia coli (STEC) serogroup O121 and O26 infections linked to contaminated flour from a large domestic producer. A case was defined as infection with an outbreak strain in which illness onset was between December 21, 2015, and September 5, 2016. To identify exposures associated with the outbreak, outbreak cases were compared with non-STEC enteric illness cases, matched according to age group, sex, and state of residence. Products suspected to be related to the outbreak were collected for STEC testing, and a common point of contamination was sought. Whole-genome sequencing was performed on isolates from clinical and food samples. A total of 56 cases were identified in 24 states. Univariable exact conditional logistic-regression models of 22 matched sets showed that infection was significantly associated with the use of one brand of flour (odds ratio, 21.04; 95% confidence interval [CI], 4.69 to 94.37) and with tasting unbaked homemade dough or batter (odds ratio, 36.02; 95% CI, 4.63 to 280.17). Laboratory testing isolated the outbreak strains from flour samples, and whole-genome sequencing revealed that the isolates from clinical and food samples were closely related to one another genetically. Trace-back investigation identified a common flour-production facility. This investigation implicated raw flour as the source of an outbreak of STEC infections. Although it is a low-moisture food, raw flour can be a vehicle for foodborne pathogens.