A SEVERE OUTBREAK OF ESCHERICHIA-COLI O157-H7 - ASSOCIATED HEMORRHAGIC COLITIS IN A NURSING-HOME
A SEVERE OUTBREAK OF ESCHERICHIA-COLI O157-H7 - ASSOCIATED HEMORRHAGIC COLITIS IN A NURSING-HOME
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DOI：
10.1056/nejm198712103172403
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发表时间：
1987-12-10
影响因子：
158.5
通讯作者：
LIOR, H
中科院分区：
文献类型：
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作者：
CARTER, AO;BORCZYK, AA;LIOR, H
1985年9月，一场大肠杆菌O157：H7肠炎的暴发影响了169名居民中的55人和一家疗养院137名工作人员中的18人。疫情的特点是两个阶段：第一波的来源可能是受污染的三明治餐，第二波与人与人之间的感染传播相适应。在老年居民中，潜伏期为4至9天(平均5.7+-)。1.2)。年龄较大和有胃切除史的患者感染风险增加(P=0.01和0.03)。暴露期间使用抗生素与继发感染有关(P=0.001)。12名受影响的居民(22%)出现溶血性尿毒症综合征，其中11人死亡。总体而言，19名(35%)受影响的居民死亡，17名(31%)死于可归因于他们的感染。症状出现后进行抗生素治疗与病情较重的患者病死率较高有关，这可能是因为病情较重的患者倾向于使用抗生素治疗。受影响的工作人员中没有并发症或死亡。在70例病例中，有30例在分离这种细菌或在粪便中发现游离维罗毒素的基础上，发现了感染产生维罗毒素的大肠杆菌O157：H7的证据。所有菌株均属于同一噬菌体类型。与这种情况相关的高发病率和死亡率强调了需要适当的食品卫生，迅速确定疾病的暴发，并在住院老年人中迅速建立感染控制技术。
In September 1985, an outbreak of Escherichia coli O157:H7 enteritis affected 55 of 169 residents and 18 of 137 staff members at a nursing home. The outbreak was characterized by two phases: a primary wave whose source was probably a contaminated sandwich meal and a secondary wave compatible with person-to-person transmission of infection. Among the elderly residents, the incubation period was 4 to 9 days (mean, 5.7 .+-. 1.2). Older age and previous gastrectomy increased the risk of acquiring the infection (P = 0.01 and 0.03, respectively). Antibiotic therapy during exposure was associated with acquiring a secondary infection (P = 0.001). Hemolytic uremic syndrome developed in 12 affected residents (22 percent), 11 of whom died. Overall, 19 (35 percent) of the affected residents died, 17 (31 percent) from causes attributable to their infection. Antibiotic therapy after the onset of symptoms was associated with a higher case fatality rate in the more severe cases, possibly because patients with more severe disease tended to be treated with antibiotics. There were no complications or deaths among the affected members of the staff. Evidence of infection by verotoxin-producing E. coli O157:H7 was detected in 30 of 70 cases on the basis of isolation of this organism or demonstration of free verotoxin in stools. All isolates belonged to the same phage type. The high morbidity and mortality associated with this condition emphasize the need for proper food hygiene, rapid identification of outbreaks of disease, and prompt institution of infection-control techniques among the institutionalized elderly.