Data_Sheet_1_Do asymptomatic STEC-long-term carriers need to be isolated or decolonized? New evidence from a community case study and concepts in favor of an individualized strategy.PDF

Asymptomatic long-term carriers of Shigatoxin producing Escherichia coli (STEC) are regarded as potential source of STEC-transmission. The prevention of outbreaks via onward spread of STEC is a public health priority. Accordingly, health authorities are imposing far-reaching restrictions on asymptomatic STEC carriers in many countries. Various STEC strains may cause severe hemorrhagic colitis complicated by life-threatening hemolytic uremic syndrome (HUS), while many endemic strains have never been associated with HUS. Even though antibiotics are generally discouraged in acute diarrheal STEC infection, decolonization with short-course azithromycin appears effective and safe in long-term shedders of various pathogenic strains. However, most endemic STEC-strains have a low pathogenicity and would most likely neither warrant antibiotic decolonization therapy nor justify social exclusion policies. A risk-adapted individualized strategy might strongly attenuate the socio-economic burden and has recently been proposed by national health authorities in some European countries. This, however, mandates clarification of strain-specific pathogenicity, of the risk of human-to-human infection as well as scientific evidence of social restrictions. Moreover, placebo-controlled prospective interventions on efficacy and safety of, e.g., azithromycin for decolonization in asymptomatic long-term STEC-carriers are reasonable. In the present community case study, we report new observations in long-term shedding of various STEC strains and review the current evidence in favor of risk-adjusted concepts.</p

MOESM1 of Incidence of acquired thrombotic thrombocytopenic purpura in Germany: a hospital level study

Additional file 1. Protocol and results of systematic literature search on German epidemiology data about thrombotic thrombocytopenic purpura (TTP)

Performance characteristics of Western Blot in detecting <i>E.coli</i> O104:H4 antibodies.

<p>LR+ – likelihood ratio of a positive test; LR- -likelihood ratio of a negative test.</p><p><i>E. coli- Escherichia coli.</i></p

Positivity rates identified by the Western Blot (WB) assay among restaurant cohorts' participants (n = 66).

*<p>All patients meeting the outbreak case definition including culture-negative cases (a case was defined as a patient with clinically diagnosed hemolytic-uremic syndrome, bloody diarrhea and/or culture confirmation).</p

Predicted probability for HUS according to risk score.

<p>Grid (“rug”) above indicates observed HUS cases and corresponding scores, grid below indicates patients without HUS and corresponding scores. 95% confidence interval is in grey shades.</p

Specificity and sensitivity of the risk score.

<p>Specificity and sensitivity of the risk score.</p

Characteristics of patients treated for STEC infection without evidence for hemolytic uremic syndrome (HUS) at first presentation to health care center.

*<p>Student’s t-test and chi-squared test.</p

Laboratory values in patients without evidence of hemolytic uremic syndrome (HUS) at first presentation to health care center.

*<p>Mann-Whitney U test.</p

Receiver operating characteristic (ROC) curve indicating specificity and sensitivity of the risk score (Numbers indicate score-cutoffs).

<p>Receiver operating characteristic (ROC) curve indicating specificity and sensitivity of the risk score (Numbers indicate score-cutoffs).</p

Multivariable logistic regression model analyzing risk factors for hemolytic uremic syndrome and risk score to predict development of HUS in patients with proven STEC infection (add points to get total risk score).

*<p>vs. <75 years.</p