Shiga toxin-producing Escherichia coli in children with diarrhea: a prospective point-of-care study

J Pediatr. 2002 Aug;141(2):172-7. doi: 10.1067/mpd.2002.125908.


Objective: To conduct a prospective cohort study to determine the frequency and characteristics of Shiga toxin (Stx)-producing Escherichia coli (STEC) infections in children with diarrhea attending an emergency department and a private clinic in Seattle, Washington.

Methods: Between November 1998 and October 2001, 1851 stools were processed for STEC by sorbitol-MacConkey (SMAC) agar screening and a commercial Stx enzyme immunoassay (EIA).

Results: STEC belonging to serotypes O157:H7 (n = 28), O103:H2 (n = 4), O118:H16 (n = 2), O26:H11, O111:nonmotile, O111:H8, O121:H19, and O rough:H11 (n = 1 each) were recovered from 39 (2.1%) stools. EIA and SMAC agar detected 89% and 100% of the patients with E coli O157:H7, respectively. E coli O157:H7-infected patients had significantly higher frequencies of bloody stools, fecal leukocytes, and abdominal tenderness and shorter symptom duration. Hemolytic uremic syndrome developed in 5 (18%) and none of the children infected with E coli O157:H7 and non-O157:H7 STEC, respectively (P =.30).

Conclusions: E coli O157:H7 is the predominant STEC in this population. Children infected with E coli O157:H7 have clinical presentations different from those whose stools contain non-O157:H7 STEC. Culture and Stx detection are needed to optimally detect STEC of all serotypes in stools. SMAC agar screening should not be replaced by EIA.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Child
  • Child Welfare
  • Child, Preschool
  • Cohort Studies
  • Diarrhea / microbiology*
  • Diarrhea / therapy
  • Emergency Service, Hospital
  • Escherichia coli Infections / microbiology
  • Escherichia coli Infections / therapy
  • Escherichia coli* / classification
  • Escherichia coli* / isolation & purification
  • Escherichia coli* / metabolism
  • Feces / microbiology
  • Female
  • Humans
  • Infant
  • Infant Welfare
  • Male
  • Point-of-Care Systems*
  • Prospective Studies
  • Shiga Toxin / adverse effects*
  • Shiga Toxin / biosynthesis*
  • Statistics as Topic
  • Washington


  • Shiga Toxin