An Outbreak of Multi-drug Resistant Enterotoxigenic Escherichia coli (ETEC) Infection among Infants in a City of Southwest China, 2012

Authors

  • Xi Chen Chinese Field Epidemiology Training Program, Chinese Center for Disease Control, Beijing, China; Zigong Center of Disease Control, Sichuan Province, China
  • W Yuan Chinese Field Epidemiology Training Program, Chinese Center for Disease Control, Beijing, China; Sichuan Center of Disease Control, Sichuan Province, China
  • L J Zhang Chinese Field Epidemiology Training Program, Chinese Center for Disease Control, Beijing, China
  • Q Li Zigong Center of Disease Control, Sichuan Province, China
  • Z D Zhang Zigong Center of Disease Control, Sichuan Province, China
  • H Wang Zigong Center of Disease Control, Sichuan Province, China
  • Y J Sun Chinese Field Epidemiology Training Program, Chinese Center for Disease Control, Beijing, China; Zhuhai Center of Disease Control, Guangdong Province, China

DOI:

https://doi.org/10.59096/osir.v8i3.263273

Keywords:

multi-drug resistant, ETEC, hospital-associated infections

Abstract

Multi-drug resistant (MDR) diarrheagenic Escherichia coli has rapidly spread worldwide and represents the most serious threat to management of diarrhea in developing countries. We investigated an outbreak of severe diarrhea in a neonatal ward during 1 Apr-30 Jul 2012, where 60 suspected cases were found. To identify possible sources of infection, we conducted a case-control study through which we identified the increased infection risk of 4.6 fold for each liter of bottle milk feeding (OR = 4.6, 95%CI = 1.50-14.70). E. coli serotype O128:H45 with virulence gene stIb was found in 14 out of 18 stool or diaper swab samples and were MDR. This was a neonatal diarrhea outbreak caused by multi-drug resistant E. coli while bottle milk feeding was the possible vehicle in facilitating the transmission. This outbreak reinforces that enterotoxigenic Escherichia coli (ETEC) should be considered when the clinical picture is consistent and common gastrointestinal pathogens are not found.

References

Qadri F, Das SK, Faruque AS, Fuchs GJ, Albert MJ, Sack RB, et al. Prevalence of toxin types and colonization factors in enterotoxigenic Escherichia coli isolated during a 2-year period from diarrheal patients in Bangladesh. J Clin Microbiol. 2000 Jan; 38(1):27-31.

Rao MR, Abu-Elyazeed R, Savarino SJ, Naficy AB, Wierzba TF, Abdel-Messih I, et al. High disease burden of diarrhea due to enterotoxigenic Escherichia coli among rural Egyptian infants and young children. J Clin Microbiol. 2003 Oct; 41(10):4862-4.

Qadri F, Svennerholm AM, Faruque AS, Sack RB. Enterotoxigenic Escherichia coli in developing countries: epidemiology, microbiology, clinical features, treatment, and prevention. Clin Microbiol Rev. 2005 Jul. 18(3): 465-83.

Black RE, Merson MH, Huq I, Alim AR, Yunus M. Incidence and severity of rotavirus and Escherichia coli diarrhea in rural Bangladesh. Implications for vaccine development. Lancet. 1981 Jan;1(8212):141-3.

Qadri F, Wenneras C, Ahmed F, Asaduzzaman M, Saha D, Albert MJ, et al. Safety and immunogenicity of an oral, inactivated enterotoxigenic Escherichia coli plus cholera toxin B subunit vaccine in Bangladeshi adults and children. Vaccine. 2000 Jun; 18(24):2704-12.

Holmgren J, Svennerholm AM, Lindblad M. Receptor-like glycocompounds in human milk that inhibit classical and El Tor Vibrio cholerae cell adherence (hemagglutination). Infect Immun. 1983 Jan; 39(1):147-54.

Jingsong Y, Yuyan L, Hui L, Lin J, Chaochen L. Pathogenic Escherichia coli surveillance result analysis in Fujian Province, 2010-2012. Preventive Medicine Forum. 2014;3:161-2.

Kun G, Xuetao Z, Qian H, Huitin H. Pathogenic Escherichia coli test and epidemic state analysis on intestinal infection. International Journal of Laboratory Medicine. 2014;7:853-4.

National Health and Family Planning Commission. China diagnostic criteria and principles of management of infectious diarrhea. 1997 Oct 6 [cited 2015 Aug 1]. <http://www.nhfpc.gov.cn/zwgkzt/s9491/201212/34041.shtml>

Brandal LT, Lindstedt BA, Aas L, Stavnes TL, Lassen J, Kapperud G. Octaplex PCR and fluorescence-based capillary electrophoresis for identification of human diarrheagenic Escherichia coli and Shigella spp. J Microbiol Methods. 2007 Feb;68(2):331-41.

Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; nineteenth informational supplement. CLSI document M100-S22. Wayne, PA: Clinical and Laboratory Standards Institute; 2009.

Centers for Disease Control and Prevention. Epi Info™ 7.1.5 [cited 2015 Aug 1]. <http://wwwn.cdc.gov/epiinfo/7/>

National Health and Family Planning Commission. Hygienic standards for disinfection in hospitals. 1997 Oct 6 [cited 2015 Aug 1]. <http://www.moh.gov.cn/zwgkzt/s9488/201410/0e39d3b287e347ccb317a16ae2a4899f.shtml>

Huilan S, Zhen LG, Mathan MM, Mathew MM, Olarte J, Espejo R, et al. Etiology of acute diarrhea among children in developing countries: a multicentre study in five countries. Bull World Health Organ. 1991; 69(5):549-55.

Kosek M, Bern C, Guerrant RL. The global burden of diarrheal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ. 2003; 81(3):197-204.

Sack DA, Kaminsky DC, Sack RB, Itotia JN, Arthur RR, Kapikian AZ, et al. Prophylactic doxycycline for travelers' diarrhea. Results of a prospective double-blind study of Peace Corps volunteers in Kenya. N Engl J Med. 1978 Apr; 298(14):758-63.

Sack RB, Froehlich JL, Zulich AW, Hidi DS, Kapikian AZ, Orskov F, et al. Prophylactic doxycycline for travelers' diarrhea: results of a prospective double-blind study of Peace Corps volunteers in Morocco. Gastroenterology. 1979 Jun; 76(6):1368-73.

Levine MM, Nalin DR, Hoover DL, Bergquist EJ, Hornick RB, Young CR. Immunity to enterotoxigenic Escherichia coli. Infect Immun. 1979 Mar; 23(3):729-36.

Black RE, Merson MH, Rowe B, Taylor PR, Abdul AAR, Gross RJ, et al. Enterotoxigenic Escherichia coli diarrhoea: acquired immunity and transmission in an endemic area. Bull World Health Organ. 1981;59(2):263-8.

Downloads

Published

2015-09-30

How to Cite

Chen, X., Yuan, W., Zhang, L. J., Li, Q., Zhang, Z. D., Wang, H., & Sun, Y. J. (2015). An Outbreak of Multi-drug Resistant Enterotoxigenic Escherichia coli (ETEC) Infection among Infants in a City of Southwest China, 2012. Outbreak, Surveillance, Investigation & Response (OSIR) Journal, 8(3), 8–14. https://doi.org/10.59096/osir.v8i3.263273

Issue

Vol. 8 No. 3 (2015): July - September

Section

Original article

License

Copyright (c) 2023 Outbreak, Surveillance, Investigation & Response (OSIR) Journal

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.