PDF(Pubmed)
Abstract：
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.
摘要：
无症状的长期带菌者产志贺毒素大肠杆菌（STEC）被认为是STEC传播的潜在来源。通过STEC的进一步传播预防疫情是公共卫生的优先事项。因此，在许多国家，卫生当局对无症状的STEC携带者实施了深远的限制。各种STEC菌株可能会导致严重的出血性结肠炎并发危及生命的溶血性尿毒综合征（HUS），而许多地方性毒株从未与HUS相关。尽管在急性腹泻STEC感染中通常不建议使用抗生素，短程阿奇霉素的脱色在各种病原菌的长期脱落中似乎是有效和安全的。然而,大多数地方性STEC菌株的致病性较低,很可能既不需要抗生素去定植治疗,也不需要采取社会排斥政策.适应风险的个性化策略可能会大大减轻社会经济负担，最近一些欧洲国家的国家卫生当局提出了这种策略。这个,然而,要求澄清菌株特异性致病性，人与人之间感染的风险以及社会限制的科学证据。此外，安慰剂对照前瞻性干预措施的疗效和安全性，例如，阿奇霉素用于无症状的长期STEC携带者的去定植是合理的。在目前的社区案例研究中，我们报告了各种STEC菌株长期脱落的新观察结果,并回顾了目前的证据,支持风险调整后的概念.
