Infect Chemother.  2017 Dec;49(4):275-281. 10.3947/ic.2017.49.4.275.

Community-acquired Escherichia coli Enteritis in Korean Children: The Clinical Application of a Stool Polymerase Chain Reaction Assay

• Kim Y
• Kim HJ
• Lim S
• Bae KS
• Han SB
• Jeong DC
• Kang JH
• Shin GJ
• Lee GD
• Park YJ

• KMID: 2399195
• DOI: http://doi.org/10.3947/ic.2017.49.4.275

Abstract

BACKGROUND
Although Escherichia coli is a common cause of bacterial enteritis in Korea, reports on community-acquired E. coli enteritis in Korean children are scarce. This study aimed to determine the clinical characteristics and pathotype distribution of community-acquired E. coli enteritis diagnosed by a multiplex polymerase chain reaction (PCR) assay in Korean children.
MATERIALS AND METHODS
The medical records of children aged 18 years or less who were diagnosed with acute gastroenteritis by the attending physician between 2013 and 2016 were retrospectively reviewed. The clinical characteristics of children diagnosed with E. coli enteritis were investigated and compared with those diagnosed with Salmonella enteritis. E. coli and Salmonella infections were diagnosed by a stool PCR assay.
RESULTS
Among 279 children, in whom PCR assays for E. coli and Salmonella spp. were performed, Salmonella enteritis and E. coli enteritis were diagnosed in 43 (15.4%) and 39 (14.0%) children, respectively. Among the 39 children with E. coli enteritis, enteropathogenic E. coli (n=21, 53.8%) and enteroaggregative E. coli (n=15, 38.4%) were the most common causative agents. Empirical antibiotics were administered to 33 (84.6%) children. A total of 31 (79.5%) children developed fever, and 25 (80.6%) of them had the fever for 3 days or less, which resolved a median of 1 day (range 0-3 days) after hospitalization. The most frequent gastrointestinal symptom was diarrhea (n=36, 92.3%). Significantly more children with E. coli enteritis were aged 2 years or less as compared with those with Salmonella enteritis (41.0% vs. 21.9%, P = 0.021). Children with Salmonella enteritis more frequently complained of fever (97.7% vs. 79.5%, P = 0.012), abdominal pain (90.7% vs. 64.1%, P = 0.004), and hematochezia (46.5% vs. 10.3%, P < 0.001) than those with E. coli enteritis. Erythrocyte sedimentation rate and C-reactive protein levels were significantly higher in children with Salmonella enteritis than those with E. coli enteritis (P < 0.001).
CONCLUSION
Enteropathogenic E. coli was the most frequent pathotype in Korean children with E. coli enteritis that caused mild clinical symptoms. A stool PCR assay for E. coli may be useful for epidemiological purpose and for an early diagnosis of E. coli enteritis.

Keyword

Escherichia coli; Polymerase chain reaction; Child; Korea

MeSH Terms

Abdominal Pain
Anti-Bacterial Agents
Blood Sedimentation
C-Reactive Protein
Child*
Diarrhea
Early Diagnosis
Enteritis*
Enteropathogenic Escherichia coli
Escherichia coli*
Escherichia*
Fever
Gastroenteritis
Gastrointestinal Hemorrhage
Hospitalization
Humans
Korea
Medical Records
Multiplex Polymerase Chain Reaction
Polymerase Chain Reaction*
Retrospective Studies
Salmonella
Salmonella Infections
Anti-Bacterial Agents
C-Reactive Protein