Introduction. Shiga toxin-producing Escherichia coli (STEC) can cause severe disease and large outbreaks. In England, the incidence and clinical significance of STEC serogroups other than O157 (non-O157) is unknown due to a testing bias for detection of STEC O157. Since 2013, the implementation of PCR to detect all STEC serogroups by an increasing number of diagnostic laboratories has led to an increase in the detection of non-O157 STEC. Hypothesis/Gap statement. Due to a bias in testing methodologies to select for STEC serogroup O157 in frontline diagnostic laboratories in most countries, very little surveillance data have been previously generated on non-O157 STEC. Aim. Five years (2014–2018) of STEC national surveillance data were extracted and descriptive analysis undertaken to assess disease severity of non-O157 STEC strains. Methods. Data from 1 January 2014 to 31 December 2018 were extracted from the National Enhanced Surveillance System for STEC and analysed. Results. The implementation of Gastrointestinal Polymerase Chain Reaction (GI-PCR) has resulted in a four-fold increase in the detection of non-O157 STEC cases between 2014 and 2018. There were 2579 cases infected with 97 different non-O157 serogroups. The gender distribution was similar amongst STEC O157 and non-O157 STEC cases with 57 and 56 % of cases being female respectively, but a significantly higher proportion of cases (P <0.001) under 5 years of age was observed among STEC O157 (22 %) cases compared to non-O157 STEC (14 %). The most common non-O157 serogroups were O26 (16 %), O146 (11 %), O91 (10 %), O128 (7 %), O103 (5 %) and O117 (3 %). Overall, rates of bloody diarrhoea were highest in O26 (44 %) and O103 (48 %) cases and lowest in STEC O117 cases (17 %). Strains harbouring Shiga toxin stx1a caused the highest proportion of diarrhoea (93 %) and caused the same level of bloody diarrhoea as stx2a (39 %). However, stx2a caused the highest proportion of vomiting (46 %), hospitalisation (49 %) and considerably more HUS (29 %) than other stx profiles. Conclusion. The implementation of PCR targeting stx at diagnostic laboratories has shown that non-O157 STEC, most notably STEC O26, are an emerging risk to public health.

中文翻译：

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英格兰除血清群 O157 以外的产志贺毒素大肠杆菌的重要性

介绍。产志贺毒素大肠杆菌(STEC) 可导致严重疾病和大规模爆发。在英格兰，由于 STEC O157 检测的测试偏倚，除 O157（非 O157）之外的 STEC 血清群的发生率和临床意义尚不清楚。自 2013 年以来，越来越多的诊断实验室实施 PCR 检测所有 STEC 血清群，导致非 O157 STEC 检测增加。假设/差距陈述。由于在大多数国家的一线诊断实验室中选择 STEC 血清群 O157 的测试方法存在偏差，以前对非 O157 STEC 生成的监测数据非常少。目的。 提取了五年（2014-2018 年）的 STEC 国家监测数据并进行了描述性分析，以评估非 O157 STEC 菌株的疾病严重程度。方法。2014 年 1 月 1 日至 2018 年 12 月 31 日的数据是从国家增强型 STEC 监测系统中提取并分析的。结果。胃肠道聚合酶链反应 (GI-PCR) 的实施导致 2014 年至 2018 年非 O157 STEC 病例的检测增加了四倍。 有 2579 例感染了 97 个不同的非 O157 血清群。STEC O157 和非 O157 STEC 病例的性别分布相似，分别为 57 % 和 56 % 的病例为女性，但病例比例明显更高（P<0.001) 与非 O157 STEC (14 %) 相比，在 STEC O157 (22 %) 病例中观察到 5 岁以下。最常见的非 O157 血清群是 O26 (16 %)、O146 (11 %)、O91 (10 %)、O128 (7 %)、O103 (5 %) 和 O117 (3 %)。总体而言，O26 (44 %) 和 O103 (48 %) 病例的血性腹泻率最高，STEC O117 病例 (17 %) 最低。携带志贺毒素stx1a 的菌株引起的腹泻比例最高 (93 %)，并引起与stx2a相同水平的血性腹泻(39 %)。然而，与其他stx配置文件相比，stx2a引起的呕吐 (46%)、住院 (49%) 和 HUS (29%) 的比例最高。结论。PCR靶向stx的实现 诊断实验室的研究表明，非 O157 STEC，尤其是 STEC O26，是对公共卫生的新风险。