大腸桿菌O104:H4

2011年在德國及歐洲爆發由一種新型大腸桿菌（Escherichia coli） O104:H4所引起的大規模食物中毒，在2011年5月1日至7月4日間，至少有3816病例，其中845個受感染病人併發嚴重的溶血性尿毒綜合症（36個死亡病例），2971個病人有腸胃炎病徵（18個死亡病例）。此菌株同時帶有腸聚集性大腸桿菌及腸出血性大腸桿菌的毒力因子，與之前大家較熟悉的腸出血性大腸桿菌O157:H7不同，因此被歸類為新病原型-腸聚集溶血性大腸桿菌（Entero-Aggregative-Haemorrhagic E. coli, EAHEC）。此外，大腸桿菌O104:H4亦同時對多種抗生素具抗藥性（如β-lactam類抗生素、第三代cephalosporins等）。由於此菌株可能造成較嚴重的溶血性尿毒綜合症，臨床上快速診斷及實驗室鑑定甚為重要。本文將主要概述大腸桿菌O104:H4細菌特性、流行病學、臨床表徵、實驗室檢驗方法及治療策略和感染管控。

In 2011, a new strain of Escherichia coli O104:H4 was found to cause outbreaks of food poisoning in Germany and Europe. A total of 3816 cases were reported in Germany from May 1 through July 4, 2011, including 845 cases associated with hemolytic uremic syndrome (36 fatal cases). The outbreak strain carries virulence genes of enteroaggregative E. coli (EAEC) and enterohemorrhagic E. coli (EHEC), thus was referred as a new pathotype "Entero-Aggregative-Haemorrhagic E. coli (EAHEC)". The outbreak strain was also resistant to many beta-lactam antibiotics and third-generation cephalosporins. As this strain can result in severe hemolytic uremic syndrome, it is important to promptly diagnose the disease and identify the causing agents. Accordingly, this article summarizes the characteristics, epidemiology and clinical spectrum of E. coli O104:H4, as well as the diagnosis, laboratory identification and current strategies of treatment and infection control.