E coli outbreak in Germany continues

As the current virulent Shiga toxin-producing Escherichia coli (STEC) outbreak in Germany spreads, experts from The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) are concerned not only about the pressure health facilities are being put under, but also the use of antibiotics and broader implications for preparedness across Europe to cope, both now and in the future.

The current E coli outbreak is caused by a very rare strain. It has affected more than 1500 people, causing at least 17 deaths. Unlike previous STEC epidemics, the current outbreak is affecting mostly female adults. This infection is associated with a severe complication known as haemolytic-uremic syndrome (HUS) that leads to organ damage and often requires intensive care.

“This most recent E coli epidemic of a strain previously unseen in an outbreak shows us yet again that new bacteria and infections are just around the corner, and we are far from winning the fight against infectious diseases in Europe”, said ESCMID President, Professor Giuseppe Cornaglia. “It reminds us that we continue to face new challenges, and must ensure we are vigilant in our preparedness, including monitoring, detection, and speedy and appropriate treatment.”

Experts in Germany are concerned about public health facilities’ capacity to cope with the outbreak. “The severity of this strain has resulted in great pressure on the health services, for example in the northern part of Germany, which has been experiencing a problem with availability of intensive care beds due to the high number of cases with life threatening complications,” said Professor Winifred Kern, ESCMID Treasurer and Head of the Centre for Infectious Diseases and Travel Medicine at the University Hospital in Freiburg, Germany.

The use of antibiotics with this outbreak had previously been discouraged due to experience indicating there is a danger of aggravating the disease. But German infectious diseases experts have now issued a position paper stating that antibiotic therapy should not be withheld in certain clinical situations, and that carbapenem (a type of antibiotic) therapy can probably be used without putting the patient at an additional risk. Experiments with new therapies that neutralize the toxin are currently taking place. 

Professor Kern also notes that, “Of particular concern to experts is the production of an antibiotic resistance mechanism called ESBL by this strain of E coli which highlights the risks of spread of resistance across human and animal microorganisms which could be linked to inappropriate antibiotic use.”

Although focused largely in Germany, this outbreak has so far spread to Sweden, Denmark, The Netherlands, UK and Spain. “The pan-European nature of this E coli outbreak, and the multi-dimensional problems it presents, reinforce the need for concerted cooperation across borders to tackle not only this outbreak, but also future ones, “said Professor Cornaglia.

ESCMID experts stress the rapid identification of potential cases is vital to try and limit the development of severe disease, and that we have to avoid complacency about food and personal hygiene.

The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) is a non-profit organization whose mission is to improve the diagnosis, treatment and prevention of infection-related diseases. This is achieved by promoting and supporting research, education, training, and good medical practice   www.escmid.org