4 Things Pharmacists Should Know About the E. coli Outbreak

The recent Escherichia coli (E. coli) outbreak linked to romaine lettuce is extremely virulent and has affected 22 states across the United States. Foodborne disease outbreaks occur when 2 or more individuals are affected with the same illness from the same contaminated food or drink.¹ E.coli bacteria normally live in the intestines of humans, and animals and are usually harmless. However, some strains such as Shiga toxin-producing E. coli (STEC) can be very dangerous. According to the CDC, STEC causes 3,600 United States hospitalizations, and 30 deaths each year.¹ Pharmacists can play an important role in educating patients on foodborne illness prevention strategies.

Here are 4 things pharmacists should know about the E. coli outbreak:

1. Romaine lettuce from the Yuma, Arizona region may be contaminated.

The FDA and CDC investigation indicate that romaine lettuce from the Yuma, Arizona growing region could be contaminated with E. coli O157:H7.^1,2 Advise patients to avoid eating or buying romaine lettuce unless they can confirm it is not from the Yuma, Arizona growing region. Products include the following romaine lettuce types: whole heads, hearts, chopped, baby, organic, salads, and salad mixes. Product labels generally do not identify growing regions so it is best to avoid purchasing romaine lettuce from grocery stores. Many restaurants have removed their romaine lettuce products, even those that are not from the Yuma growing region as a precaution. Advise patients to err on the side of caution and avoid romaine lettuce for now.

2. This is a nationwide outbreak.

As of April 27, 2018, 98 people across 22 states have been infected with E. coli linked to romaine lettuce, and fortunately no deaths have currently been reported.^1,2 Additionally, 46 individuals have been hospitalized, including 10 people who developed a type of kidney failure known as hemolytic uremic syndrome (HUS).¹ There may be more cases that have not been reported yet since it takes an average of 3-4 days to develop symptoms after ingesting STEC contaminated foods.¹

3. E.coli infections can cause severe diarrhea and lead to HUS.

Symptoms of STEC infection include bloody diarrhea, severe stomach cramps, and vomiting. Most patients will recover within 5-7 days; however, the illness can be life-threatening.¹ HUS generally develops about 7 days after symptoms start and is most common in children under 5 years of age, adults aged 65 years and older, and individuals who are immunocompromised.¹ Symptoms of HUS include decreased urination and tiredness.

4. Antimicrobial therapy is not recommended for STEC infections.

Antibiotics should not be used to treat STEC infections as evidence demonstrates they may increase the risk of developing HUS.³ Treatment should include supportive measures such as rehydration therapy.³ Patients that develop HUS may also need red blood cell and platelet transfusions, plasma exchange, and dialysis.⁴ Pharmacists can play an important role in educating healthcare professionals on appropriate treatment measures for patients affected by the E.coli outbreak.

References

• Centers for Disease Control and Prevention. Multistate outbreak of E. coli O157:H7 infections linked to romaine lettuce. CDC website. www.cdc.gov/ecoli/2018/o157h7-04-18/index.html. Accessed April 27, 2018.
• U.S. Food and Drug Administration. FDA investigating multistate outbreak of E. coli O157:H7 infections likely linked to romaine lettuce from the Yuma growing region. FDA website. www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm604254.htm. Accessed April 27, 2018.
• Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clin Infect Dis. 2017;65(12):e45-e80.
• Mayo Clinic. Hemolytic uremic syndrome (HUS). Mayo Clinic website. www.mayoclinic.org/diseases-conditions/hemolytic-uremic-syndrome/diagnosis-treatment/drc-20352405. Accessed April 28, 2018.