A severe outbreak of XXXX O157:H7--associated hemorrhagic colitis in a nursing home.

@entity1 @entity6846 @entity281 @entity1381 @entity204 @entity526 @entity1681
In September 1985, an outbreak of @entity526 O157:H7 @entity1681 affected 55 of 169 residents and 18 of 137 staff members at a nursing home. The outbreak was characterized by two phases: a primary wave whose source was probably a contaminated sandwich meal and a secondary wave compatible with @entity1 -to- @entity1 transmission of @entity281 . Among the elderly residents, the incubation period was 4 to 9 days (mean, 5.7 +/- 1.2). Older age and previous gastrectomy increased the risk of acquiring the @entity281 (P = 0.01 and 0.03, respectively). Antibiotic therapy during exposure was associated with acquiring a secondary @entity281 (P = 0.001). @entity1381 developed in 12 affected residents (22 percent), 11 of whom died. Overall, 19 (35 percent) of the affected residents died, 17 (31 percent) from causes attributable to their @entity281 . Antibiotic therapy after the onset of symptoms was associated with a higher case fatality rate in the more severe cases, possibly because @entity1 with more severe disease tended to be treated with antibiotics. There were no complications or @entity204 among the affected members of the staff. Evidence of @entity281 by verotoxin-producing @entity526 O157:H7 was detected in 30 of 70 cases on the basis of isolation of this organism or demonstration of free @entity6846 in stools. All isolates belonged to the same phage type. The high morbidity and mortality associated with this condition emphasize the need for proper food hygiene, rapid identification of outbreaks of disease, and prompt institution of @entity281 -control techniques among the institutionalized elderly.
