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Summary Non-O157 Shiga toxin-producing Escherichia coli (STEC) are a frequent cause of STEC-related infections such as diarrhoea. Fermentation by presumptive probiotic Lactobacillus plantarum strain B411 isolated from cereal fermentation was investigated to prevent the growth of acid-adapted (AA) and non-acid-adapted (NAA) non-O157 STEC in traditionally fermented maize gruel, a widely used complementary food in Africa. L. plantarum strain B411 possessed probiotic characteristics and antimicrobial activity against selected pathogenic bacteria. Growth of AA and NAA non-O157 STEC strains was substantially inhibited by 3.6 and 4.8 log reductions, respectively, in the maize gruel fermented with the L. plantarum B411, while their growth was only inhibited by 1.0 and 1.2 log reductions, respectively, by traditional fermentation alone. Inclusion of fermentative strains of L. plantarum exhibiting probiotic activity is a feasible method to ensure safety of traditionally fermented African cereal porridges through inhibition of non-O157 STEC.

We describe multiple-aetiology infections involving non-O157 Shiga toxin-producing Escherichia coli (STEC) identified through laboratory-based surveillance in nine FoodNet sites from 2001 to 2010. A multiple-aetiology infection (MEI) was defined as isolation of non-O157 STEC and laboratory evidence of any of the other nine pathogens under surveillance or isolation of >1 non-O157 STEC serogroup from the same person within a 7-day period. We compared exposures of patients with MEI during 2001-2010 with those of patients with single-aetiology non-O157 STEC infections (SEI) during 2008-2009 and with those of the FoodNet population from a survey conducted during 2006-2007. In total, 1870 non-O157 STEC infections were reported; 68 (3.6%) were MEI; 60 included pathogens other than non-O157 STEC; and eight involved >1 serogroup of non-O157 STEC. Of the 68 MEI, 21 (31%) were part of six outbreaks. STEC O111 was isolated in 44% of all MEI. Of patients with MEI, 50% had contact with farm animals compared with 29% (P < 0.01) of persons with SEI; this difference was driven by infections involving STEC O111. More patients with non-outbreak-associated MEI reported drinking well water (62%) than respondents in a population survey (19%) (P < 0.01). Drinking well water and having contact with animals may be important exposures for MEI, especially those involving STEC O111.