Abstract:
A method for detecting  Escherichia coli  in a sample by providing a sample suspected of containing  Escherichia coli ; contacting the sample with beads coated with a mixture of antibodies or anti-serum specific to one or more surface antigens of  Escherichia coli , each of the one or more surface antigens having a molecular weight of 21±2 KDa, 26±2 KDa, 31±2 KDa, 36±2 KDa, 38±2 KDa, 67±2 KDa, or 77.8±2 KDa; and observing agglutination of the beads, where the presence of the agglutination indicates the presence of  Escherichia coli  in the sample.

Description:
BACKGROUND OF THE INVENTION 
     Although  Escherichia coli  is considered part of the normal bowel flora of healthy individuals, the microorganism is also recognized as an important pathogen in human diseases and conditions, including urinary tract infections, meningitis, and diarrhea. Therefore, a highly sensitive and specific method that can rapidly identify  E. coli  in biological samples would be useful. 
     SUMMARY OF THE INVENTION 
     The invention is based on the discovery that a highly sensitive and specific  E. coli  agglutination assay can be performed using antibodies against total urea-extracted  E. coli  antigens. Surprisingly, the sensitivity of the assay is dramatically reduced when using antibodies against specific  E. coli  antigens, even though such a strategy proved useful in agglutination assays for other bacterium (see, e.g., U.S. Pat. No. 5,418,140). Consequently, the invention relates in part to the unexpectedly superior performance of the assay using antibodies against total urea-extracted antigens, rather than specific surface antigens. 
     Accordingly, the invention features a method for detecting  Escherichia coli  in a sample by providing a sample suspected of containing  Escherichia coli ; contacting the sample with beads coated with a mixture of antibodies or anti-serum specific to one or more surface antigens of  Escherichia coli , each of the one or more surface antigens having a molecular weight of 21±2 KDa, 26±2 KDa, 31±2 KDa, 36±2 KDa, 38±2 KDa, 67±2 KDa, or 77.8±2 KDa; and observing agglutination of the beads, where the presence of the agglutination indicates the presence of  Escherichia coli  in the sample. The method can further include determining whether a microorganism in the sample produces indole or ferments lactose, both of which are characteristic of  E. coli.    
     The invention further features a kit for testing whether  E. coli  is present in a sample. The kit contains beads and a mixture of antibodies or antisera specific to one or more surface antigens of  Escherichic coli , wherein each of the one or more surface antigens has a molecular weight selected from the group consisting of 21±2 KDa, 26±2 KDa, 31±2 KDa, 36±2 KDa, 38±2 KDa, 67±2 KDa, and 77.8±2 KDa. The kit can also include (1) a composition containing eosin-methylene blue for determining whether a microorganism ferments lactose, (2) a composition containing p-dimethylaminocinnamaldehyde for determining whether a microorganism produces indole, (3) a positive control reagent that is expected to agglutinate the beads coated with the mixture of antibodies, or (4) a negative control reagent that is not expected to agglutinate the beads coated with the mixture of antibodies. 
     As used herein, “total urea-extracted  Escherichia coli  antigens” means the antigens collected from the supernatant of a centrifuged mixture containing  E. coli  bacteria incubated in an aqueous mixture containing about 4 M urea. 
     Other features or advantages of the present invention will be apparent from the following detailed description, and also from the claims. 
     DETAILED DESCRIPTION 
     The invention relates to methods of detecting  E. coli  in a sample, such as a biological sample (e.g., a serum or cerebral spinal fluid sample) using an agglutination assay. While agglutination assays have been used to detect various species of bacteria in samples, the moieties attached to the beads and useful for agglutination are different, depending on the species to be detected (see, e.g., Chang et al., J. Food Protect. 57:31-36, 1994; and Chang et al., J. Food Protect. 56:759-762, 1993). Indeed, it is thus far uncertain which moieties are needed to detect a different species of bacterium. 
     The present invention is based in part on the identification of the particular moiety required for a highly sensitive and specific agglutination assay for detection of  E. coli . As shown in the example below, the  E. coli  agglutination assay is not specific enough for clinical applications unless the beads are coated (e.g., by standard covalent or non-covalent methods) with a mixture of antibodies specific for total urea-extracted  E. coli  antigens. Such a mixture of antibodies can be produced by immunizing a vertebrate with total urea-extracted  E. coli  antigens and harvesting the antibodies produced by the animal, using standard techniques such as the ones described in the example below. 
     Without further elaboration, it is believed that one skilled in the art can, based on the above disclosure and the agglutination assays described below, utilize the present invention to its fullest extent. The following example is to be construed as merely illustrative of how one skilled in the art can isolate total urea-extracted  E. coli  antigens, immunize an animal with such antigens, and harvest antibodies produced by the animal, and are not limitative of the remainder of the disclosure in any way. Any publications cited in this disclosure are hereby incorporated by reference. 
    
    
     EXAMPLE 
     Materials and Methods 
     Bacterial strains and culture conditions. The microorganisms used in this study are listed in Table 1. A total of 1838 strains of gram-negative bacteria was tested, including 1028 strains of  E. coli  (among them, 748 strains were from clinical specimens, 268 strains from food samples, and 12 strains from the Culture Collection and Research Center [CCRC], Hsinchu, Taiwan), 632 strains of Enterobacteriaceae other than  E. coli , 21 strains of Aeromonas spp., 75 strains of Pseudomonas spp., 18 strains of Vibrio spp, and 64 strains of other bacteria. Most strains were clinical isolates. All bacteria were first subcultured on tryptic soy agar (except  Vibrio parahaemolyticus , was cultured on tryptic soy agar—2% NaCl), then subcultured on sheep blood agar and Levin&#39;s eosin-methylene blue (EMB) agar. The plates were incubated at 35° C. for 18 to 24 hours. Strains grown on EMB were observed for their ability to ferment lactose: strains having colonies of a brown (or black) center or metallic sheen were considered lactose fermenters. Bacteria grown on blood agar were tested for indole production by the spot indole test using the p-dimethylaminocinnarnaldehyde reagent (BBL DMACA Indole Reagent Droppers, Becton Dickinson Microbiology Systems, Cockeysville, Md.). Bacteria grown on blood agar were also used for the latex agglutination test (LAT). 
     Preparation of cell surface antigens.  E. coli  CCRC 15481 were grown on tryptic soy agar at 35° C. for 18 to 24 hours. The cells on each plate were collected by suspending them in 2 ml of phosphate-buffered saline (PBS; 10 mM phosphate buffer, 0.14 M NaCl, pH 7.2), and pelleting by centrifugation (2,000×g, 15 minutes) at room temperature. The bacterial cells were washed with PBS, suspended in 1 ml of 4 M urea, and incubated in a 50° C. water bath for 90 minutes with occasional shaking. The cell suspension was centrifuged (10,000×g, 15 minutes) at room temperature to remove insoluble particles, and the supernatant was dialyzed against 0.2× strength of PBS to remove urea. Cell surface antigens of two arbitrarily selected species ( Enterobacter sakazakii  CCRC 1415 and  Klebsiella pneumoniae  06048, a clinical isolate) were also extracted with 4 M urea as controls. 
     Preparation and purification of antibodies. The  E. coli  urea-extracted cell surface antigens (abut 1 mg/ml) were emulsified with an equal volume of incomplete Freund&#39;s adjuvant (Difco Laboratories, Detroit, Mich.). Two milliliters of the emulsified antigen was injected subcutaneously into four to six sites on the back of each New Zealand White rabbit. The animals were boosted four times at 4-week interval, using the same injection conditions as the initial inoculation. Ten days after the final injection, ear arterial blood was collected. Antibody titers in sera were determined by an enzyme-linked immunosorbent assay (ELISA) using urea-extracted cell surface antigens (10 μg/ml) as the capture moiety, which coated the wells of a microtiter plate (Nunc, Kamstrup, Denmark). About 0.1 ml of a serially 10-fold diluted antisera was added to each well. After standard washings, horseradish peroxidase-labeled goat anti-rabbit IgG (Sigma Chemical Co., St. Louis, Mo.) was added to each well. 
     The IgG fraction of the antisera was purified by diethylaminoethyl (DEAE) ion-exchange chromatography as described in Linn et al., Proc. Natl. Acad. Sci. USA 70:1865-1869, 1973. The IgG was further purified by affinity chromatography using the urea-extracted cell antigens of  E. coli  coupled to CNBr-activated Sepharose™ 4B gel (Amersham Pharmacia Biotech, Uppsala, Sweden) using the manufacturer&#39;s instructions. Specific antibodies were eluted from the affinity column (1.5×5 cm) with 0.1 M glycine-HCl buffer, pH 2.6, and thereafter were immediately neutralized with 1 M Tris-HCl buffer, pH 8.0. 
     Sensitization of latex. Latex particles were coated with antibodies by physical adsorption. One milliliter of a 10% (wt./vol.) latex suspension (diameter 1.09 μm, Japan Synthetic Rubber, Tokyo) was washed two times with deionized water and suspended in 20 ml of water. To the washed latex suspension, an equal volume of affinity-purified antibodies (70 μg/ml) was added. The suspension was incubated at room temperature for 1 hour on an end-over-end mixer, and then centrifuged (2,000×g, 15 min) to remove unbound antibodies. The antibody-coated latex was washed twice with 0.1% bovine serum albumin, and resuspended in 20 ml of 0.1% bovine serum albumin. Control latex was coated with preimmune serum IgG in the same manner. The final concentration of latex reagent was 0.5% (wt./vol.) 
     Latex agglutination test. On a microscope slide, two circles with a diameter of about 1.5 cm were marked with a wax pencil. By using a sterile toothpick, one to two colonies grown overnight on blood agar were transferred to each circle on the slide. One drop of control latex was added to one circle (control circle), and one drop of test latex (sensitized with antibodies) was added to the other circle (test circle). The contents were smeared with the toothpick and gently rocked back and forth for 1 to 2 minutes. A test was positive if agglutination was observed in the test circle, while no agglutination was found in the control circle. A test was negative if no agglutination was found in the test circle. A few strains produced results of autoagglutination, i.e., agglutination was found in both control and test circles. These strains were excluded for calculation of test performance and were not included in Table 1. 
     sensitivity and specificity. Sensitivity was defined as the number of strains of  e. coli  that gave positive results (true positives) divided by total number of bacterial strains tested. specificity was defined as the number of non- E. coli  strains that gave negative results (true negatives) divided by total number of bacterial strains tested. 
     Immunoblotting. To determine the molecular weights of the urea-extracted cell surface antigens, the Western blotting technique described by Hu et al., J. Immunol. Methods 202:113-121, 1997 was used with the following modifications. The urea-extracted antigens were separated by sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE) and blotted onto nitrocellulose membranes (Hybond ECL™, Amersham Pharmacia Biotech). After blotting, the lane of protein molecular weight markers was cut out, stained with 0.1% amidoblack and then destained. The remaining part of the membrane was blocked overnight at 4° C. in blocking solution (5% non-fat dry milk and 1% Tween™ 20). After washing, the blot was incubated with affinity-purified antibodies (0.5 μg/ml) produced as described above, and then with horseradish peroxidase-labeled goat anti-rabbit IgG (Sigma Chemical Co., 1:1,500 dilution). After washing, the membrane was developed in substrate solution (30 mg of 4-chloro-1-naphthol and 30 μl of 30% H 2 O 2  in 10 ml methanol) to reveal the antigens recognized by the primary antibodies. 
     Results 
     In the beginning of this study, four surface antigens with molecular masses ranging from 20 to 90 KDa were purified from the total urea-extracted antigen is of  E. coli  (CCRC 15481) by preparative SDS-PAGE. Each of the four antigens was used to raise antibodies in rabbits, and the purified antibodies against the individual antigen were used to prepare latex reagent for the identification of  E. coli . However, using antibodies against any one of the four antigens resulted in a relatively poor LAT sensitivity of less than 70%. This was surprising, given that a similar LAT using specific  Vibrio parahaemolyticus  surface antigens resulted in specificities well above 90% (U.S. Pat. No. 5,418,140). Thus, the failure to apply to  E. coli  a LAT strategy previously known to be successful for another bacterium indicated that successful strategies differ for different pathogenic bacteria, and that success with one strategy for one bacterium does not lead to a reasonable expectation of success for using the same strategy for another bacterium. In view of this unexpected but revealing finding, other strategies were contemplated. It was found that antibodies raised against total urea-extracted  E. coli  antigens were necessary for a highly sensitive LAT. 
     Titers of antisera. After a series of five immunizations, the titers of antisera against the urea-extracted cell surface antigens of  E. coli  15481 were 10 7 , as determined by ELISA. 
     Immunoblotting. The affinity-purified antibodies recognized, multiple surface antigen is of  E. coli  CCRC 15481. These antigens were estimated to have molecular masses of 77.8, 67, 38, 36, 31, 26, and 21 kDa. Because the polyclonal antibodies were raised against multiple antigens of  E. coli , it may have been expected that cross-reactions with antigens from other species were unavoidable. For example, 26 and 21 kDa antigens purified from  Enterobacter sakazakii  and  Klebsiella pneumoniae  also cross-reacted with the antibodies against total urea-extracted  E. coli  antigens. The fact that a high level of specificity was nevertheless achieved, as shown below, provided another unexpected result. 
     Latex agglutination test. The results of LAT, indole production, and lactose fermnentation of the 1838 bacterial strains are listed in Table 1. Of the 1028 isolates of  E. coli  tested, 1021 strains (99.3%) yielded positive reactions of LAT, 1011 strains (98.3%) were positive for indole production, and 986 strains (95.9%) were lactose fermenters. Bacteria causing false-positive LAT were mainly from some isolates of Citrobacter, Enterobacter, Klebsiella, Morganella, Proteus, Serratia, and Shiglella (Table 1). 
     
       
         
               
               
               
             
               
               
               
               
               
               
               
             
           
               
                   
                 TABLE 1 
               
             
             
               
                   
                   
               
               
                   
                 No. of 
                 No. of strains which were 
               
             
          
           
               
                   
                   
                 strains 
                 LAT 
                 LAT 
                 indole 
                 lactose 
               
               
                 Microorganism 
                 Source 
                 tested 
                 (+) 
                 (−) 
                 (+) 
                 (+) 
               
               
                   
               
               
                 
                   E. coli 
                 
                 Clinical, 
                 1028  
                 1021  
                  7 
                 1011  
                 986  
               
               
                   
                 food, and 
               
               
                   
                 CCRC 
               
               
                 
                   Acinetobacter baumannii 
                 
                 Clinical 
                 11 
                  0 
                 11 
                  0 
                  2 
               
               
                 
                   Acinetobacter calcoaceticus 
                 
                 Clinical 
                  6 
                  1 
                  5 
                  0 
                  3 
               
               
                 
                   Acinetobacter lwoffii 
                 
                 Clinical 
                  3 
                  0 
                  3 
                  0 
                  1 
               
               
                 Acinetobacter spp. 
                 Clinical 
                  2 
                  0 
                  2 
                  0 
                  1 
               
               
                 
                   Aeromonas caviae 
                 
                 Clinical 
                  2 
                  0 
                  2 
                  1 
                  0 
               
               
                 
                   Aeromonas hydrophila 
                 
                 Clinical 
                 13 
                  0 
                 13 
                 12 
                 11 
               
               
                 
                   Aeromonas sobria 
                 
                 Clinical 
                  6 
                  1 
                  5 
                  6 
                  1 
               
               
                 
                   Alcaligenes faecalis 
                 
                 Clinical 
                  1 
                  0 
                  1 
                  0 
                  0 
               
               
                 
                   Alcaligenes xylosoxidans 
                 
                 Clinical 
                  2 
                  0 
                  2 
                  0 
                  0 
               
               
                 
                   Citrobacter amalonaticus 
                 
                 Clinical 
                  5 
                  0 
                  5 
                  5 
                  3 
               
               
                 
                   Citrobacter diversus 
                 
                 Clinical 
                 23 
                  2 
                 21 
                 19 
                  4 
               
               
                 
                   Citrobacter freundii 
                 
                 Clinical 
                 57 
                  8 
                 49 
                  4 
                 50 
               
               
                 
                   Edwardsiella tarda 
                 
                 Clinical 
                  3 
                  0 
                  3 
                  3 
                  0 
               
               
                 
                   Enterobacter aerogenes 
                 
                 Clinical 
                 17 
                  0 
                 17 
                  0 
                 13 
               
               
                 
                   Enterobacter agglomerans 
                 
                 Clinical 
                  8 
                  0 
                  8 
                  0 
                  3 
               
               
                 
                   Enterobacter cloacae 
                 
                 Clinical 
                 63 
                  5 
                 58 
                  0 
                 20 
               
               
                 
                   Enterobacter sakazakii 
                 
                 Clinical 
                  2 
                  0 
                  2 
                  0 
                  2 
               
               
                 Enterobacter spp. 
                 Clinical 
                  7 
                  1 
                  6 
                  0 
                  3 
               
               
                 
                   Escherichia blattae 
                 
                 CCRC 
                  3 
                  0 
                  3 
                  0 
                  0 
               
               
                 
                   Escherichia fergusonii 
                 
                 CCRC 
                  5 
                  1 
                  4 
                  4 
                  0 
               
               
                 
                   Escherichia hermannii 
                 
                 CCRC 
                  2 
                  0 
                  2 
                  2 
                  1 
               
               
                 
                   Escherichia vulneris 
                 
                 CCRC 
                  5 
                  0 
                  5 
                  0 
                  0 
               
               
                 
                   Flavobacterium indolgenes 
                 
                 Clinical 
                  5 
                  0 
                  5 
                  0 
                  0 
               
               
                 
                   Flavobacterium meningosepticum 
                 
                 Clinical 
                  7 
                  0 
                  7 
                  0 
                  1 
               
               
                 Flavobacterium spp. 
                 Clinical 
                  3 
                  0 
                  3 
                  0 
                  0 
               
               
                 
                   Klebsiella oxytoca 
                 
                 Clinical 
                 32 
                  3 
                 29 
                 31 
                 30 
               
               
                 
                   Klebsiella ozaenae 
                 
                 Clinical 
                 11 
                  1 
                 10 
                  1 
                  4 
               
               
                 
                   Klebsiella pneumoniae 
                 
                 Clinical 
                 91 
                  9 
                 82 
                  0 
                 83 
               
               
                 Kurthia spp. 
                 Clinical 
                  1 
                  0 
                  1 
                  0 
                  0 
               
               
                 Moraxella spp. 
                 Clinical 
                  2 
                  0 
                  2 
                  0 
                  0 
               
               
                 
                   Morganella morganii 
                 
                 Clinical 
                 83 
                  3 
                 80 
                 64 
                  2 
               
               
                 Pasteurella sp. 
                 Clinical 
                  1 
                  0 
                  1 
                  1 
                  1 
               
               
                 
                   Plesiomonas shigelloides 
                 
                 Clinical 
                  2 
                  0 
                  2 
                  2 
                  0 
               
               
                 
                   Proteus mirabilis 
                 
                 Clinical 
                 46 
                 10 
                 36 
                  0 
                  0 
               
               
                 
                   Proteus vulgaris 
                 
                 Clinical 
                 14 
                  0 
                 14 
                 12 
                  1 
               
               
                 
                   Providencia rettgeri 
                 
                 Clinical 
                  2 
                  0 
                  2 
                  0 
                  0 
               
               
                 Providencia spp. 
                 Clinical 
                  2 
                  0 
                  2 
                  0 
                  0 
               
               
                 
                   Pseudomonas aeruginosa 
                 
                 Clinical 
                 50 
                  1 
                 49 
                  0 
                  0 
               
               
                 
                   Pseudomonas cepacia 
                 
                 Clinical 
                  3 
                  0 
                  3 
                  1 
                  0 
               
               
                 
                   Pseudomonas pickettii 
                 
                 Clinical 
                 11 
                  0 
                 11 
                  0 
                  0 
               
               
                 
                   Pseudomonas putida 
                 
                 Clinical 
                  2 
                  0 
                  2 
                  0 
                  0 
               
               
                 
                   Pseudomonas putrefaciens 
                 
                 Clinical 
                  3 
                  0 
                  3 
                  0 
                  0 
               
               
                 
                   Pseudomonas stutzeri 
                 
                 Clinical 
                  4 
                  0 
                  4 
                  1 
                  1 
               
               
                 Pseudomonas spp. 
                 Clinical 
                  2 
                  0 
                  2 
                  0 
                  1 
               
               
                 
                   Salmonella choleraesuis 
                 
                 CCRC 
                 21 
                  1 
                 21 
                  0 
                  0 
               
               
                 subsp.  choleraesuis   
               
               
                 
                   Salmonella choleraesuis 
                 
                 CCRC 
                  2 
                  0 
                  2 
                  0 
                  0 
               
               
                 subsp.  houtenae   
               
               
                 Salmonella group B 
                 Clinical 
                 52 
                  3 
                 49 
                  0 
                  0 
               
               
                 Salmonella group C1 
                 Clinical 
                  3 
                  0 
                  3 
                  0 
                  0 
               
               
                 Salmonella group C2 
                 Clinical 
                  2 
                  0 
                  2 
                  0 
                  0 
               
               
                 Salmonella group D 
                 Clinical 
                 15 
                  1 
                  5 
                  0 
                  0 
               
               
                 
                   Serratia marcescens 
                 
                 Clinical 
                 23 
                  4 
                 19 
                  0 
                  1 
               
               
                 
                   Serratia liquefaciens 
                 
                 Clinical 
                  1 
                  0 
                  1 
                  0 
                  0 
               
               
                 
                   Shigella boydii 
                 
                 CCRC 
                  3 
                  0 
                  3 
                  0 
                  0 
               
               
                 
                   Shigella flexneri 
                 
                 CCRC and 
                  8 
                  4 
                  4 
                  0 
                  0 
               
               
                   
                 Clinical 
               
               
                 
                   Shigella sonnei 
                 
                 CCRC and 
                 14 
                  1 
                 13 
                  0 
                  0 
               
               
                   
                 Clinical 
               
               
                 Shigella spp. 
                 Clinical 
                  4 
                  1 
                  3 
                  0 
                  0 
               
               
                 
                   Sphingomonas paucimobilis 
                 
                 Clinical 
                  3 
                  0 
                  3 
                  0 
                  0 
               
               
                 
                   Stenotrophomonas maltophilia 
                 
                 Clinical 
                 15 
                  0 
                 15 
                  0 
                  0 
               
               
                   Vibrio cholerae  non-O1 
                 Clinical 
                  4 
                  0 
                  4 
                  3 
                  2 
               
               
                 
                   Vibrio vulnificus 
                 
                 Clinical 
                  3 
                  0 
                  3 
                  2 
                  0 
               
               
                 
                   Vibrio parahaemolyticus 
                 
                 Clinical 
                 11 
                  0 
                 11 
                 11 
                  0 
               
               
                 
                   Yersinia enterocolitica 
                 
                 CCRC 
                  3 
                  0 
                  3 
                  3 
                  3 
               
               
                   
               
             
          
         
       
     
     The sensitivities for the identification of  E. coli  based on the results of LAT, indole production, and lactose fermentation are shown in Table 2. Based on LAT only, the sensitivity was 99.3%. If LAT was used in conjunction with the indole production assay, lactose fermentation assay, or both assays, the sensitivities decreased to 98, 95.7, and 94.4%, respectively. About 5% of sensitivity was sacrificed by integrating LAT with the two additional biological assays for the identification of  E. coli . 
     
       
         
               
               
               
             
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
               
               
             
           
               
                   
                 TABLE 2 
               
             
             
               
                   
                   
               
               
                   
                   
                 Sensitivity (%) based on strains which were 
               
               
                   
                 No. of strains which were 
                 positive for 
               
             
          
           
               
                   
                 No. of strains 
                 positive for 
                   
                 LAT and 
                 LAT and 
                 LAT, indole, and 
               
             
          
           
               
                 Microorganism 
                 tested 
                 LAT 
                 Indole 
                 Lactose 
                 LAT 
                 Indole 
                 Lactose 
                 lactose 
               
               
                   
               
               
                 
                   E. coli 
                 
                 1028 
                 1021 
                 1011 
                 986 
                 99.3 
                 98.0 
                 95.7 
                 94.4 
               
               
                   
               
             
          
         
       
     
     The specificities for the identification of  E. coli  based on the results of LAT, indole production, and lactose fermentation are shown in Table 3. Based on LAT only, the specificities ranged from 79.3 to 100 %, depending on the particular non- E. coli  strains used for comparison. Strains producing relatively low specificities were Shiglella (79.3%), Proteus (83.3%), Serratia (83.3%), and Citrobacter (88.2%). The glucose noni-fermenting bacteria (e.g., Acinetobacter, Pseudomonas, and  Stenotrophomonas maltophilia ) and. cytochrome oxidase-positive bacteria (e.g:, Vibrio and Aeromonas) displayed low cross-reactivity with the latex reagent. The overall specificity of LAT for the identification of  E. Coli  was 93.3% (Table 3). The overall specificities increased to 98.8, 98.7, and 99.7%, respectively, if the production of indole, fermentation of lactose, or both assays, were used in conjunction with LAT for the identification of  E. coli . 
     
       
         
               
               
               
             
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
               
               
             
           
               
                   
                 TABLE 3 
               
             
             
               
                   
                   
               
               
                   
                   
                 Sensitivity (%) based on strains which were 
               
               
                   
                 No. of strains which were 
                 positive for 
               
             
          
           
               
                   
                 No. of strains 
                 positive for 
                   
                 LAT and 
                 LAT and 
                 LAT, indole, and 
               
             
          
           
               
                 Microorganism 
                 tested 
                 LAT 
                 Indole 
                 Lactose 
                 LAT 
                 indole 
                 lactose 
                 lactose 
               
               
                   
               
             
          
           
               
                 Acinetobacter spp. 
                 22 
                 1 
                 0 
                 7 
                 95.5 
                 100 
                 95.5 
                 100 
               
               
                 Aeromonas spp. 
                 21 
                 1 
                 19  
                 12  
                 95.2 
                 95.2 
                 100 
                 100 
               
               
                 Citrobacter spp. 
                 85 
                 10  
                 28  
                 57  
                 88.2 
                 95.3 
                 91.8 
                 97.6 
               
               
                 Enterobacter spp. 
                 97 
                 6 
                 0 
                 41  
                 93.8 
                 100 
                 100 
                 100 
               
               
                 Escherichia spp. b   
                 15 
                 1 
                 6 
                 1 
                 93.3 
                 93.3 
                 100 
                 100 
               
               
                 Flavobacterium spp. 
                 15 
                 0 
                 0 
                 1 
                 100 
                 100 
                 100 
                 100 
               
               
                 Klebsiella spp. 
                 134  
                 13  
                 32  
                 117  
                 90.5 
                 97.8 
                 91.8 
                 97.8 
               
               
                 
                   Morganella morganii 
                 
                 83 
                 3 
                 64  
                 2 
                 96.4 
                 98.8 
                 100 
                 100 
               
               
                 Proteus spp. 
                 60 
                 10  
                 12  
                 1 
                 83.3 
                 100 
                 100 
                 100 
               
               
                 Pseudomonas spp. 
                 75 
                 1 
                 2 
                 2 
                 98.7 
                 100 
                 100 
                 100 
               
               
                 Salmonella spp. 
                 95 
                 5 
                 0 
                 0 
                 94.7 
                 100 
                 100 
                 100 
               
               
                 Serratia spp. 
                 24 
                 4 
                 0 
                 1 
                 83.3 
                 100 
                 100 
                 100 
               
               
                 Shigella spp. 
                 29 
                 6 
                 0 
                 0 
                 79.3 
                 100 
                 100 
                 100 
               
               
                 
                   Stenotrophomonas 
                 
                 15 
                 0 
                 0 
                 0 
                 100 
                 100 
                 100 
                 100 
               
               
                 
                   maltophilia 
                 
               
               
                 Vibrio spp. 
                 18 
                 0 
                 16  
                 2 
                 100 
                 100 
                 100 
                 100 
               
               
                 Other bacteria a   
                 18 
                 0 
                   
                   
                 100 
                 100 
                 100 
                 100 
               
               
                 Total 
                   
                   
                   
                   
                 93.3 
                 98.8 
                 98.7 
                 99.7 
               
               
                   
               
               
                   a Including the following bacteria (number of strains): Alcaligenes spp. (3),  Edwardsiella tarda  (3), Kurthia sp. (1), Pasteurella spp. (1), Moroxella spp. (2),  Plesiomonas shigelloides  (2),  Shingomonas paucimobilis  (3), and  Yersinia enterocolitica  (3).  
               
               
                   b Non- E. coli  species.  
               
             
          
         
       
     
     Strains displaying both LAT- and indole-positive reactions included  Escherichia fergusonii, Morganella morganii  and a few isolates from Citrobacter and Klebsiella (Tables 1 and 3). Strains producing both LAT- and lactose-positive reactions were  Acinetobacter calcoaceticus, Morganella morganii  and a few isolates from Citrobacter and Klebsiella (Tables 1 and 3). In this study, 10% (3/30) of the strains of  Klebsiella oxytoca , 3.5% (2/57) of the strains of  Citrobacter freundii , and 4.3% (1/23) of the strains of  Citrobacter diversus  were LAT-, indole-, and lactose-positive. 
     In conclusion, suspect gram-negative  E. coli  bacilli can be accurately identified using agglutination with an overall sensitivity and specificity of 94.4 and 99.7%, respectively. 
     Other Embodiments 
     It is to be understood that while the invention has been described in conjunction with the detailed description thereof, the foregoing description is intended to illustrate and not limit the scope of the invention, which is defined by the scope of the appended claims. Other aspects, advantages, and modifications are within the scope of this invention.