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HELENA, Mont. (AP) — The state Department of Public Health and Human Services is investigating several reports of E. coli among western Montana residents that are likely linked to chopped romaine lettuce grown in the Yuma, Arizona area.

Officials say laboratory testing confirms three cases are linked to a multi-state outbreak and four more are suspected while further testing is pending.

The cases have been reported in Missoula, Flathead, Lincoln and Ravalli counties. Three people have been hospitalized.

Nationally, the Centers for Disease Control and Prevention reports 35 people from 11 other states have also been sickened. Twenty-two of them have been hospitalized. Two of three cases involving a type of kidney failure occurred in Idaho.

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Health officials are urging people not to eat any store-bought chopped romaine lettuce or salad mixes containing chopped romaine lettuce they may have at home.