Clinical and Laboratory Predictors of Shiga Toxin–Producing Escherichia coli Infection in Children With Bloody Diarrhea

McKee, Ryan S; Tarr, Phillip I.; Dietzen, Dennis J.; Chawla, Rachit; Schnadower, David

doi:10.1093/jpids/piy025

Cited by 18 publications

(11 citation statements)

References 30 publications

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“…In about two-thirds of cases with BD, a bacterial pathogen was recognized. This is in accordance with previously reported data [20]. In our study, about 12% of cases with BD tested positive for STEC infection.…”

Section: Discussionsupporting

confidence: 94%

“…These data were in accordance with the serogroup results reported for HUS cases in Italy and the Apulia region in particular over the last few years [13,15,22,23]. In a 1-year prospective cohort study conducted in a single hospital in Missouri on 108 patients younger than 18 years with BD, McKee et al found a STEC infection prevalence of 9% (10 cases) [20]. Although the overall prevalence of STEC infections in our study was comparable to that reported by McKee et al, they found that almost all their cases were due to serogroup O157, thus reflecting differences in STEC circulation between North America and Southern Italy [20].…”

Section: Discussionsupporting

confidence: 88%

See 1 more Smart Citation

Case-management protocol for bloody diarrhea as a model to reduce the clinical impact of Shiga toxin-producing Escherichia coli infections. Experience from Southern Italy

Loconsole

Giordano

Laforgia

et al. 2019

Eur J Clin Microbiol Infect Dis

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To describe an operating protocol for bloody diarrhea (BD) in a pediatric population as a rapid response to a public health threat represented by an excess of pediatric HUS cases in the Apulia region (Southern Italy) starting from 2013. The protocol was set up with the goal of correct clinical management of Shiga toxin-producing Escherichia coli (STEC) infections, reductions in subsequent cases of hemolytic uremic syndrome (HUS), and improved short-and long-term disease outcomes. The protocol consisted of rapid hospitalization of children with bloody diarrhea (BD), hematochemical laboratory tests every 12-24 hours, and prompt laboratory diagnosis of STEC. No antibiotics were recommended until diagnosis. Children positive for STEC infections underwent early vigorous volume expansion. In June-December 2018, 438 children with BD were hospitalized, of which 53 (12.1%) had a STEC infection. The most common serogroups were O26 (36.1%), O111 (23.0%), and O157 (14.8%). Thirty-one samples carried the stx2 gene. Four cases evolved into HUS (7.5%), all with favorable outcome despite neurological involvement in two cases. Prompt and accurate laboratory diagnosis of STEC infections is of the utmost importance in patients with BD for correct clinical management. The strict adherence to the protocol could reduce the progression rate of STEC infections to HUS and prevents complications. Enhanced BD surveillance may help reduce cases of pediatric HUS in Southern Italy.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 88%

Case-management protocol for bloody diarrhea as a model to reduce the clinical impact of Shiga toxin-producing Escherichia coli infections. Experience from Southern Italy

Loconsole

Giordano

Laforgia

et al. 2019

Eur J Clin Microbiol Infect Dis

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show abstract

“…During the surveillance period, STEC infection was identified in approximately 11% of BD cases. This finding is consistent with 9% being reported in a one-year cohort study conducted recently in a single hospital, where 108 cases of BD were studied [24]. Most cases of STEC infection, irrespective of serogroup, occurred in the warmer months, thus agreeing with other studies that also found a seasonal trend for STEC infections [19,25].…”

Section: Discussionsupporting

confidence: 92%

Epidemiology of Shiga Toxin-Producing Escherichia coli Infections in Southern Italy after Implementation of Symptom-Based Surveillance of Bloody Diarrhea in the Pediatric Population

Loconsole

Giordano

Centrone

et al. 2020

IJERPH

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Shiga toxin-producing Escherichia coli (STEC) infections result in a significant public health impact because of the severity of the disease that, in young children especially, can lead to hemolytic–uremic syndrome (HUS). A rise in the number of HUS cases was observed in the Apulia region of Italy from 2013 to 2017, and so, in 2018, a symptom-based surveillance system for children with bloody diarrhea (BD) was initiated in order to detect and manage STEC infections. The objective of the study was to describe the epidemiology of STEC infections in children from June 2018 to August 2019. Children <15 years old with BD were hospitalized and tested for STEC. Real-time PCR for virulence genes (stx1, stx2, eae) and serogroup identification tests were performed on stool samples/rectal swabs of cases. STEC infection was detected in 87 (10.6%) BD cases. The median age of STEC cases was 2.7 years, and 60 (68.9%) were <4. Of these 87 cases, 12 (13.8%) came from households with diarrhea. The reporting rate was 14.2/100,000, with the highest incidence in cases from the province of Bari (24.2/100,000). Serogroups O26 and O111 were both detected in 22/87 (25.3%) cases. Co-infections occurred in 12.6% of cases (11/87). Twenty-nine STEC were positive for stx1, stx2, and eae. Five cases (5.7%) caused by O26 (n = 2), O111 (n = 2), and O45 (n = 1) developed into HUS. A risk-oriented approach based on the testing of children with BD during the summer may represent a potentially beneficial option to improve the sensitivity of STEC surveillance, not only in Italy but also in the context of Europe as a whole.

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“…Systemic infection and organ failure lead to the increase in D-dimer level. It can serve as an early-stage diagnostic marker for these diseases [28,29]. In the prospective study, Schwameis et al [30] found that within 3.5 hours of early bacteremia, rapidly elevated D-dimer level could identify bacteremia and assess the prognosis and mortality in advanced septic shock.…”

Section: Discussionmentioning

confidence: 99%

Combined Measurement of D-Dimer and C-Reactive Protein Levels: Highly Accurate for Diagnosing Chronic Periprosthetic Joint Infection

Qin

Gong

et al. 2020

The Journal of Arthroplasty

101

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Clinical and Laboratory Predictors of Shiga Toxin–Producing Escherichia coli Infection in Children With Bloody Diarrhea

Cited by 18 publications

References 30 publications

Case-management protocol for bloody diarrhea as a model to reduce the clinical impact of Shiga toxin-producing Escherichia coli infections. Experience from Southern Italy

Case-management protocol for bloody diarrhea as a model to reduce the clinical impact of Shiga toxin-producing Escherichia coli infections. Experience from Southern Italy

Epidemiology of Shiga Toxin-Producing Escherichia coli Infections in Southern Italy after Implementation of Symptom-Based Surveillance of Bloody Diarrhea in the Pediatric Population

Combined Measurement of D-Dimer and C-Reactive Protein Levels: Highly Accurate for Diagnosing Chronic Periprosthetic Joint Infection

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