Early Volume Expansion During Diarrhea and Relative Nephroprotection During Subsequent Hemolytic Uremic Syndrome

Hickey, Christina; Beattie, Tom F.; Cowieson, Jennifer; Miyashita, Yosuke; Strife, C. Frederic; Frem, Juliana C.; Peterson, Johann M.; Butani, Lavjay; Jones, Deborah; Havens, Peter L.; Patel, Hiren P.; Wong, Craig S.; Andreoli, Sharon P.; Rothbaum, Robert; Beck, Anne Marie; Tarr, Phillip I.

doi:10.1001/archpediatrics.2011.152

Cited by 116 publications

(101 citation statements)

References 27 publications

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“…The single randomized controlled trial included, which did not influence the results, was of limited utility because the treatment was provided late (day 7), which is close to the median day of onset of HUS in many North American series [9,27]. We attempted to mitigate this weakness by addressing publication and selection biases and broadening our search criteria to identify all publications, even when antibiotic use and development of HUS was not the focus.…”

Section: Discussionmentioning

confidence: 99%

“…The inconclusive nature of these reviews has contributed to practice variation despite Centers for Disease Control and Prevention urgings against antibiotic use in these infections [8]. Nonetheless, approximately onethird of HUS patients in a 2007-2008 multicenter study of US and Scottish institutions [9] and in a nationwide survey of childhood HUS [10] received antibiotics prior to the development of HUS.…”

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confidence: 99%

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Shiga Toxin–ProducingEscherichia coliInfection, Antibiotics, and Risk of Developing Hemolytic Uremic Syndrome: A Meta-analysis

et al. 2016

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Background. Antibiotic administration to individuals with Shiga toxin-producing Escherichia coli (STEC) infection remains controversial. We assessed if antibiotic administration to individuals with STEC infection is associated with development of hemolytic uremic syndrome (HUS).Methods. The analysis included studies published up to 29 April 2015, that provided data from patients (1) with STEC infection, (2) who received antibiotics, (3) who developed HUS, and (4) for whom data reported timing of antibiotic administration in relation to HUS. Risk of bias was assessed; strength of evidence was adjudicated. HUS was the primary outcome. Secondary outcomes restricted the analysis to low-risk-of-bias studies employing commonly used HUS criteria. Pooled estimates of the odds ratio (OR) were obtained using random-effects models.Results. Seventeen reports and 1896 patients met eligibility; 8 (47%) studies were retrospective, 5 (29%) were prospective cohort, 3 (18%) were case-control, and 1 was a trial. The pooled OR, including all studies, associating antibiotic administration and development of HUS was 1.33 (95% confidence interval [CI], .89-1.99; I 2 = 42%). The repeat analysis including only studies with a low risk of bias and those employing an appropriate definition of HUS yielded an OR of 2.24 (95% CI, 1.45-3.46; I 2 = 0%).Conclusions. Overall, use of antibiotics was not associated with an increased risk of developing HUS; however, after excluding studies at high risk of bias and those that did not employ an acceptable definition of HUS, there was a significant association. Consequently, the use of antibiotics in individuals with STEC infections is not recommended.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Shiga Toxin–ProducingEscherichia coliInfection, Antibiotics, and Risk of Developing Hemolytic Uremic Syndrome: A Meta-analysis

et al. 2016

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“…This situation can further intensify the prothrombotic environment created by STX-associated endothelial injury. 45,46 Early volume expansion in patients affected by EHEC, implemented within the first 4 days from the onset of diarrhea, can improve renal and general outcomes of D+HUS. 45,46 Type of fluids and way of administration should follow the general guidelines for hydration and rehydration in children with acute gastroenteritis.…”

mentioning

confidence: 99%

“…45,46 Early volume expansion in patients affected by EHEC, implemented within the first 4 days from the onset of diarrhea, can improve renal and general outcomes of D+HUS. 45,46 Type of fluids and way of administration should follow the general guidelines for hydration and rehydration in children with acute gastroenteritis. 47,48 Antibiotic treatment Antibiotic treatment of EHEC infections before and after development of D+HUS has been a subject of great interest for researchers.…”

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confidence: 99%

Management of hemolytic-uremic syndrome in children

Grisaru¹

2014

IJNRD

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Acute renal failure associated with a fulminant, life-threatening systemic disease is rare in previously healthy young children; however, when it occurs, the most common cause is hemolytic-uremic syndrome (HUS). In most cases (90%), this abrupt and devastating illness is a result of ingestion of food or drink contaminated with pathogens that produce very potent toxins. Currently, there are no proven treatment options that can directly inactivate the toxin or effectively interfere with the cascade of destructive events triggered by the toxin once it gains access to the bloodstream and binds its receptor. However, HUS is self-limited, and effective supportive management during the acute phase is proven to be a life saver for children affected by HUS. A minority of childhood HUS cases, approximately 5%, are caused by various genetic mutations causing uncontrolled activation of the complement system. These children, who used to have a poor prognosis leading to end-stage renal disease, now have access to exciting new treatment options that can preserve kidney function and avoid disease recurrences. This review provides a summary of the current knowledge on the epidemiology, pathophysiology, and clinical presentation of childhood HUS, focusing on a practical approach to best management measures.

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“…For example, reliance on an abnormal urinalysis to define HUS, especially if the serum creatinine is normal, risks consideration of incorrect diagnoses such as urinary tract infections, especially as the possibility of contamination with fecal material is high in the setting of diarrhea. Moreover, these widely available blood tests enable physicians to relate their patient's course to those described in many other studies during the past 3 decades from multiple countries (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31).…”

Section: Definitionsmentioning

confidence: 99%

Shiga Toxin/Verocytotoxin-Producing Escherichia coli Infections: Practical Clinical Perspectives

2014

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Escherichia coli strains that produce Shiga toxins/verotoxins are rare, but important, causes of human disease. They are responsible for a spectrum of illnesses that range from the asymptomatic to the life-threatening hemolyticuremic syndrome; diseases caused by E. coli belonging to serotype O157:H7 are exceptionally severe. Each illness has a fairly predictable trajectory, and good clinical practice at one phase can be inappropriate at other phases. Early recognition, rapid and definitive microbiology, and strategic selection of tests increase the likelihood of good outcomes. The best management of these infections consists of avoiding antibiotics, antimotility agents, and narcotics and implementing aggressive intravenous volume expansion, especially in the early phases of illness.

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Early Volume Expansion During Diarrhea and Relative Nephroprotection During Subsequent Hemolytic Uremic Syndrome

Cited by 116 publications

References 27 publications

Shiga Toxin–ProducingEscherichia coliInfection, Antibiotics, and Risk of Developing Hemolytic Uremic Syndrome: A Meta-analysis

Shiga Toxin–ProducingEscherichia coliInfection, Antibiotics, and Risk of Developing Hemolytic Uremic Syndrome: A Meta-analysis

Management of hemolytic-uremic syndrome in children

Shiga Toxin/Verocytotoxin-Producing Escherichia coli Infections: Practical Clinical Perspectives

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