Effect of subinhibitory concentrations of antibiotics on extracellular shiga-like toxin I

Walterspiel, JuanN.; Ashkenazi, Shai; Morrow, Ardythe L.; Cleary, Thomas G.

doi:10.1007/bf01704889

Cited by 174 publications

(115 citation statements)

References 26 publications

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“…Addition of the antibiotic norfloxacin induces lambdoid bacteriophages into the lytic life cycle (Matsushiro et al, 1999;Walterspiel et al, 1992) by activation of the RecAmediated SOS response (Heddle et al, 2000). RecA is then responsible for directing phage derepression via rapid autocleavage of the lambdoid repressor protein CI (Craig & Roberts, 1980).…”

Section: P C M Fogg and Othersmentioning

confidence: 99%

Cumulative effect of prophage burden on Shiga toxin production in Escherichia coli

et al. 2012

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Section: P C M Fogg and Othersmentioning

confidence: 99%

Cumulative effect of prophage burden on Shiga toxin production in Escherichia coli

et al. 2012

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“…These 4 patients had anemia (median hematocrit 27%; range [23][24][25][26][27][28][29] and thrombocytopenia (median 42 000/L; range 29 000 to 122 000), but no azotemia; 3 had proteinuria or hematuria. The median interval between onset of the first symptom to hospitalization for HUS was 6 days (range 1 to 12).…”

Section: Outcomes Identifiedmentioning

confidence: 99%

Predictors of Hemolytic Uremic Syndrome in Children During a Large Outbreak of Escherichia coli O157:H7 Infections

et al. 1997

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ABSTRACT. Objective. To evaluate risk factors for progression of Escherichia coli O157:H7 infection to the hemolytic uremic syndrome (HUS).Study Design. We conducted a retrospective cohort study among 278 Washington State children <16 years old who developed symptomatic culture-confirmed E coli O157:H7 infection during a large 1993 outbreak. The purpose of the study was to determine the relative risk (RR) of developing HUS according to demographic characteristics, symptoms, laboratory test results, and medication use in the first 3 days of illness.Results. Thirty-seven (14%) children developed HUS. In univariate analysis, no associations were observed between HUS risk and any demographic characteristic, the presence of bloody diarrhea or of fever, or medication use. In multivariate analysis, HUS risk was associated with, in the first 3 days of illness, use of antimotility agents (odds ratio [OR] ‫؍‬ 2.9; 95% confidence interval [CI] 1.2-7.5) and, among children <5.5 years old, vomiting (OR ‫؍‬ 4.2; 95% CI 1.4 -12.7). Among the 128 children tested, those whose white blood cell (WBC) count was 13 000/L in the first 3 days of illness had a 7-fold increased risk of developing HUS (RR 7.2; 95% CI 2.8 -18.5). Thirteen (38%) of the 34 patients with a WBC count 13 000/L developed HUS, but only 5 (5%) of the 94 children whose initial WBC count was <13 000/L progressed to HUS. Among children who did not develop HUS, use of antimotility agents in the first 3 days of illness was associated with longer duration of bloody diarrhea.Conclusions. Prospective studies are needed to further evaluate measures to prevent the progression of E coli O157:H7 infection to HUS and to assess further clinical and laboratory risk factors. These data argue against the use of antimotility agents in acute childhood diarrhea. Our finding that no intervention decreased HUS risk underscores the importance of preventing E coli O157:H7 infections. Pediatrics 1997;100(1). URL: http:// www.pediatrics.org/cgi/content/full/100/1/e12; antibiotics, antimotility agents, Escherichia coli O157:H7, kidney failure, leukocytosis.ABBREVIATIONS. HUS, hemolytic uremic syndrome; BUN, blood urea nitrogen; RR, relative risk; CI, confidence interval; TMP/SMZ, trimethoprim/sulfamethoxazole; OR, odds ratio; WBC, white blood cell; Stx, Shiga toxin. E scherichia coli O157:H7 causes bloody and nonbloody diarrhea that progresses to hemolytic uremic syndrome (HUS) in a subset of patients.1,2 Though the gastrointestinal manifestations of infection with E coli O157:H7 can be severe, HUS accounts for the major acute and chronic morbidity and mortality caused by this organism.Associations between certain host-specific factors and the risk of progression of enteric infection with E coli O157:H7 to HUS have been reported. In population-based studies of HUS, age-specific incidence was highest among children Ͻ5 years of age, but these studies did not evaluate risk factors for progression of diarrhea or hemorrhagic colitis to HUS. [3][4][5][6] In some studies of children with E coli O...

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“…HUS consists of nonimmune hemolytic anemia, thrombocytopenia, and renal insufficiency and is believed to be caused by circulating Shiga toxins [1]. An association between antibiotic administration and HUS is plausible: in vitro, a variety of antibiotics increase Shiga toxin production by E. coli [2,3].…”

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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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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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Effect of subinhibitory concentrations of antibiotics on extracellular shiga-like toxin I

Cited by 174 publications

References 26 publications

Cumulative effect of prophage burden on Shiga toxin production in Escherichia coli

Cumulative effect of prophage burden on Shiga toxin production in Escherichia coli

Predictors of Hemolytic Uremic Syndrome in Children During a Large Outbreak of Escherichia coli O157:H7 Infections

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

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