Escherichia coli 0157:H7 and the Hemolytic Uremic Syndrome: Importance of Early Cultures in Establishing the Etiology

Tarr, Phillip I.; Neill, Marguerite A.; Clausen, Carla R.; Watkins, Sandra L.; Christie, Dennis L.; Hickman, Robert O.

doi:10.1093/infdis/162.2.553

Cited by 232 publications

(134 citation statements)

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“…Dr Bell was contacted to provide the number of HUS cases that were culture positive, but the data were unavailable for review because of the time that has elapsed since the publication. Based on the following reasons, it was decided that the study and all cases should be considered as STEC positive: (1) E. coli O157:H7 was the overwhelming cause of HUS in Washington State in the 1980s and 1990s [29,30]; (2) inability to recover E. coli O157:H7 from a patient in Seattle with HUS is not uncommon if no antecedent stool culture is performed [29]; (3) intense analysis of 37 children with HUS at a single pediatric hospital in Seattle, during the outbreak (and included in the report) reported by Bell et al, failed to identify an STEC pathogen in only 5 children [31]; (4) endemic HUS and E. coli O157:H7 infections rarely occur in Washington State in January and February [18,29,30,32,33]. c Ikeda et al included in their study some cases of HUS in the absence of the identification of an STEC pathogen.…”

Section: Outcome Measuresmentioning

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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Section: Outcome Measuresmentioning

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 suggests that E. coli 0157 remains a significantly under-recognized cause of sporadic diarrhoea because not all laboratories routinely test all diarrhoeal stools for E. coli 0157, and the sensitivity of the standard culture technique decreases with the interval from the onset of diarrhoea (Tarr et al 1990). …”

Section: Epidemiologymentioning

confidence: 99%

Clinical presentation, complications and treatment of infection with verocytotoxin-producingEscherichia coli. Challenges for the clinician

Dundas

Todd

2000

Journal of Applied Microbiology

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SUMMARY Seventeen years after its recognition, outbreaks and sporadic infections attributed to Escherichia coli O157 continue to increase. Acute gastrointestinal, and the systemic complications haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP), are frequent and severe. Current challenges that face clinicians are the early recognition of infection, identification of risk factors for poor prognosis, determination of appropriate monitoring for the development of complications, establishment of a therapeutic strategy and, finally, advice for patients about their long‐term prognosis. Clinical features which, in combination, have been shown to distinguish E. coli O157 infection from other enteric pathogens are a history of bloody diarrhoea, visibly bloody stools, absence of fever, a leucocyte count greater than 10 × 109 1−1 and abdominal tenderness on physical examination. The most consistent risk factors for the development of HUS/TTP are the extremes of age and a raised leucocyte count. Bloody diarrhoea and ‘antimotility’ drugs are also likely to be important risk factors. Recent evidence from the central Scotland outbreak suggests that individuals who are taking drugs that reduce gastric acidity or antibiotics at the time of infection with E. coli O157, or who have a short incubation period, may also be at increased risk of progression to HUS/TTP. Clinical management, in particular the role of antibiotics in gastrointestinal infection, remains controversial, and retrospective assessment of the 1996 outbreaks from central Scotland and Japan only adds to this controversy. Therapeutic plasma exchange is a promising treatment for adults who develop HUS/TTP, but its role has yet to be determined definitively, either in a randomized controlled trial or by an international register of cases. Significant chronic sequelae of infection occur, particularly irritable bowel syndrome after uncomplicated gastrointestinal infection, and renal failure after HUS/TTP. Their frequency and severity are likely to become evident over the next decade.

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“…1 Microbiologic detection of STEC is highly dependent on obtaining stool cultures within 6 days of symptom onset, and the presence of fecal leukocytes indicates a higher yield sample. 2 The gold standard for diagnosis is stool culture on sorbitol MacConkey agar, followed by latex agglutination. ELISA, direct toxin assays, and toxin PCR methods all provide rapid diagnosis, with comparable sensitivity and specificity (77-96 % sensitivity, 98-99 % specificity).…”

mentioning

confidence: 99%

A Couple’s Colitis

2015

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A 32-year-old woman was admitted with 4 days of bloody diarrhea, abdominal pain, leukocytosis, and fever following fast food consumption and use of methamphetamine. An abdominal CT scan revealed continuous colonic mural thickening from the cecum to the splenic flexure (Fig. 1). Stool cultures for bacteria, ova and parasites, and fecal leukocytes were negative. Her symptoms resolved with supportive care, and on the day of discharge, her partner presented with identical symptoms (Fig. 2). His stool cultures grew shiga toxin 2-producing E. coli, serogroup O157:H7 (STEC). Based on his positive stool culture and the presence of diffuse colitis on both scans, a final diagnosis of STEC was given to both patients.STEC is a common cause of hemorrhagic colitis, usually occurring in food-borne outbreaks. Among patients diagnosed with STEC, 6 % subsequently develop hemolytic uremic syndrome. 1 Microbiologic detection of STEC is highly dependent on obtaining stool cultures within 6 days of symptom onset, and the presence of fecal leukocytes indicates a higher yield sample. 2 The gold standard for diagnosis is stool culture on sorbitol MacConkey agar, followed by latex agglutination. ELISA, direct toxin assays, and toxin PCR methods all provide rapid diagnosis, with comparable sensitivity and specificity (77-96 % sensitivity, 98-99 % specificity). 3

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Escherichia coli 0157:H7 and the Hemolytic Uremic Syndrome: Importance of Early Cultures in Establishing the Etiology

Cited by 232 publications

References 0 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

Clinical presentation, complications and treatment of infection with verocytotoxin-producingEscherichia coli. Challenges for the clinician

A Couple’s Colitis

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