Hemolytic–Uremic Syndrome in a Grandmother

Crawford, Lane; Crawford, Mark; Moore, Sean R.

doi:10.3201/eid1611.ad1611

Cited by 1 publication

(2 citation statements)

References 8 publications

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“…The use of fluoroquinolones and metronidazole suggests that clinicians considered diagnoses other than O157 diarrhea highly likely, or were unaware that evidence does not support empirical treatment of most patients with presumed infectious diarrhea [ 4 ]. E. coli O157 diarrhea has been misdiagnosed as ischemic colitis, diverticular disease, peritonitis, and inflammatory bowel disease [ 29 , 30 , 31 , 32 ]; these conditions are sometimes treated with this combination of antimicrobials [ 33 , 34 , 35 ]. Misdiagnosis of O157 infections as these other conditions can contribute to poor outcomes and unnecessary procedures [ 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…E. coli O157 diarrhea has been misdiagnosed as ischemic colitis, diverticular disease, peritonitis, and inflammatory bowel disease [ 29 , 30 , 31 , 32 ]; these conditions are sometimes treated with this combination of antimicrobials [ 33 , 34 , 35 ]. Misdiagnosis of O157 infections as these other conditions can contribute to poor outcomes and unnecessary procedures [ 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

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Risk of Hemolytic Uremic Syndrome Related to Treatment of Escherichia coli O157 Infection with Different Antimicrobial Classes

et al. 2021

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Treatment of Shiga toxin-producing Escherichia coli O157 (O157) diarrhea with antimicrobials might alter the risk of hemolytic uremic syndrome (HUS). However, full characterization of which antimicrobials might affect risk is lacking, particularly among adults. To inform clinical management, we conducted a case-control study of residents of the FoodNet surveillance areas with O157 diarrhea during a 4-year period to assess antimicrobial class-specific associations with HUS among persons with O157 diarrhea. We collected data from medical records and patient interviews. We measured associations between treatment with agents in specific antimicrobial classes during the first week of diarrhea and development of HUS, adjusting for age and illness severity. We enrolled 1308 patients; 102 (7.8%) developed confirmed HUS. Antimicrobial treatment varied by age: <5 years (12.6%), 5–14 (11.5%), 15–39 (45.4%), ≥40 (53.4%). Persons treated with a β-lactam had higher odds of developing HUS (OR 2.80, CI 1.14–6.89). None of the few persons treated with a macrolide developed HUS, but the protective association was not statistically significant. Exposure to “any antimicrobial” was not associated with increased odds of HUS. Our findings confirm the risk of β-lactams among children with O157 diarrhea and extends it to adults. We observed a high frequency of inappropriate antimicrobial treatment among adults. Our data suggest that antimicrobial classes differ in the magnitude of risk for persons with O157 diarrhea.

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