Management of Shiga toxin producing <i>Escherichia coli</i>‐infected children: A multi‐national, multi‐specialty survey

Freedman, Stephen B.; Grisaru, Silviu; Xie, Jianling; Samuel, Susan; Dixon, Andrew; Plint, Amy C.; Schnadower, David

doi:10.1111/jpc.13778

Cited by 8 publications

(7 citation statements)

References 32 publications

(37 reference statements)

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“…The lack of recognition of STEC infections might have contributed to underuse this strategy; nevertheless, no patient with early pathogen identification received this treatment, raising the possibility that providers hesitated to give fluids to children at risk of impending renal failure or that they were not aware that intravenous volume expansion is warranted for these infections. Supporting this, a multinational survey conducted in the United States and Canada indicated that pediatric emergency physicians recommend intravenous fluids in this setting less frequently than do nephrologists 30 …”

Section: Discussionmentioning

confidence: 99%

“…Supporting this, a multinational survey conducted in the United States and Canada indicated that pediatric emergency physicians recommend intravenous fluids in this setting less frequently than do nephrologists. 30 A strength of this investigation is the large cohort analyzed unbiased by outbreak situations. The long period of time studied also provides information on change management over time.…”

Section: Discussionmentioning

confidence: 99%

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Prodromal Phase of Hemolytic Uremic Syndrome Related to Shiga Toxin–Producing Escherichia coli

et al. 2019

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Objectives: This study aimed to evaluate practice patterns during prodromal phase of hemolytic uremic syndrome related to Shiga toxin-producing Escherichia coli (STEC-HUS).Methods: Trajectories of children from first symptoms until STEC-HUS admitted consecutively at our center (period 2000-2017) were retrospectively reviewed. Early recommended practices include identification of STEC infections, antibiotics and antiperistaltic avoidance, and administration of anticipatory intravenous fluids; therefore, implementation and changes over time (before and after 2011) of such interventions were assessed. In addition, early management was correlated with acute disease outcomes.Results: Of 172 patients, 98 (57%) had early consults, 75 of them visit the pediatric emergency department. Those seen with watery diarrhea (n = 74) were managed as outpatients, whereas 27 of the 45 assisted with bloody diarrhea were hospitalized for diagnosis other than STEC-HUS. Stool cultures were performed in 13.4% (23/172), 18% (31/172) received antibiotics, and 12.8% (22/172) received endovenous fluids; none received antiperistaltic agents. Shiga toxin-producing E. coli infection was proven in 4% (7/172) before HUS. Rate of cultured patients and treated with intravenous fluids remained unchanged over time (P = 0.13 and P = 0.48, respectively), whereas antibiotic prescription decreased from 42.8% to 16.6% (P = 0.005). Main acute outcomes (need for dialysis, pancreatic compromise, central nervous system involvement, and death) were similar (P > 0.05) regardless of whether they received antibiotics or intravenous fluids.Conclusions: During the diarrheal phase, 57% of patients consulted; three-quarters of them consulted to the pediatric emergency department. Shiga toxin-producing E. coli detection was poor, antibiotic use remained high, and anticipatory volume expansion was underused. These findings outline the critical need to improve the early management of STEC-HUS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prodromal Phase of Hemolytic Uremic Syndrome Related to Shiga Toxin–Producing Escherichia coli

et al. 2019

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“…The general medical community remain inadequately informed of the risks of developing HUS following an enteric infection with STEC organisms. This was highlighted in a recent study which showed that emergency physicians responded in a different manner to children diagnosed with a STEC infection when compared with paediatric nephrologists [28]. Improved education of primary and secondary healthcare workers may help in early recognition and the initiation of appropriate treatment.…”

Section: Discussionmentioning

confidence: 99%

Shiga Toxin Producing <em>Escherichia coli</em> Infections and Associated Haemolytic Uraemic Syndrome in New Zealand Children: Twenty Three Years of Epidemiology and Clinical Observations

William¹

2022

Int J Pediatr Res

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Background:The epidemiology of childhood haemolytic uraemic syndrome in New Zealand was on active surveillance from January 1, 1998 to December 31, 2020. The aim of this study is to describe the demographic, epidemiological and some clinical features of childhood Shiga toxin producing E. coli infections (STEC) and its association with diarrhoea associated haemolytic uremic syndrome (D+HUS) over past 23 years. Methods:The New Zealand Paediatric Surveillance Unit (NZPSU) sent out a monthly report card to all practising paediatricians with conditions under active surveillance. Those paediatricians who had cared for a child aged 0 to 15 years of age with D+HUS in the past month were requested to report their patient to the NZPSU. The reporting clinicians were then contacted by the principal investigator who sent out a questionnaire to the clinician requesting patient clinical and laboratory information. The group was divided into 2 cohorts; A: 1998-2008 and B: 2009-2020 to examine trends in STEC infections and childhood D+HUS.Results: Two hundred and twenty six children aged 3 months up to 15 years (median 2.8 years (IQR 1.7-4.9) were diagnosed with D+HUS. E. coli O157: H7 was identified in 130 (57.1%) and 8 were due to serotypes 026 H11 and 0113. Over the 23 years, the mean annual incidence in children under age 5 between cohort A and cohort B was not statistically significant (2.2 per 100,000 vs. 2.85 per 100,000. The mean annual incidence was 1.2 per 100,000 in all children under age 15 for the whole study period. Disease severity as measured by the requirement for acute dialysis had not changed and was required in 128/226 (56.2%) of children for a median of 9 days (range 1-38). The overall mortality was 3/226 (1.3%), which was due exclusively to severe cerebral injury. Conclusion:There has been an increase in STEC infections in childhood over the past 23 years, in part due improved methods of detection, however, the incidence children developing D+HUS has remained stable over the study period. E. coli serotypes other than O157:H7 have increased in prevalence over the past 6 years due to methodological changes in diagnostic laboratories, but with only a small number of infected children developing D+HUS. The mortality rate over the study period was low, consistent with other reported series.

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“…Hyponatremia is related to CNS complications, such as seizures and encephalopathy, and is also a strong predictor of death risk in D+HUS patients. [24][25][26][27] In our study, the initial hyponatremia was corrected in 24 hours, and blood sodium was kept within normal ranges in the VE group. After 48 hours, the number of patients with hyponatremia was statistically and significantly higher in the FR group (p = 0.014).…”

Section: Diarrhea-associated Hemolytic Uremic Syndrome and Hyponatremiamentioning

confidence: 91%

Hydration in hemolytic uremic syndrome

Bilkis

Bonany

2021

Arch Argent Pediat

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Management of Shiga toxin producing Escherichia coli‐infected children: A multi‐national, multi‐specialty survey

Abstract: Compared with paediatric nephrologists, paediatric emergency medicine physicians are less likely to perform baseline and follow-up blood tests and to administer intravascular volume expansion in children at risk of, and with confirmed, E. coli O157:H7 infection.

Cited by 8 publications

References 32 publications

Prodromal Phase of Hemolytic Uremic Syndrome Related to Shiga Toxin–Producing Escherichia coli

Prodromal Phase of Hemolytic Uremic Syndrome Related to Shiga Toxin–Producing Escherichia coli

Shiga Toxin Producing <em>Escherichia coli</em> Infections and Associated Haemolytic Uraemic Syndrome in New Zealand Children: Twenty Three Years of Epidemiology and Clinical Observations

Hydration in hemolytic uremic syndrome

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