Shiga toxin-producing Escherichia coli in children with diarrhea: A prospective point-of-care study

Klein, Eileen J.; Stapp, Jennifer R.; Clausen, Carla R.; Boster, Daniel R.; Wells, Joy G.; Qin, Xuan; Swerdlow, David L.; Tarr, Phillip I.

doi:10.1067/mpd.2002.125908

Cited by 130 publications

(130 citation statements)

References 39 publications

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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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“…Enterohaemorrhagic Escherichia coli /Shiga-toxin producing Escherichia coli (EHEC/STEC) is among the diarrhoeagenic E.coli (DEC) pathogenic strains which cause gastroenteritis cases ranging from non-invasive diarrhoea to bloody diarrhoea and haemorrhagic colitis (Hermos et al, 2011). STEC infection can also complicate into a life threatening condition known as haemolyticuremic syndrome(HUS) characterized by haemolytic anaemia, thrombocytopenia and renal insufficiency or failure (Klein et al, 2002). STEC can be transmitted by person-to-person through faecal-oral route, through contaminated foods such as ground beef and unchlorinated water.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and antimicrobial sensitivity of Shiga-toxin-producing Escherichia coli among underfives presenting with diarrhoea at hospitals in Mwanza City, Tanzania

Moremi¹,

Othman

Msaki³

et al. 2017

Tanzania J Hlth Res

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Background: Escherichia coli is among the most common causes of diarrhoea in children below five years of age in developing countries. Diarrhoeal diseases rank the second most common cause of morbidity and mortality in developing countries. Here we report the magnitude of Shiga toxin-producing Escherichia coli (STEC) infection among underfives with diarrhoea in Mwanza, Tanzania. Methods: This study was carried out at Nyamagana and Sekou Toure hospitals in Mwanza, Tanzania. Between July, 2015 and March, 2016, children aged < 5 years with diarrhoea were included in the study. Demographics and relevant information were recorded. Stool specimens were cultured onto MacConkey and Salmonella-Shigella Agars. CHROMagar STEC was used to identify STEC. Antimicrobial susceptibility testing was performed to all pathogenic bacteria using disc diffusion method. Results: A total of 304 children were include in the study. The mean (±standard deviation) age of the enrolled children was 1.4 (±1.03) years. Out of 304 diarrhoea cases, 32 (10.5%) were positive for STEC and 12 (3.9%) were due to other pathogenic bacteria (Salmonella and Shigella species.). Of 32 STEC isolates, 22 (68.8%) and 20 (62.5%) were resistant to amoxicillin/clavulanic acid and trimethoprim-sulfamethoxazole respectively and 3 (9.4%) were found to produce extended spectrum beta lactamases (ESBL). Use of water from wells (p=0.006) was found to be the predictor of the presence of pathogenic bacteria. Conclusion: Clinicians should consider STEC as the potential pathogens causing diarrhoea in the region. More than 60% of pathogenic bacteria were resistant to commonly prescribed antimicrobials like amoxicillin/clavulanic acid and trimethoprim-sulfamethoxazole. There is a need to emphasize on the provision of safe water, health education together with improvements in sanitation and personal hygiene as key strategies to reduce these infections.

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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%

“…Most compellingly, E. coli O157:H7 is the STEC/VTEC that remains to this day the near-exclusive cause of postdiarrheal HUS (8,12,16,21,(43)(44)(45)(46)(47)(48)(49). This serotype is also the one most strongly associated with outbreaks (though most infections are sporadic).…”

Section: Distinction Between Stec/vtec Belonging To Serotype O157:h7 mentioning

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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Shiga toxin-producing Escherichia coli in children with diarrhea: A prospective point-of-care study

Cited by 130 publications

References 39 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

Prevalence and antimicrobial sensitivity of Shiga-toxin-producing Escherichia coli among underfives presenting with diarrhoea at hospitals in Mwanza City, Tanzania

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

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