Treatment Strategies for Infections With Shiga Toxin-Producing Escherichia coli

Abstract

Infections with Shiga toxin-producing Escherichia coli (STEC) cause outbreaks of severe diarrheal disease in children and the elderly around the world. The severe complications associated with toxin production and release range from bloody diarrhea and hemorrhagic colitis to hemolytic-uremic syndrome, kidney failure, and neurological issues. As the use of antibiotics for treatment of the infection has long been controversial due to reports that antibiotics may increase the production of Shiga toxin, the recommended therapy today is mainly supportive. In recent years, a variety of alternative treatment approaches such as monoclonal antibodies or antisera directed against Shiga toxin, toxin receptor analogs, and several vaccination strategies have been developed and evaluated in vitro and in animal models. A few strategies have progressed to the clinical trial phase. Here, we review the current understanding of and the progress made in the development of treatment options against STEC infections and discuss their potential.

The Role of Escherichia coli Shiga Toxins in STEC Colonization of Cattle

“…bLF mitigates shedding of E. coli O157:H7 by cattle [222], but only if applied rectally, i.e., at the principal colonization site of bacteria of this serotype [222]. Treatment approaches such as monoclonal antibodies or antisera directed against Stxs and toxin receptor analogs, developed for the treatment of human STEC infections [16] have not been tested for their efficacy to protect cattle against the immunmodulatory effects of Stxs but will likely remain too expensive to be considered for such use.…”

“…Humans acquire the infection by oral route by consumption of food items or water contaminated with bovine fecal matter [15]. Since a targeted treatment for EHEC-induced human diseases like hemorrhagic colitis (HC) and hemolytic-uremic syndrome (HUS) has not yet reached clinical application [16], prevention of human infection is at highest priority. Prophylactic measures to prevent exposure is challenging as up to 82% of cattle globally shed STEC with their feces [15,17].…”

Antimicrobial Resistance of Non-O157 Shiga Toxin-Producing Escherichia coli Isolated from Humans and Domestic Animals

“…Stx acts as ribotoxin that inhibits protein synthesis within sensitive eukaryotic cells and induces apoptosis [ 10 ]. To date, the treatment of STEC infections is mainly supportive, including rehydration therapy and dialysis where necessary [ 11 ]. The use of antimicrobials to treat STEC infections remains highly controversial and challenging, because some antimicrobial agents can induce Stx production, thus promoting the development of HUS [ 12 , 13 ].…”

“…Due to the extensive use of antimicrobial agents in farm animals, antimicrobial-resistant bacteria have become a serious issue. A comprehensive understanding of the prevalence of antibiotic-resistant STECs and the mechanisms underlying various resistance patterns could help possible therapeutic options for human infections [ 11 ]. However, limited information on antimicrobial resistance (AMR)-STECs is available in China.…”

Síndrome hemolítico urémico en una mujer adulta mayor: reporte de caso y revisión de la literatura

“…Realizar una diferenciación entre los distintos tipos de MAT es de vital im- portancia, ya que de ello dependerá el enfoque terapéutico [5,15]. El pilar del tratamiento se basa en el manejo intrahospitalario de soporte [23,26], que se debe enfocar en la administración de líquidos endovenosos de manera temprana, ya que reduce la tasa de compromiso a nivel del sistema nervioso central [9,13,17] y la necesidad de terapia de reemplazo renal, lo cual aumenta la supervivencia de los pacientes y evita las secuelas a largo plazo [8].…”