Interventions for Shiga Toxin-producing Escherichia Coli Gastroenteritis and Risk of Hemolytic Uremic Syndrome: A Population-based Matched Case Control Study

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2022 Feb 4

PMID 35120154

Authors

Shota Myojin

Kyongsun Pak

Mayumi Sako

Tohru Kobayashi

Takuri Takahashi

Tomimasa Sunagawa

Norihiko Tsuboi

Kenji Ishikura

Masaya Kubota

Mitsuru Kubota

Takashi Igarashi

Ichiro Morioka

Isao Miyairi

Affiliations

Soon will be listed here.

Abstract

Background: The role of antibiotics in the treatment of Shiga toxin-producing Escherichia coli (STEC) infection is controversial.

Objectives: To evaluate the association between treatment (antibiotics, antidiarrheal agents, and probiotics) for STEC infection and hemolytic uremic syndrome (HUS) development.

Patients And Methods: We performed a population-based matched case-control study using the data from the National Epidemiological Surveillance of Infectious Diseases (NESID) between January 1, 2017 and December 31, 2018. We identified all patients with STEC infection and HUS as cases and matched patients with STEC infection without HUS as controls, with a case-control a ratio of 1:5. Further medical information was obtained by a standardized questionnaire. Multivariable conditional logistic regression model was used.

Results: 7760 patients with STEC infection were registered in the NESID. 182 patients with HUS and 910 matched controls without HUS were selected. 90 patients with HUS (68 children and 22 adults) and 371 patients without HUS (266 children and 105 adults) were included in the main analysis. The matched ORs of any antibiotics and fosfomycin for HUS in children were 0.56 (95% CI 0.32-0.98), 0.58 (0.34-1.01). The matched ORs for HUS were 2.07 (1.07-4.03), 0.86 (0.46-1.61) in all ages treated with antidiarrheal agent and probiotics.

Conclusions: Antibiotics, especially fosfomycin, may prevent the development of HUS in children, while use of antidiarrheal agents should be avoided.

Citing Articles

Breastfeeding and hemolytic uremic syndrome.

Giordano M, Gallo M, Ferrante M Pediatr Nephrol. 2024; 39(10):3127-3128.

PMID: 38676762 DOI: 10.1007/s00467-024-06359-9.

References

Takeda T . Strategy to prevent the progression of enterohemorrhagic Escherichia coli O157 infection to hemolytic uremic syndrome. Jpn J Med Sci Biol. 1999; 51 Suppl:S124-8. DOI: 10.7883/yoken1952.51.supplement1_s124. View

Thorpe C . Shiga toxin-producing Escherichia coli infection. Clin Infect Dis. 2004; 38(9):1298-303. DOI: 10.1086/383473. View

Kakoullis L, Papachristodoulou E, Chra P, Panos G . Shiga toxin-induced haemolytic uraemic syndrome and the role of antibiotics: a global overview. J Infect. 2019; 79(2):75-94. DOI: 10.1016/j.jinf.2019.05.018. View

Majowicz S, Scallan E, Jones-Bitton A, Sargeant J, Stapleton J, Angulo F . Global incidence of human Shiga toxin-producing Escherichia coli infections and deaths: a systematic review and knowledge synthesis. Foodborne Pathog Dis. 2014; 11(6):447-55. PMC: 4607253. DOI: 10.1089/fpd.2013.1704. View

Guerrant R, Van Gilder T, Steiner T, Thielman N, Slutsker L, Tauxe R . Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001; 32(3):331-51. DOI: 10.1086/318514. View

Fukushima H, Hashizume T, Morita Y, Tanaka J, Azuma K, Mizumoto Y . Clinical experiences in Sakai City Hospital during the massive outbreak of enterohemorrhagic Escherichia coli O157 infections in Sakai City, 1996. Pediatr Int. 1999; 41(2):213-7. DOI: 10.1046/j.1442-200x.1999.4121041.x. View

Gould L, Demma L, Jones T, Hurd S, Vugia D, Smith K . Hemolytic uremic syndrome and death in persons with Escherichia coli O157:H7 infection, foodborne diseases active surveillance network sites, 2000-2006. Clin Infect Dis. 2009; 49(10):1480-5. DOI: 10.1086/644621. View

Ethelberg S, Olsen K, Scheutz F, Jensen C, Schiellerup P, Enberg J . Virulence factors for hemolytic uremic syndrome, Denmark. Emerg Infect Dis. 2004; 10(5):842-7. PMC: 3323205. DOI: 10.3201/eid1005.030576. View

Ikeda K, Ida O, Kimoto K, Takatorige T, Nakanishi N, Tatara K . Effect of early fosfomycin treatment on prevention of hemolytic uremic syndrome accompanying Escherichia coli O157:H7 infection. Clin Nephrol. 1999; 52(6):357-62. View

10.

Launders N, Byrne L, Jenkins C, Harker K, Charlett A, Adak G . Disease severity of Shiga toxin-producing E. coli O157 and factors influencing the development of typical haemolytic uraemic syndrome: a retrospective cohort study, 2009-2012. BMJ Open. 2016; 6(1):e009933. PMC: 4735319. DOI: 10.1136/bmjopen-2015-009933. View

11.

Wong C, Mooney J, Brandt J, Staples A, Jelacic S, Boster D . Risk factors for the hemolytic uremic syndrome in children infected with Escherichia coli O157:H7: a multivariable analysis. Clin Infect Dis. 2012; 55(1):33-41. PMC: 3493180. DOI: 10.1093/cid/cis299. View

12.

Vally H, Hall G, Dyda A, Raupach J, Knope K, Combs B . Epidemiology of Shiga toxin producing Escherichia coli in Australia, 2000-2010. BMC Public Health. 2012; 12:63. PMC: 3398300. DOI: 10.1186/1471-2458-12-63. View

13.

Frenzen P, Drake A, Angulo F . Economic cost of illness due to Escherichia coli O157 infections in the United States. J Food Prot. 2005; 68(12):2623-30. DOI: 10.4315/0362-028x-68.12.2623. View

14.

Byrne L, Vanstone G, Perry N, Launders N, Adak G, Godbole G . Epidemiology and microbiology of Shiga toxin-producing Escherichia coli other than serogroup O157 in England, 2009-2013. J Med Microbiol. 2014; 63(Pt 9):1181-1188. DOI: 10.1099/jmm.0.075895-0. View

15.

Tarr G, Oltean H, Phipps A, Rabinowitz P, Tarr P . Strength of the association between antibiotic use and hemolytic uremic syndrome following Escherichia coli O157:H7 infection varies with case definition. Int J Med Microbiol. 2018; 308(7):921-926. PMC: 6287940. DOI: 10.1016/j.ijmm.2018.06.009. View

16.

Williams D, Sreedhar S, Mickell J, Chan J . Acute kidney failure: a pediatric experience over 20 years. Arch Pediatr Adolesc Med. 2002; 156(9):893-900. DOI: 10.1001/archpedi.156.9.893. View

17.

Freedman S, Williamson-Urquhart S, Farion K, Gouin S, Willan A, Poonai N . Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis. N Engl J Med. 2018; 379(21):2015-2026. DOI: 10.1056/NEJMoa1802597. View

18.

Kimmitt P, Harwood C, Barer M . Induction of type 2 Shiga toxin synthesis in Escherichia coli O157 by 4-quinolones. Lancet. 1999; 353(9164):1588-9. DOI: 10.1016/s0140-6736(99)00621-2. View

19.

Giordano M, Baldassarre M, Palmieri V, Torres D, Carbone V, Santangelo L . Management of STEC Gastroenteritis: Is There a Role for Probiotics?. Int J Environ Res Public Health. 2019; 16(9). PMC: 6539596. DOI: 10.3390/ijerph16091649. View

20.

Tajiri H, Nishi J, Ushijima K, Shimizu T, Ishige T, Shimizu M . A role for fosfomycin treatment in children for prevention of haemolytic-uraemic syndrome accompanying Shiga toxin-producing Escherichia coli infection. Int J Antimicrob Agents. 2015; 46(5):586-9. DOI: 10.1016/j.ijantimicag.2015.08.006. View