Nasia Safdar1, Adnan Said, Ronald E Gangnon, Dennis G Maki. 1. Department of Medicine, University of Wisconsin Medical School and University of Wisconsin Hospital and Clinics, Madison, WI 53792-5158, USA.
Abstract
CONTEXT: The use of antibiotics for treatment of Escherichia coli O157:H7 infection has become controversial since a recent small study found that it may increase the risk of hemolytic uremic syndrome (HUS). However, other larger studies have reported a protective effect or no association. OBJECTIVE: To determine whether antibiotic therapy for E coli O157:H7 enteritis increases the risk of HUS. DATA SOURCES: PubMed and MEDLINE computer searches were performed for studies published from January 1983 to February 2001 using the key words hemolytic uremic syndrome, risk factor, antibiotics, and Escherichia coli O157:H7. Reference lists of relevant publications were reviewed, and 12 experts in the field were contacted to identify additional reports. No language restrictions were applied to the search. STUDY SELECTION: Studies were included if they reported a series of patients with documented E coli O157:H7 enteritis, some of whom developed HUS; had clear definitions of HUS; and had adequate data delineating the relationship between antibiotic therapy and the occurrence of HUS. Nine of the 26 identified studies fulfilled these criteria. DATA EXTRACTION: Two authors (N.S. and A.S.) independently reviewed each report identified by the searches and recorded predetermined information relevant to the inclusion criteria. A pooled odds ratio was calculated using a fixed-effects model, with assessment of heterogeneity among the studies. DATA SYNTHESIS: The pooled odds ratio was 1.15 (95% confidence interval, 0.79-1.68), indicating that there does not appear to be an increased risk of HUS with antibiotic treatment of E coli O157:H7 enteritis. Incomplete reporting of data in individual studies precluded adjustment for severity of illness. CONCLUSION: Our meta-analysis did not show a higher risk of HUS associated with antibiotic administration. A randomized trial of adequate power, with multiple distinct strains of E coli O157:H7 represented, is needed to conclusively determine whether antibiotic treatment of E coli O157:H7 enteritis increases the risk of HUS.
CONTEXT: The use of antibiotics for treatment of Escherichia coli O157:H7infection has become controversial since a recent small study found that it may increase the risk of hemolytic uremic syndrome (HUS). However, other larger studies have reported a protective effect or no association. OBJECTIVE: To determine whether antibiotic therapy for E coli O157:H7enteritis increases the risk of HUS. DATA SOURCES: PubMed and MEDLINE computer searches were performed for studies published from January 1983 to February 2001 using the key words hemolytic uremic syndrome, risk factor, antibiotics, and Escherichia coli O157:H7. Reference lists of relevant publications were reviewed, and 12 experts in the field were contacted to identify additional reports. No language restrictions were applied to the search. STUDY SELECTION: Studies were included if they reported a series of patients with documented E coli O157:H7enteritis, some of whom developed HUS; had clear definitions of HUS; and had adequate data delineating the relationship between antibiotic therapy and the occurrence of HUS. Nine of the 26 identified studies fulfilled these criteria. DATA EXTRACTION: Two authors (N.S. and A.S.) independently reviewed each report identified by the searches and recorded predetermined information relevant to the inclusion criteria. A pooled odds ratio was calculated using a fixed-effects model, with assessment of heterogeneity among the studies. DATA SYNTHESIS: The pooled odds ratio was 1.15 (95% confidence interval, 0.79-1.68), indicating that there does not appear to be an increased risk of HUS with antibiotic treatment of E coli O157:H7enteritis. Incomplete reporting of data in individual studies precluded adjustment for severity of illness. CONCLUSION: Our meta-analysis did not show a higher risk of HUS associated with antibiotic administration. A randomized trial of adequate power, with multiple distinct strains of E coli O157:H7 represented, is needed to conclusively determine whether antibiotic treatment of E coli O157:H7enteritis increases the risk of HUS.
Authors: Stephen B Freedman; Jianling Xie; Madisen S Neufeld; William L Hamilton; Lisa Hartling; Phillip I Tarr; Alberto Nettel-Aguirre; Anderson Chuck; Bonita Lee; David Johnson; Gillian Currie; James Talbot; Jason Jiang; Jim Dickinson; Jim Kellner; Judy MacDonald; Larry Svenson; Linda Chui; Marie Louie; Martin Lavoie; Mohamed Eltorki; Otto Vanderkooi; Raymond Tellier; Samina Ali; Steven Drews; Tim Graham; Xiao-Li Pang Journal: Clin Infect Dis Date: 2016-02-24 Impact factor: 9.079