BACKGROUND: Escherichia coli O157:H7 is the leading cause of hemolytic uremic syndrome (HUS). Risk factors for development of this complication warrant identification. METHODS: We enrolled children infected with E. coli O157:H7 within 1 week of the onset of diarrhea in this prospective cohort study. The study was conducted in 5 states over 9.5 years . The primary and secondary outcomes were HUS (hematocrit <30% with smear evidence of hemolysis, platelet count <150 × 10(3)/µL, and serum creatinine concentration > upper limit of normal for age) and oligoanuric HUS. Univariate and multivariable and ordinal multinomial regression analyses were used to test associations between factors apparent during the first week of illness and outcomes. RESULTS: Of the 259 children analyzed, 36 (14%) developed HUS. Univariate analysis demonstrated that children who received antibiotics during the diarrhea phase more frequently developed HUS than those who did not (36% vs 12%; P = .001). The higher rate of HUS was observed across all antibiotic classes used. In multivariable analysis, a higher leukocyte count (adjusted odds ratios [aOR] 1.10; 95% CI, 1.03-1.19), vomiting (aOR 3.05; 95% CI, 1.23-7.56), and exposure to antibiotics (aOR 3.62; 95% CI, 1.23-10.6) during the first week of onset of illness were each independently associated with development of HUS. Multinomial ordinal logistic regression confirmed that initial leukocyte count and antibiotic use were independently associated with HUS and, additionally, these variables were each associated with the development of oligoanuric HUS. CONCLUSIONS: Antibiotic use during E. coli O157:H7 infections is associated with a higher rate of subsequent HUS and should be avoided.
BACKGROUND:Escherichia coli O157:H7 is the leading cause of hemolytic uremic syndrome (HUS). Risk factors for development of this complication warrant identification. METHODS: We enrolled children infected with E. coli O157:H7 within 1 week of the onset of diarrhea in this prospective cohort study. The study was conducted in 5 states over 9.5 years . The primary and secondary outcomes were HUS (hematocrit <30% with smear evidence of hemolysis, platelet count <150 × 10(3)/µL, and serum creatinine concentration > upper limit of normal for age) and oligoanuric HUS. Univariate and multivariable and ordinal multinomial regression analyses were used to test associations between factors apparent during the first week of illness and outcomes. RESULTS: Of the 259 children analyzed, 36 (14%) developed HUS. Univariate analysis demonstrated that children who received antibiotics during the diarrhea phase more frequently developed HUS than those who did not (36% vs 12%; P = .001). The higher rate of HUS was observed across all antibiotic classes used. In multivariable analysis, a higher leukocyte count (adjusted odds ratios [aOR] 1.10; 95% CI, 1.03-1.19), vomiting (aOR 3.05; 95% CI, 1.23-7.56), and exposure to antibiotics (aOR 3.62; 95% CI, 1.23-10.6) during the first week of onset of illness were each independently associated with development of HUS. Multinomial ordinal logistic regression confirmed that initial leukocyte count and antibiotic use were independently associated with HUS and, additionally, these variables were each associated with the development of oligoanuric HUS. CONCLUSIONS: Antibiotic use during E. coli O157:H7 infections is associated with a higher rate of subsequent HUS and should be avoided.
Authors: H M Tsai; W L Chandler; R Sarode; R Hoffman; S Jelacic; R L Habeeb; S L Watkins; C S Wong; G D Williams; P I Tarr Journal: Pediatr Res Date: 2001-05 Impact factor: 3.756
Authors: Wayne L Chandler; Srdjan Jelacic; Daniel R Boster; Marcia A Ciol; Glyn D Williams; Sandra L Watkins; Takashi Igarashi; Phillip I Tarr Journal: N Engl J Med Date: 2002-01-03 Impact factor: 91.245
Authors: Gillian A M Tarr; Linda Chui; Bonita E Lee; Xiao-Li Pang; Samina Ali; Alberto Nettel-Aguirre; Otto G Vanderkooi; Byron M Berenger; James Dickinson; Phillip I Tarr; Steven Drews; Judy MacDonald; Kelly Kim; Stephen B Freedman Journal: Clin Infect Dis Date: 2019-09-13 Impact factor: 9.079
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
Authors: Matthew A Croxen; Robyn J Law; Roland Scholz; Kristie M Keeney; Marta Wlodarska; B Brett Finlay Journal: Clin Microbiol Rev Date: 2013-10 Impact factor: 26.132