BACKGROUND: Whether antibiotic treatment in patients with enterohemorrhagic Escherichia coli (EHEC)-associated diarrhea influences the risk of hemolytic uremic syndrome (HUS) has still to be elucidated. PATIENTS AND METHODS: During the EHEC epidemic which occurred in northern Germany in spring 2011, 24 patients with E. coli O104:H4 infection were treated at our hospitals, 19 of whom developed HUS. The use of antibiotics before and after the onset of HUS was documented, and the outcome in patients with and without antibiotic treatment was evaluated. RESULTS: Of the 24 patients with EHEC-associated diarrhea, seven received antibiotics before any signs of HUS were present (ciprofloxacin, cefotaxime, amoxicillin and/or metronidazole). Four of these seven patients (57 %) and 15 of the 17 patients (88 %) who were treated without antibiotics developed HUS (p = 0.12). Microbiological testing showed all E. coli O104:H4 to be extended-spectrum beta lactamase producers and thus susceptible only to fluoroquinolones, aminoglycosides and carbapenems. Two of the five patients (40 %) treated with ciprofloxacin and 17 of the 19 patients (89 %) treated without ciprofloxacin developed HUS (p = 0.043). CONCLUSION: In our E. coli O104:H4-infected patients, treatment of diarrhea with antibiotics did not increase the risk of HUS. Significantly fewer patients treated with ciprofloxacin developed HUS than patients who did not receive ciprofloxacin.
BACKGROUND: Whether antibiotic treatment in patients with enterohemorrhagic Escherichia coli (EHEC)-associated diarrhea influences the risk of hemolytic uremic syndrome (HUS) has still to be elucidated. PATIENTS AND METHODS: During the EHEC epidemic which occurred in northern Germany in spring 2011, 24 patients with E. coli O104:H4infection were treated at our hospitals, 19 of whom developed HUS. The use of antibiotics before and after the onset of HUS was documented, and the outcome in patients with and without antibiotic treatment was evaluated. RESULTS: Of the 24 patients with EHEC-associated diarrhea, seven received antibiotics before any signs of HUS were present (ciprofloxacin, cefotaxime, amoxicillin and/or metronidazole). Four of these seven patients (57 %) and 15 of the 17 patients (88 %) who were treated without antibiotics developed HUS (p = 0.12). Microbiological testing showed all E. coli O104:H4 to be extended-spectrum beta lactamase producers and thus susceptible only to fluoroquinolones, aminoglycosides and carbapenems. Two of the five patients (40 %) treated with ciprofloxacin and 17 of the 19 patients (89 %) treated without ciprofloxacin developed HUS (p = 0.043). CONCLUSION: In our E. coli O104:H4-infected patients, treatment of diarrhea with antibiotics did not increase the risk of HUS. Significantly fewer patients treated with ciprofloxacin developed HUS than patients who did not receive ciprofloxacin.
Authors: Craig S Wong; Jody C Mooney; John R Brandt; Amy O Staples; Srdjan Jelacic; Daniel R Boster; Sandra L Watkins; Phillip I Tarr Journal: Clin Infect Dis Date: 2012-03-19 Impact factor: 9.079
Authors: Christina Frank; Dirk Werber; Jakob P Cramer; Mona Askar; Mirko Faber; Matthias an der Heiden; Helen Bernard; Angelika Fruth; Rita Prager; Anke Spode; Maria Wadl; Alexander Zoufaly; Sabine Jordan; Markus J Kemper; Per Follin; Luise Müller; Lisa A King; Bettina Rosner; Udo Buchholz; Klaus Stark; Gérard Krause Journal: N Engl J Med Date: 2011-06-22 Impact factor: 91.245
Authors: Kirk E Smith; Peter R Wilker; Paul L Reiter; Erin B Hedican; Jeff B Bender; Craig W Hedberg Journal: Pediatr Infect Dis J Date: 2012-01 Impact factor: 2.129
Authors: Florian M E Wagenlehner; Stephan Wydra; Hajime Onda; Martina Kinzig-Schippers; Fritz Sörgel; Kurt G Naber Journal: Antimicrob Agents Chemother Date: 2003-12 Impact factor: 5.191
Authors: Jan Menne; Martin Nitschke; Robert Stingele; Mariam Abu-Tair; Jan Beneke; Jörn Bramstedt; Jan P Bremer; Reinhard Brunkhorst; Veit Busch; Reinhard Dengler; Günther Deuschl; Klaus Fellermann; Helmut Fickenscher; Christoph Gerigk; Alexander Goettsche; Jobst Greeve; Carsten Hafer; Friedrich Hagenmüller; Hermann Haller; Stefan Herget-Rosenthal; Bernd Hertenstein; Christina Hofmann; Melanie Lang; Jan T Kielstein; Ulrich C Klostermeier; Johannes Knobloch; Markus Kuehbacher; Ulrich Kunzendorf; Hendrik Lehnert; Michael P Manns; Tobias F Menne; Tobias N Meyer; Claus Michael; Thomas Münte; Christine Neumann-Grutzeck; Jens Nuernberger; Hermann Pavenstaedt; Leyla Ramazan; Lutz Renders; Jonas Repenthin; Wolfgang Ries; Axel Rohr; Lars Christian Rump; Ola Samuelsson; Friedhelm Sayk; Bernhard M W Schmidt; Sabine Schnatter; Harald Schöcklmann; Stefan Schreiber; Cay U von Seydewitz; Jürgen Steinhoff; Sylvia Stracke; Sebastian Suerbaum; Andreas van de Loo; Martin Vischedyk; Karin Weissenborn; Peter Wellhöner; Monika Wiesner; Sebastian Zeissig; Jürgen Büning; Mario Schiffer; Tanja Kuehbacher Journal: BMJ Date: 2012-07-19
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: Dakshina M Jandhyala; Vijay Vanguri; Erik J Boll; Yushuan Lai; Beth A McCormick; John M Leong Journal: Infect Dis Clin North Am Date: 2013-07-24 Impact factor: 5.982
Authors: Elias A Rahal; Sukayna M Fadlallah; Farah J Nassar; Natalie Kazzi; Ghassan M Matar Journal: Front Cell Infect Microbiol Date: 2015-03-18 Impact factor: 5.293