Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2016 Jan 29;6(1):e009933.
doi: 10.1136/bmjopen-2015-009933.

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

N Launders  1 , L Byrne  1 , C Jenkins  2 , K Harker  1 , A Charlett  3 , G K Adak  1
Affiliations
Observational Study

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

N Launders et al. BMJ Open. .

Abstract

Objectives: Assess the disease severity of Shiga toxin-producing Escherichia coli (STEC) O157 infection and factors influencing the development of typical haemolytic uraemic syndrome (tHUS).

Design: A retrospective cohort study using data collected through routine surveillance questionnaires between 2009 and 2012.

Participants: 3323 symptomatic cases of STEC O157.

Main outcome measures: Incidence of human STEC O157 and tHUS, proportion of cases reporting bloody diarrhoea, hospitalisation, tHUS and death. Odds of progression to tHUS and predicted percentage chance of developing tHUS based on case demographics, STEC O157 strain characteristics and clinical symptoms.

Results: From 2009 to 2012, 3323 cases of symptomatic STEC O157 with completed questionnaires were reported, of which 172 developed tHUS (5.18%). Being aged 1-4 years (OR 8.65, 95% CI 5.01 to 14.94, p=0.004) or female (OR 1.61, 95% CI 1.12 to 2.30, p=0.009), being infected with phage type (PT) 21/28 (OR 2.07, 95% CI 1.25 to 3.42, p=0.005) or PT 2 (OR 2.18, 95% CI 1.06 to 4.50, p=0.034), receiving β-lactam antibiotics (OR 4.08, 95% CI 1.43 to 11.68, p=0.009) and presenting with vomiting (OR 3.16, 95% CI 2.16 to 4.62, p<0.001) or bloody diarrhoea (OR 2.10, 95% CI 1.38 to 3.20, p=0.001) were found to be significant risk factors for progression to tHUS. The predicted percentage chance of developing tHUS varied from under 1% to 50% if all risk factors were present.

Conclusions: The data from this study indicate the use of β-lactam antibiotics should be avoided in suspected cases of STEC infection in all age groups, particularly in those under the age of 5.

Keywords: MICROBIOLOGY.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(A) Incidence of symptomatic Shiga toxin-producing Escherichia coli (STEC) O157 infection by age and gender. (B) Incidence of symptomatic typical haemolytic uraemic syndrome attributable to STEC O157 infection by age and gender.
Figure 2
Figure 2
Predictive percentage chance of Shiga toxin-producing Escherichia coli O157 cases developing typical haemolytic uraemic syndrome (HUS) by age group, symptoms and antibiotic treatment.
See this image and copyright information in PMC

References

    1. Tarr PI, Gordon CA, Chandler WL. Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet 2005;365:1073–86. 10.1016/S0140-6736(05)71144-2 - DOI - PubMed
    1. Locking ME, Pollock KG, Allison LJ et al. . Escherichia coli O157 infection and secondary spread, Scotland, 1999–2008. Emerg Infect Dis 2011;17:524–7. 10.3201/eid1703.100167 - DOI - PMC - PubMed
    1. Walker CL, Applegate JA, Black RE. Haemolytic-uraemic syndrome as a sequela of diarrhoeal disease. J Health Popul Nutr 2012;30:257–61. 10.3329/jhpn.v30i3.12288 - DOI - PMC - PubMed
    1. Gould LH, Demma L, Jones TF et al. . 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;49:1480–5. 10.1086/644621 - DOI - PubMed
    1. Wong CS, Mooney JC, Brandt JR et al. . Risk factors for the hemolytic uremic syndrome in children infected with Escherichia coli O157:H7: a multivariable analysis. Clin Infect Dis 2012;55:33–41. 10.1093/cid/cis299 - DOI - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources