Retrospecive Analysis of the Relationship between HUS Incidence and Antibiotics among Patients with Eshcerichia coli O157 Enterocolitis in the Sakai Outbreak

Abstract

An outbreak of Escherichia coli O157:H7 infection occurred in July 1996 in Sakai City. About 5000 children were infected, 122 of whom developed hemolytic uremic syndrome (HUS). In this outbreak, almost all patients were administrated some type of antibiotics. The effects of antibiotics on E. coli O157 associated hemorrhagic colitis (HC) have been controversial. In this study, we focused on the effects of antibiotics on development of HUS in the HUS in the Sakai outbreak. We retrospectively determined the antibiotics administrated within three days after the onset of HC, clinical courses, and laboratory data of 301 patients who were hospitalized and identified as Escherichia coli O157 infection by stool culture, from results of questionnaires sent by the Osaka Prefecture Medical Association to hospitals in Osaka Prefecture. The antibiotics used could be identified for 216 patients. The incidence of HUS among these patients was 11.6%. They were divided into 19 groups based on the type of antibiotics administrated. The incidence of HUS in the new quinolone (3.7%) group was low, but was high in the intravenous cephalosporin (18.2%) group. The differences in the incidence of HUS among the 19 antibiotic groups was significant (p < 0.05) on analysis of covariance which eliminated the contributions of variables including age, sex and laboratory data. These findings indicate that the suitable antibiotics can prevent the development of E. coli O157-associated HUS.

Variation in virulence among clades of Escherichia coli O157:H7 associated with disease outbreaks

“…Clade 3 consists of seven genotypes and includes the genome strain EDL-933 (30) (SG-12) from the first human O157 outbreak in 1982 linked to hamburgers sold at a chain of fast food restaurant outlets in Michigan and Oregon (36). Although these outbreaks representing clades 1, 2, and 3 affected Ϸ12,000 people combined, the rate of HUS and hospitalization was low for each (4,14,15,36) compared with the average rates for 350 North American outbreaks (3) ( Table 1). Clade 8, in contrast, consists of five SGs that include O157 strains from multistate outbreaks linked to contaminated spinach (37) and lettuce (7) (SG-30) in North America.…”

“…The 1993 outbreak in western North America (4) and the large 1996 outbreak in Japan (13) had low rates of hospitalization and HUS (14,15), whereas the 2006 North American spinach outbreak (8) had high rates of both hospitalization (Ͼ50%) and HUS (Ͼ10%). One hypothesis is that outbreak strains differ in virulence as a result of variation in the presence and expression of different Shiga toxin (Stx) gene combinations (16)(17)(18)(19).…”

Genetic Differentiation of Escherichia coli O157:H7 Clades Associated with Human Disease by Real-Time PCR

“…Variations in disease severity among O157 outbreaks are evident, as measured by the frequencies of hospitalization and HUS. For example, the 1993 multistate outbreak in North America (2) and the large 1996 outbreak in Japan (10) had low rates of hospitalization and HUS (4,7). By comparison, two recent outbreaks in the United States, caused by contaminated spinach and lettuce, resulted in much higher frequencies of both hospitalization (average, 63%) and HUS (average, 13%) (1).…”

E. coli O104:H4 outbreak and haemolytic–uraemic syndrome

“…Nonetheless, sub-inhibitory levels that target DNA synthesis (ciprofloxacin/TMP-SMX) increase STX production; whilst ciprofloxacin's complete suppression of O157:H7 markedly increases levels of STX. Antibiotics targeting cell wall, 20 Prospective cohort 292 0.12 (0.02---0.75) Cimolai et al 21 Retrospective case---control 128 0.63 (0.27---1.43) Dundas et al 32 Retrospective cohort 120 1.23 (0.4---3.8) Martin et al 26 Retrospective cohort 117 9.4 (1.2---199) Higami et al 27 Retrospective control 216 NS d Shiomi et al 28 Retrospective 22 Prospective cohort 10 14.25 (3.62---56.1) h Pavia et al 23 Retrospective case---control 23 NS i Slutsker et al 29 Retrospective case---control 93 11.5 (1.4---91.8) j Ostroff et al 31 Retrospective case---control 80 3.1 (0.6---9.8) k 9.1 (NS) l Carter et al 30 Retrospective transcription and translation do not have any effect on STX levels. Based on the evidence, during this outbreak Germany's infectious diseases society recommended to avoid the use of FQ, TMP-SMX, aminoglycosides and fosfomycin in EHEC patients.…”