Shiga Toxin–ProducingEscherichia coliInfection, Antibiotics, and Risk of Developing Hemolytic Uremic Syndrome: A Meta-analysis

Abstract

Background. Antibiotic administration to individuals with Shiga toxin-producing Escherichia coli (STEC) infection remains controversial. We assessed if antibiotic administration to individuals with STEC infection is associated with development of hemolytic uremic syndrome (HUS).Methods. The analysis included studies published up to 29 April 2015, that provided data from patients (1) with STEC infection, (2) who received antibiotics, (3) who developed HUS, and (4) for whom data reported timing of antibiotic administration in relation to HUS. Risk of bias was assessed; strength of evidence was adjudicated. HUS was the primary outcome. Secondary outcomes restricted the analysis to low-risk-of-bias studies employing commonly used HUS criteria. Pooled estimates of the odds ratio (OR) were obtained using random-effects models.Results. Seventeen reports and 1896 patients met eligibility; 8 (47%) studies were retrospective, 5 (29%) were prospective cohort, 3 (18%) were case-control, and 1 was a trial. The pooled OR, including all studies, associating antibiotic administration and development of HUS was 1.33 (95% confidence interval [CI], .89-1.99; I 2 = 42%). The repeat analysis including only studies with a low risk of bias and those employing an appropriate definition of HUS yielded an OR of 2.24 (95% CI, 1.45-3.46; I 2 = 0%).Conclusions. Overall, use of antibiotics was not associated with an increased risk of developing HUS; however, after excluding studies at high risk of bias and those that did not employ an acceptable definition of HUS, there was a significant association. Consequently, the use of antibiotics in individuals with STEC infections is not recommended.

C septicum Complicating Hemolytic Uremic Syndrome: Survival Without Surgical Intervention

“…These symptoms may be attributed to an established HUS diagnosis but should prompt further evaluation for bacteremia. Antibiotics are typically avoided in patients with STEC-related diarrhea due to the association of antibiotics with the development of HUS 18 ; however, we are unaware of any literature suggesting that antibiotic therapy worsens outcomes of existing HUS. Therefore, there is no reason to delay the initiation of antibiotics if sepsis is suspected.…”

Evaluating Meta-Analysis Research of <i>Escherichia coli</i>

“…An increasingly common cause of extra-intestinal infections is the pathotype responsible for meningitis and sepsis/meningitis-associated E. coli [32]. The included meta-analyses here addressed issues with E. coli strains such as STEC, VTEC, ETEC and EAEC [16,40,44,[47][48][49][50][51]. Two of these strains were addressed with antibiotics [47,49].…”

“…The included meta-analyses here addressed issues with E. coli strains such as STEC, VTEC, ETEC and EAEC [16,40,44,[47][48][49][50][51]. Two of these strains were addressed with antibiotics [47,49]. Resistance to antibiotics was the subject of five studies [52][53][54][55][56].…”

Clinical Evaluation and Cost Analysis of Great Basin Shiga Toxin Direct Molecular Assay for Detection of Shiga Toxin-Producing Escherichia coli in Diarrheal Stool Specimens

“…tility agents or antibiotics commonly prescribed to treat acute gastroenteritis (AGE) may actually increase the risk of HUS (1,4,5). Specifically, ciprofloxacin is associated with a 10-to 100-fold increase in transcription of stx 2 and up to a 1,000-fold-higher titer of toxin (4).…”

“…Specifically, ciprofloxacin is associated with a 10-to 100-fold increase in transcription of stx 2 and up to a 1,000-fold-higher titer of toxin (4). Based on these data, optimal management of patients with STEC infection relies on intravenous rehydration and other supportive measures and should not include antibiotic treatment (1,5).…”