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Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis: a meta-analysis.
JAMA. 2002 Aug 28; 288(8):996-1001.JAMA

Abstract

CONTEXT

The use of antibiotics for treatment of Escherichia coli O157:H7 infection has become controversial since a recent small study found that it may increase the risk of hemolytic uremic syndrome (HUS). However, other larger studies have reported a protective effect or no association.

OBJECTIVE

To determine whether antibiotic therapy for E coli O157:H7 enteritis increases the risk of HUS.

DATA SOURCES

PubMed and MEDLINE computer searches were performed for studies published from January 1983 to February 2001 using the key words hemolytic uremic syndrome, risk factor, antibiotics, and Escherichia coli O157:H7. Reference lists of relevant publications were reviewed, and 12 experts in the field were contacted to identify additional reports. No language restrictions were applied to the search.

STUDY SELECTION

Studies were included if they reported a series of patients with documented E coli O157:H7 enteritis, some of whom developed HUS; had clear definitions of HUS; and had adequate data delineating the relationship between antibiotic therapy and the occurrence of HUS. Nine of the 26 identified studies fulfilled these criteria.

DATA EXTRACTION

Two authors (N.S. and A.S.) independently reviewed each report identified by the searches and recorded predetermined information relevant to the inclusion criteria. A pooled odds ratio was calculated using a fixed-effects model, with assessment of heterogeneity among the studies.

DATA SYNTHESIS

The pooled odds ratio was 1.15 (95% confidence interval, 0.79-1.68), indicating that there does not appear to be an increased risk of HUS with antibiotic treatment of E coli O157:H7 enteritis. Incomplete reporting of data in individual studies precluded adjustment for severity of illness.

CONCLUSION

Our meta-analysis did not show a higher risk of HUS associated with antibiotic administration. A randomized trial of adequate power, with multiple distinct strains of E coli O157:H7 represented, is needed to conclusively determine whether antibiotic treatment of E coli O157:H7 enteritis increases the risk of HUS.

Authors+Show Affiliations

Department of Medicine, University of Wisconsin Medical School and University of Wisconsin Hospital and Clinics, Madison, WI 53792-5158, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12190370

Citation

Safdar, Nasia, et al. "Risk of Hemolytic Uremic Syndrome After Antibiotic Treatment of Escherichia Coli O157:H7 Enteritis: a Meta-analysis." JAMA, vol. 288, no. 8, 2002, pp. 996-1001.
Safdar N, Said A, Gangnon RE, et al. Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis: a meta-analysis. JAMA. 2002;288(8):996-1001.
Safdar, N., Said, A., Gangnon, R. E., & Maki, D. G. (2002). Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis: a meta-analysis. JAMA, 288(8), 996-1001.
Safdar N, et al. Risk of Hemolytic Uremic Syndrome After Antibiotic Treatment of Escherichia Coli O157:H7 Enteritis: a Meta-analysis. JAMA. 2002 Aug 28;288(8):996-1001. PubMed PMID: 12190370.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis: a meta-analysis. AU - Safdar,Nasia, AU - Said,Adnan, AU - Gangnon,Ronald E, AU - Maki,Dennis G, PY - 2002/8/23/pubmed PY - 2002/9/11/medline PY - 2002/8/23/entrez SP - 996 EP - 1001 JF - JAMA JO - JAMA VL - 288 IS - 8 N2 - CONTEXT: The use of antibiotics for treatment of Escherichia coli O157:H7 infection has become controversial since a recent small study found that it may increase the risk of hemolytic uremic syndrome (HUS). However, other larger studies have reported a protective effect or no association. OBJECTIVE: To determine whether antibiotic therapy for E coli O157:H7 enteritis increases the risk of HUS. DATA SOURCES: PubMed and MEDLINE computer searches were performed for studies published from January 1983 to February 2001 using the key words hemolytic uremic syndrome, risk factor, antibiotics, and Escherichia coli O157:H7. Reference lists of relevant publications were reviewed, and 12 experts in the field were contacted to identify additional reports. No language restrictions were applied to the search. STUDY SELECTION: Studies were included if they reported a series of patients with documented E coli O157:H7 enteritis, some of whom developed HUS; had clear definitions of HUS; and had adequate data delineating the relationship between antibiotic therapy and the occurrence of HUS. Nine of the 26 identified studies fulfilled these criteria. DATA EXTRACTION: Two authors (N.S. and A.S.) independently reviewed each report identified by the searches and recorded predetermined information relevant to the inclusion criteria. A pooled odds ratio was calculated using a fixed-effects model, with assessment of heterogeneity among the studies. DATA SYNTHESIS: The pooled odds ratio was 1.15 (95% confidence interval, 0.79-1.68), indicating that there does not appear to be an increased risk of HUS with antibiotic treatment of E coli O157:H7 enteritis. Incomplete reporting of data in individual studies precluded adjustment for severity of illness. CONCLUSION: Our meta-analysis did not show a higher risk of HUS associated with antibiotic administration. A randomized trial of adequate power, with multiple distinct strains of E coli O157:H7 represented, is needed to conclusively determine whether antibiotic treatment of E coli O157:H7 enteritis increases the risk of HUS. SN - 0098-7484 UR - https://www.unboundmedicine.com/medline/citation/12190370/Risk_of_hemolytic_uremic_syndrome_after_antibiotic_treatment_of_Escherichia_coli_O157:H7_enteritis:_a_meta_analysis_ L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/288/pg/996 DB - PRIME DP - Unbound Medicine ER -