Tags

Type your tag names separated by a space and hit enter

Risk factors for the hemolytic uremic syndrome in children infected with Escherichia coli O157:H7: a multivariable analysis.
Clin Infect Dis. 2012 Jul; 55(1):33-41.CI

Abstract

BACKGROUND

Escherichia coli O157:H7 is the leading cause of hemolytic uremic syndrome (HUS). Risk factors for development of this complication warrant identification.

METHODS

We enrolled children infected with E. coli O157:H7 within 1 week of the onset of diarrhea in this prospective cohort study. The study was conducted in 5 states over 9.5 years . The primary and secondary outcomes were HUS (hematocrit <30% with smear evidence of hemolysis, platelet count <150 × 10(3)/µL, and serum creatinine concentration > upper limit of normal for age) and oligoanuric HUS. Univariate and multivariable and ordinal multinomial regression analyses were used to test associations between factors apparent during the first week of illness and outcomes.

RESULTS

Of the 259 children analyzed, 36 (14%) developed HUS. Univariate analysis demonstrated that children who received antibiotics during the diarrhea phase more frequently developed HUS than those who did not (36% vs 12%; P = .001). The higher rate of HUS was observed across all antibiotic classes used. In multivariable analysis, a higher leukocyte count (adjusted odds ratios [aOR] 1.10; 95% CI, 1.03-1.19), vomiting (aOR 3.05; 95% CI, 1.23-7.56), and exposure to antibiotics (aOR 3.62; 95% CI, 1.23-10.6) during the first week of onset of illness were each independently associated with development of HUS. Multinomial ordinal logistic regression confirmed that initial leukocyte count and antibiotic use were independently associated with HUS and, additionally, these variables were each associated with the development of oligoanuric HUS.

CONCLUSIONS

Antibiotic use during E. coli O157:H7 infections is associated with a higher rate of subsequent HUS and should be avoided.

Authors+Show Affiliations

Department of Pediatrics, Division of Nephrology, University of New Mexico Children's Hospital, Albuquerque, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22431799

Citation

Wong, Craig S., et al. "Risk Factors for the Hemolytic Uremic Syndrome in Children Infected With Escherichia Coli O157:H7: a Multivariable Analysis." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 55, no. 1, 2012, pp. 33-41.
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(1):33-41.
Wong, C. S., Mooney, J. C., Brandt, J. R., Staples, A. O., Jelacic, S., Boster, D. R., Watkins, S. L., & Tarr, P. I. (2012). Risk factors for the hemolytic uremic syndrome in children infected with Escherichia coli O157:H7: a multivariable analysis. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 55(1), 33-41. https://doi.org/10.1093/cid/cis299
Wong CS, 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(1):33-41. PubMed PMID: 22431799.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for the hemolytic uremic syndrome in children infected with Escherichia coli O157:H7: a multivariable analysis. AU - Wong,Craig S, AU - Mooney,Jody C, AU - Brandt,John R, AU - Staples,Amy O, AU - Jelacic,Srdjan, AU - Boster,Daniel R, AU - Watkins,Sandra L, AU - Tarr,Phillip I, Y1 - 2012/03/19/ PY - 2012/3/21/entrez PY - 2012/3/21/pubmed PY - 2012/12/21/medline SP - 33 EP - 41 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 55 IS - 1 N2 - BACKGROUND: Escherichia coli O157:H7 is the leading cause of hemolytic uremic syndrome (HUS). Risk factors for development of this complication warrant identification. METHODS: We enrolled children infected with E. coli O157:H7 within 1 week of the onset of diarrhea in this prospective cohort study. The study was conducted in 5 states over 9.5 years . The primary and secondary outcomes were HUS (hematocrit <30% with smear evidence of hemolysis, platelet count <150 × 10(3)/µL, and serum creatinine concentration > upper limit of normal for age) and oligoanuric HUS. Univariate and multivariable and ordinal multinomial regression analyses were used to test associations between factors apparent during the first week of illness and outcomes. RESULTS: Of the 259 children analyzed, 36 (14%) developed HUS. Univariate analysis demonstrated that children who received antibiotics during the diarrhea phase more frequently developed HUS than those who did not (36% vs 12%; P = .001). The higher rate of HUS was observed across all antibiotic classes used. In multivariable analysis, a higher leukocyte count (adjusted odds ratios [aOR] 1.10; 95% CI, 1.03-1.19), vomiting (aOR 3.05; 95% CI, 1.23-7.56), and exposure to antibiotics (aOR 3.62; 95% CI, 1.23-10.6) during the first week of onset of illness were each independently associated with development of HUS. Multinomial ordinal logistic regression confirmed that initial leukocyte count and antibiotic use were independently associated with HUS and, additionally, these variables were each associated with the development of oligoanuric HUS. CONCLUSIONS: Antibiotic use during E. coli O157:H7 infections is associated with a higher rate of subsequent HUS and should be avoided. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/22431799/full_citation L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cis299 DB - PRIME DP - Unbound Medicine ER -