Tags

Type your tag names separated by a space and hit enter

Predictors of hemolytic uremic syndrome in children during a large outbreak of Escherichia coli O157:H7 infections.
Pediatrics. 1997 Jul; 100(1):E12.Ped

Abstract

OBJECTIVE

To evaluate risk factors for progression of Escherichia coli O157:H7 infection to the hemolytic uremic syndrome (HUS).

STUDY DESIGN

We conducted a retrospective cohort study among 278 Washington State children <16 years old who developed symptomatic culture-confirmed E coli O157:H7 infection during a large 1993 outbreak. The purpose of the study was to determine the relative risk (RR) of developing HUS according to demographic characteristics, symptoms, laboratory test results, and medication use in the first 3 days of illness.

RESULTS

Thirty-seven (14%) children developed HUS. In univariate analysis, no associations were observed between HUS risk and any demographic characteristic, the presence of bloody diarrhea or of fever, or medication use. In multivariate analysis, HUS risk was associated with, in the first 3 days of illness, use of antimotility agents (odds ratio [OR] = 2.9; 95% confidence interval [CI] 1.2-7.5) and, among children <5.5 years old, vomiting (OR = 4. 2; 95% CI 1.4-12.7). Among the 128 children tested, those whose white blood cell (WBC) count was >/=13 000/microL in the first 3 days of illness had a 7-fold increased risk of developing HUS (RR 7. 2; 95% CI 2.8-18.5). Thirteen (38%) of the 34 patients with a WBC count >/=13 000/microL developed HUS, but only 5 (5%) of the 94 children whose initial WBC count was <13 000/microL progressed to HUS. Among children who did not develop HUS, use of antimotility agents in the first 3 days of illness was associated with longer duration of bloody diarrhea.

CONCLUSIONS

Prospective studies are needed to further evaluate measures to prevent the progression of E coli O157:H7 infection to HUS and to assess further clinical and laboratory risk factors. These data argue against the use of antimotility agents in acute childhood diarrhea. Our finding that no intervention decreased HUS risk underscores the importance of preventing E coli O157:H7 infections.

Authors+Show Affiliations

Epidemic Intelligence Service and the Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

9200386

Citation

Bell, B P., et al. "Predictors of Hemolytic Uremic Syndrome in Children During a Large Outbreak of Escherichia Coli O157:H7 Infections." Pediatrics, vol. 100, no. 1, 1997, pp. E12.
Bell BP, Griffin PM, Lozano P, et al. Predictors of hemolytic uremic syndrome in children during a large outbreak of Escherichia coli O157:H7 infections. Pediatrics. 1997;100(1):E12.
Bell, B. P., Griffin, P. M., Lozano, P., Christie, D. L., Kobayashi, J. M., & Tarr, P. I. (1997). Predictors of hemolytic uremic syndrome in children during a large outbreak of Escherichia coli O157:H7 infections. Pediatrics, 100(1), E12.
Bell BP, et al. Predictors of Hemolytic Uremic Syndrome in Children During a Large Outbreak of Escherichia Coli O157:H7 Infections. Pediatrics. 1997;100(1):E12. PubMed PMID: 9200386.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of hemolytic uremic syndrome in children during a large outbreak of Escherichia coli O157:H7 infections. AU - Bell,B P, AU - Griffin,P M, AU - Lozano,P, AU - Christie,D L, AU - Kobayashi,J M, AU - Tarr,P I, PY - 1997/7/1/pubmed PY - 1998/4/3/medline PY - 1997/7/1/entrez SP - E12 EP - E12 JF - Pediatrics JO - Pediatrics VL - 100 IS - 1 N2 - OBJECTIVE: To evaluate risk factors for progression of Escherichia coli O157:H7 infection to the hemolytic uremic syndrome (HUS). STUDY DESIGN: We conducted a retrospective cohort study among 278 Washington State children <16 years old who developed symptomatic culture-confirmed E coli O157:H7 infection during a large 1993 outbreak. The purpose of the study was to determine the relative risk (RR) of developing HUS according to demographic characteristics, symptoms, laboratory test results, and medication use in the first 3 days of illness. RESULTS: Thirty-seven (14%) children developed HUS. In univariate analysis, no associations were observed between HUS risk and any demographic characteristic, the presence of bloody diarrhea or of fever, or medication use. In multivariate analysis, HUS risk was associated with, in the first 3 days of illness, use of antimotility agents (odds ratio [OR] = 2.9; 95% confidence interval [CI] 1.2-7.5) and, among children <5.5 years old, vomiting (OR = 4. 2; 95% CI 1.4-12.7). Among the 128 children tested, those whose white blood cell (WBC) count was >/=13 000/microL in the first 3 days of illness had a 7-fold increased risk of developing HUS (RR 7. 2; 95% CI 2.8-18.5). Thirteen (38%) of the 34 patients with a WBC count >/=13 000/microL developed HUS, but only 5 (5%) of the 94 children whose initial WBC count was <13 000/microL progressed to HUS. Among children who did not develop HUS, use of antimotility agents in the first 3 days of illness was associated with longer duration of bloody diarrhea. CONCLUSIONS: Prospective studies are needed to further evaluate measures to prevent the progression of E coli O157:H7 infection to HUS and to assess further clinical and laboratory risk factors. These data argue against the use of antimotility agents in acute childhood diarrhea. Our finding that no intervention decreased HUS risk underscores the importance of preventing E coli O157:H7 infections. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/9200386/Predictors_of_hemolytic_uremic_syndrome_in_children_during_a_large_outbreak_of_Escherichia_coli_O157:H7_infections_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&amp;pmid=9200386 DB - PRIME DP - Unbound Medicine ER -