Risk Factors for HUS With Shiga Toxin–ProducingE coliDiarrhea

Abstract

Research Article| September 01 2020 Risk Factors for HUS With Shiga Toxin–Producing E coli Diarrhea AAP Grand Rounds (2020) 44 (3): 31. https://doi.org/10.1542/gr.44-3-31 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Risk Factors for HUS With Shiga Toxin–Producing E coli Diarrhea. AAP Grand Rounds September 2020; 44 (3): 31. https://doi.org/10.1542/gr.44-3-31 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: diarrhea, hemolytic-uremic syndrome, shiga-toxigenic escherichia coli Source: McKee RS, Schnadower D, Tarr PI, et al. Predicting hemolytic uremic syndrome and renal replacement therapy in Shiga toxin-producing Escherichia coli–infected children. Clin Infect Dis. 2020; 70(8): 1643– 1651; doi: https://doi.org/10.1093/cid/ciz432Google Scholar Investigators from multiple institutions conducted a retrospective study to identify risk factors for development of hemolytic uremic syndrome (HUS) in children with Shiga toxin–producing E coli (STEC) gastroenterits. Study participants were identified by review of microbiologic testing results from 38 medical centers in the US and Canada with pediatric EDs. Patients with STEC, seen in an ED at a participating site who did not have HUS at their initial ED visit, were enrolled. The medical records of study children were reviewed, and demographic, clinical, and laboratory data were abstracted. The primary study outcome was development of HUS, defined as: hematocrit <30%, platelet count <150 × 103/μL, and serum creatinine (Cr) above upper limit of normal for age. The association of multiple clinical and laboratory characteristics with development of HUS was assessed in bivariate analyses using chi-square and Mann-Whitney U tests. Logistic regression was used to identify independent predictors for HUS. A total of 927 patients with STEC were identified; 41 had HUS at the time of the initial ED visit and were excluded. Of the remaining 866 children, HUS developed in 126 (14.2%). On bivariate analysis, risk factors statistically associated with HUS included fever, reduced oral intake and urine output, hematochezia, vomiting, receipt of antibiotics, and ill appearance. Lower median values for serum sodium and bicarbonate, higher lactate dehydrogenase, blood urea nitrogen, white blood cell count (WBC), and C-reactive protein levels also were risk factors for HUS. In the multivariate analysis, younger age (odds ratio [OR] 0.77 per year increase; 95% CI, 0.69, 0.85), higher hematocrit (OR 1.83 for every 5% increase; 95% CI, 1.21, 2.77), WBC >13 × 103/μL (OR 2.54; 95% CI, 1.42, 4.54), platelet count <250 × 103/μL (OR 1.92; 95% CI, 1.02, 3.60), elevated Cr (OR 10.82 for every 1 mg/dL increase; 95% CI, 1.49, 78.69), low serum sodium (OR 1.12 for every 1 mmol/L decrease; 95% CI, 1.02, 1.23), and receipt of IV fluid >4 days after start of diarrhea (OR 2.50; 95% CI, 1.14, 5.46) were identified as independent predictors of HUS. A longer time from start of diarrhea to ED visit (OR 0.70 per day; 95% CI, 0.54, 0.90) was associated with reduced HUS risk. The authors conclude that the risk factors for developing HUS highlight the importance of avoiding dehydration and close clinical and laboratory monitoring in children with STEC infections. Dr Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. In 2019, the CDC investigated STEC outbreaks associated with salad kits, romaine lettuce, flour, bison, and ground beef.1 E coli O157:H7, the STEC most often implicated in outbreaks, is associated with the development... You do not currently have access to this content.