Abstract
Background
Whether antibiotic treatment in patients with enterohemorrhagic Escherichia coli (EHEC)-associated diarrhea influences the risk of hemolytic uremic syndrome (HUS) has still to be elucidated.
Patients and methods
During the EHEC epidemic which occurred in northern Germany in spring 2011, 24 patients with E. coli O104:H4 infection were treated at our hospitals, 19 of whom developed HUS. The use of antibiotics before and after the onset of HUS was documented, and the outcome in patients with and without antibiotic treatment was evaluated.
Results
Of the 24 patients with EHEC-associated diarrhea, seven received antibiotics before any signs of HUS were present (ciprofloxacin, cefotaxime, amoxicillin and/or metronidazole). Four of these seven patients (57 %) and 15 of the 17 patients (88 %) who were treated without antibiotics developed HUS (p = 0.12). Microbiological testing showed all E. coli O104:H4 to be extended-spectrum beta lactamase producers and thus susceptible only to fluoroquinolones, aminoglycosides and carbapenems. Two of the five patients (40 %) treated with ciprofloxacin and 17 of the 19 patients (89 %) treated without ciprofloxacin developed HUS (p = 0.043).
Conclusion
In our E. coli O104:H4-infected patients, treatment of diarrhea with antibiotics did not increase the risk of HUS. Significantly fewer patients treated with ciprofloxacin developed HUS than patients who did not receive ciprofloxacin.
References
Frank C, Werber D, Cramer JP, et al. Epidemic profile of Shiga-toxin–producing Escherichia coli O104:H4 outbreak in Germany. N Engl J Med. 2011;365:1771–80.
Wong CS, Jelacic S, Habeeb RL, Watkins SL, Tarr PI. The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections. N Engl J Med. 2000;342:1930–6.
Safdar N, Said A, Gangnon RE, Maki DG. Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis. A meta-analysis. JAMA. 2002;288:996–1001.
Phillips B, Tyerman K, Whiteley SM. Use of antibiotics in suspected haemolytic-uraemic syndrome—evidence based case report. Br Med J. 2005;330:409–10.
Panos GZ, Betsi GI, Falagas ME. Systematic review: are antibiotics detrimental or beneficial for the treatment of patients with Escherichia coli O157:H7 infection? Aliment Pharmacol Ther. 2006;24:731–42.
Robert Koch Institute (RKI). Available at: http://www.rki.de/DE/Content/InfAZ/E/EHEC/Falldefinition.pdf.
Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing: 21st informational supplement. Approved standard CLSI document M100-S21. CLSI, Wayne, 2011.
Menne J, Nitschke M, Stingele R, et al. Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: case-control study. Br Med J. 2012;345:e4565.
Rosales A, Hofer J, Zimmerhackl LB, et al. Need for long-term follow-up in enterohemorrhagic Escherichia coli-associated hemolytic uremic syndrome due to late-emerging sequelae. Clin Infect Dis. 2012;54:1413–21.
Wong CS, Mooney JC, Brandt JR, Staples AO, Jelacic S, Boster DR, Watkins SL, Tarr PI. Risk factors for the hemolytic uremic syndrome in children infected with Escherichia coli O157:H7: a multivariable analysis. Clin Infect Dis. 2012;55:33–41.
Smith KE, Wilker PR, Reiter PL, Hedican EB, Bender JB, Hedberg CW. Antibiotic treatment of Escherichia coli O157 infection and the risk of hemolytic uremic syndrome, Minnesota. Pediatr Infect Dis J. 2012;31:37–41.
Walterspiel JN, Ashkenazi S, Morrow AL, Cleary TG. Effect of subinhibitory concentrations of antibiotics on extracellular Shiga-like toxin I. Infection. 1992;20:25–9.
Bielaszewska M, Idelevich EA, Zhang W, Bauwens A, Schaumburg F, Mellmann A, Peters G, Karch H. Epidemic Escherichia coli O104:H4: effects of antibiotics on Shiga toxin 2 production and bacteriophage induction. Antimicrob Agents Chemother. 2012;56:3277–82.
Wagenlehner FM, Wydra S, Onda H, Kinzig-Schippers M, Sörgel F, Naber KG. Concentrations in plasma, urinary excretion, and bactericidal activity of linezolid (600 milligrams) versus those of ciprofloxacin (500 milligrams) in healthy volunteers receiving a single oral dose. Antimicrob Agents Chemother. 2003;47:3789–94.
Isogai E, Isogai H, Hayashi S, Kubota T, Kimura K, Fujii N, Ohtani T, Sato K. Effect of antibiotics, levofloxacin and fosfomycin, on a mouse model with Escherichia coli O157 infection. Microbiol Immunol. 2000;44:89–95.
Shiomi M, Togawa M, Fujita K, Murata R. Effect of early oral fluoroquinolones in hemorrhagic colitis due to Escherichia coli O157:H7. Pediatr Int. 1999;41:228–32.
Borgatta B, Kmet-Lunaček N, Rello J. E. coli O104:H4 outbreak and haemolytic-uraemic syndrome. Med Intensiva. 2012. doi:10.1016/j.medin.2011.11.022.
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Geerdes-Fenge, H.F., Löbermann, M., Nürnberg, M. et al. Ciprofloxacin reduces the risk of hemolytic uremic syndrome in patients with Escherichia coli O104:H4-associated diarrhea. Infection 41, 669–673 (2013). https://doi.org/10.1007/s15010-012-0387-6
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DOI: https://doi.org/10.1007/s15010-012-0387-6