The Risk of the Hemolytic-Uremic Syndrome After Antibiotic Treatment of Escherichia Coli O157:H7 Infections

N Engl J Med. 2000 Jun 29;342(26):1930-6. doi: 10.1056/NEJM200006293422601.

Abstract

Background: Children with gastrointestinal infections caused by Escherichia coli O157:H7 are at risk for the hemolytic-uremic syndrome. Whether antibiotics alter this risk is unknown.

Methods: We conducted a prospective cohort study of 71 children younger than 10 years of age who had diarrhea caused by E. coli O157:H7 to assess whether antibiotic treatment in these children affects the risk of the hemolytic-uremic syndrome and to assess the influence of confounding factors on this outcome. Estimates of relative risks were adjusted for possible confounding effects with the use of logistic-regression analysis.

Results: Among the 71 children, 9 (13 percent) received antibiotics and the hemolytic-uremic syndrome developed in 10 (14 percent). Five of these 10 children had received antibiotics. Factors significantly associated with the hemolytic-uremic syndrome were a higher initial white-cell count (relative risk, 1.3; 95 percent confidence interval, 1.1 to 1.5), evaluation with stool culture soon after the onset of illness (relative risk, 0.3; 95 percent confidence interval, 0.2 to 0.8), and treatment with antibiotics (relative risk, 14.3; 95 percent confidence interval, 2.9 to 70.7). The clinical and laboratory characteristics of the 9 children who received antibiotics and the 62 who did not receive antibiotics were similar. In a multivariate analysis that was adjusted for the initial white-cell count and the day of illness on which stool was obtained for culture, antibiotic administration remained a risk factor for the development of the hemolytic uremic syndrome (relative risk, 17.3; 95 percent confidence interval, 2.2 to 137).

Conclusions: Antibiotic treatment of children with E. coli O157:H7 infection increases the risk of the hemolytic-uremic syndrome.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-Bacterial Agents / adverse effects*
  • Anti-Bacterial Agents / therapeutic use
  • Cephalosporins / adverse effects
  • Child
  • Child, Preschool
  • Diarrhea / complications
  • Diarrhea / drug therapy*
  • Diarrhea / microbiology
  • Escherichia coli Infections / complications
  • Escherichia coli Infections / drug therapy*
  • Escherichia coli Infections / microbiology
  • Escherichia coli O157*
  • Feces / microbiology
  • Female
  • Hemolytic-Uremic Syndrome / etiology*
  • Humans
  • Infant
  • Logistic Models
  • Male
  • Prospective Studies
  • Risk
  • Trimethoprim, Sulfamethoxazole Drug Combination / adverse effects

Substances

  • Anti-Bacterial Agents
  • Cephalosporins
  • Trimethoprim, Sulfamethoxazole Drug Combination