Clinical course and the role of shiga toxin-producing Escherichia coli infection in the hemolytic-uremic syndrome in pediatric patients, 1997-2000, in Germany and Austria: a prospective study

J Infect Dis. 2002 Aug 15;186(4):493-500. doi: 10.1086/341940. Epub 2002 Aug 2.


Hemolytic-uremic syndrome (HUS) is mainly associated with foodborne infections by Shiga toxin-producing Escherichia coli (STEC). From January 1997 through December 2000, 394 children with HUS were evaluated in a prospective multicenter surveillance study in Germany and Austria (incidences, 0.7/100,000 and 0.4/100,000 children <15 years old, respectively). Blood leukocytosis was associated with increased detection of STEC in stool cultures (P<.01) and a more severe disease course. Risk of death was associated with cerebral involvement (P<.01). Most strikingly, non-O157:H7 STEC were detected in 43% of stool cultures of patients with HUS: O26 was detected in 15%, sorbitol-fermenting O157:H(-) in 10%, O145 in 9%, O103 in 3%, and O111 in 43%. Patients with O157:H7 serotypes required dialysis for a longer time and had bloody diarrhea detected more frequently, compared with patients with non-O157:H7 serotypes (P<.05). This large study in children with HUS underlines the rising importance of non-O157:H7 serotypes, and, despite increased public awareness, the number of patients remained unchanged.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Austria / epidemiology
  • Child
  • Child, Preschool
  • Culture Media
  • Escherichia coli / classification
  • Escherichia coli / isolation & purification
  • Escherichia coli / metabolism*
  • Escherichia coli Infections / epidemiology*
  • Escherichia coli Infections / microbiology
  • Escherichia coli Infections / physiopathology*
  • Escherichia coli O157 / classification
  • Escherichia coli O157 / metabolism
  • Feces / microbiology
  • Female
  • Germany / epidemiology
  • Hemolytic-Uremic Syndrome / epidemiology*
  • Hemolytic-Uremic Syndrome / microbiology
  • Hemolytic-Uremic Syndrome / physiopathology*
  • Humans
  • Incidence
  • Infant
  • Male
  • Prospective Studies
  • Sentinel Surveillance
  • Serotyping
  • Shiga Toxins / biosynthesis*


  • Culture Media
  • Shiga Toxins