Shiga Toxin-Associated Hemolytic Uremic Syndrome in Adults, France, 2009-2017

Emerg Infect Dis. 2021;27(7):1876-1885. doi: 10.3201/eid2707.204638.


We conducted a retrospective study on hemolytic uremic syndrome caused by Shiga toxin-producing Escherichia coli (STEC) in 96 adults enrolled in the cohort of the National Reference Center for Thrombotic Microangiopathies network in France during 2009-2017. Most infections were caused by STEC strains not belonging to the O157 or O104 serogroups. Thirty (31.3%) patients had multiple risk factors for thrombotic microangiopathy. In total, 61 (63.5%) patients required dialysis, 50 (52.1%) had a serious neurologic complication, 34 (35.4%) required mechanical ventilation, and 19 (19.8%) died during hospitalization. We used multivariate analysis to determine that the greatest risk factors for death were underlying immunodeficiency (hazard ratio 3.54) and severe neurologic events (hazard ratio 3.40). According to multivariate analysis and propensity score-matching, eculizumab treatment was not associated with survival. We found that underlying conditions, especially immunodeficiency, are strongly associated with decreased survival in adults who have hemolytic uremic syndrome caused by STEC.

Keywords: E. coli; Escherichia coli; France; HUS; STEC; Shiga toxin; Shiga toxin–producing Escherichia coli; bacteria; enteric infections; food safety; food-borne infections; hemolytic uremic syndrome; thrombotic microangiopathy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Escherichia coli Infections*
  • France
  • Hemolytic-Uremic Syndrome*
  • Humans
  • Retrospective Studies
  • Shiga Toxin
  • Shiga-Toxigenic Escherichia coli*


  • Shiga Toxin