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Cited by 42Escherichia coli research studiesComplement system in diseasesSalmonella and Campylobacter epidemiology

Infections in Pediatric Postdiarrheal Hemolytic Uremic Syndrome: Factors Associated With Identifying Shiga Toxin–Producing Escherichia coli

Mody, Rajal K., Luna-Gierke, Ruth E., Jones, Timothy F., Comstock, Nicole, Hurd, Sharon, Scheftel, Joni, Lathrop, Sarah, Smith, Glenda +6 more·2012·Archives of Pediatrics & Adolescent Medicine
DOI 10.1001/archpediatrics.2012.471
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Abstract

OBJECTIVE: To describe pathogens identified through routine clinical practice and factors associated with identifying Shiga toxin-producing Escherichia coli (STEC) infection in patients with postdiarrheal hemolytic uremic syndrome (DHUS). DESIGN: Population-based active surveillance. SETTING: Hospitals in the FoodNet surveillance areas from 2000 through 2010. PARTICIPANTS: Children younger than 18 years with DHUS. MAIN EXPOSURES: Testing for STEC and demographic and clinical characteristics. MAIN OUTCOME MEASURES: Percentage of patients with evidence of infection with likely HUS-causing agents and associations between exposures and evidence of STEC infection. RESULTS: Of 617 patients, 436 (70.7%) had evidence of infection with likely HUS-causing agents: STEC O157 (401 patients), non-O157 STEC (21 patients), O157 and non-O157 STEC (1 patient), Streptococcus pneumoniae (11 patients), and other pathogens (2 patients). Among patients without microbiological evidence of STEC, 76.9% of those tested had serologic evidence of STEC infection. Children more likely to have evidence of STEC infections included those patients tested for STEC less than 4 days after diarrhea onset, 12 months or older (71.6% vs 27.8% if <12 months of age), with infections as part of an outbreak (94.3% vs 67.3%), with bloody diarrhea (77.2% vs 40.4%), with onset during June through September (76.9% vs 60.1%), with a leukocyte count greater than 18 000/μL (to convert to ×10(9)/L, multiply by 0.001) (75.7% vs 65.3%), or with only moderate anemia (hemoglobin 7.0 g/dL [to convert to grams per liter, multiply by 10] or hematocrit greater than 20% [to convert to a proportion of 1, multiply by 0.01]) (75.1% vs 66.3%). However, many of these associations were weaker among children with thorough STEC testing. CONCLUSIONS: Early stool collection for E coli O157 culture and Shiga toxin testing of all children with possible bacterial enteric infection will increase detection of STEC strains causing HUS. In the absence of microbiological evidence of STEC, serologic testing should be performed.

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  • Diarrhea appears approximately 2-12 days after consumption of STEC, and around 90% of patients experience bloody stool.

    “Diarrhea appears approximately 2 - 12 days after consumption of STEC, and symptoms vary between mild and bloody diarrhea, with around 90% of patients experiencing bloody stool [14].”

    From Guideline for the Antibiotic Use in Acute Gastroenteritis (2019) · cites this paper as [14]

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Authors
Mody, R. K., Luna-Gierke, R. E., Jones, T. F., Comstock, N., Hurd, S., Scheftel, J., Lathrop, S., Smith, G., Palmer, A., Strockbine, N., Talkington, D., Mahon, B. E., Hoekstra, R. M., & Griffin, P. M.
Affiliations
Centers for Disease Control and Prevention (US)
Corresponding author
Mody, Rajal K.
ORCID
Venue
Archives of Pediatrics & Adolescent Medicine
Publisher
American Medical Association (AMA)
Published
2012-10-01
Volume
166
Issue
10
Pages
902
ISSN
1072-4710 (ISSN-L)
DOI
10.1001/archpediatrics.2012.471
OpenAlex
W2096653887
Cited by
42
References
49
Citations by year
2026: 4 · 2025: 2 · 2023: 1 · 2021: 2 · 2020: 5 · 2019: 2 · 2018: 5 · 2017: 5 · 2016: 3 · 2015: 4 · 2014: 6 · 2013: 2 · 2012: 1
FWCI
2.64
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Pediatrics and Adolescent Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Endocrinology › Escherichia coli research studies
  • Life Sciences › Immunology and Microbiology › Immunology › Complement system in diseases
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Salmonella and Campylobacter epidemiology
Keywords
Shiga toxin-producing Escherichia coli, Escherichia coli O157, non-O157 STEC, Streptococcus pneumoniae, pediatric patients, serologic evidence of infection, bloody diarrhea, risk factors, hemolytic uremic syndrome
MeSH terms
Adolescent, Child, Child, Preschool, Diarrhea, Escherichia coli Infections, Feces, Female, Hemolytic-Uremic Syndrome, Humans, Infant, Male, Pneumococcal Infections, Risk Factors, Serologic Tests, United States, Incidence, Infection Control, Escherichia coli O157, Shiga-Toxigenic Escherichia coli, Public Health Surveillance

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