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Cited by 267Escherichia coli research studiesComplement system in diseasesUrinary Tract Infections Management

Shiga Toxin–Producing Escherichia coli Infection, Antibiotics, and Risk of Developing Hemolytic Uremic Syndrome: A Meta-analysis

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Freedman, Stephen B., Xie, Jianling, Neufeld, Madisen S., Hamilton, William L., Hartling, Lisa, Tarr, Phillip I.·2016·Clinical Infectious Diseases
DOI 10.1093/cid/ciw099PMC PMC4845788
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Abstract

BACKGROUND: Antibiotic administration to individuals with Shiga toxin-producing Escherichia coli (STEC) infection remains controversial. We assessed if antibiotic administration to individuals with STEC infection is associated with development of hemolytic uremic syndrome (HUS). METHODS: The analysis included studies published up to 29 April 2015, that provided data from patients (1) with STEC infection, (2) who received antibiotics, (3) who developed HUS, and (4) for whom data reported timing of antibiotic administration in relation to HUS. Risk of bias was assessed; strength of evidence was adjudicated. HUS was the primary outcome. Secondary outcomes restricted the analysis to low-risk-of-bias studies employing commonly used HUS criteria. Pooled estimates of the odds ratio (OR) were obtained using random-effects models. RESULTS: Seventeen reports and 1896 patients met eligibility; 8 (47%) studies were retrospective, 5 (29%) were prospective cohort, 3 (18%) were case-control, and 1 was a trial. The pooled OR, including all studies, associating antibiotic administration and development of HUS was 1.33 (95% confidence interval [CI], .89-1.99; I(2) = 42%). The repeat analysis including only studies with a low risk of bias and those employing an appropriate definition of HUS yielded an OR of 2.24 (95% CI, 1.45-3.46; I(2) = 0%). CONCLUSIONS: Overall, use of antibiotics was not associated with an increased risk of developing HUS; however, after excluding studies at high risk of bias and those that did not employ an acceptable definition of HUS, there was a significant association. Consequently, the use of antibiotics in individuals with STEC infections is not recommended.

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  • When the analysis was repeated only on studies with low risk of bias and appropriate definition of hemolytic uremic syndrome, the risk of hemolytic uremic syndrome doubled when antibiotics were used.

    “when the analysis was repeated only on studies with low risk of bias and appropriate definition of the hemolytic uremic syndrome, the risk of hemolytic uremic syndrome doubled when antibiotics were used [75].”

    From Guideline for the Antibiotic Use in Acute Gastroenteritis (2019) · cites this paper as [75]

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Research works printed but not linked: 2

  1. Wong CS, Brandt JR. Risk of hemolytic uremic syndrome from antibiotic treat- ment of Escherichia coli O157:H7 colitis. JAMA 2002; 288:3111.
  2. Tserenpuntsag B, Chang HG, Smith PF, Morse DL. Hemolytic uremic syndrome risk and Escherichia coli O157:H7. Emerg Infect Dis 2005; 11:1955-7.

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Authors
Freedman, S. B., Xie, J., Neufeld, M. S., Hamilton, W. L., Hartling, L., & Tarr, P. I.
Affiliations
  • University of Calgary (CA)
  • University of Cambridge (GB)
  • University of Alberta (CA)
  • Washington University in St. Louis (US)
Corresponding author
Freedman, Stephen B.
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2016-02-24
Volume
62
Issue
10
Pages
1251-1258
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1093/cid/ciw099
PMC
PMC4845788
OpenAlex
W2280719726
Cited by
267
References
43
Citations by year
2026: 23 · 2025: 26 · 2024: 26 · 2023: 31 · 2022: 25 · 2021: 28 · 2020: 22 · 2019: 28 · 2018: 28 · 2017: 21 · 2016: 9
FWCI
4.09
Type
journal article
Language
en
Open access
Locations
  • Clinical Infectious Diseases (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • Alberta Provincial Pediatric EnTeric Infection TEam
  • Alberta Innovates–Health Solutions Team Collaborative Innovation Opportunity
  • Alberta Children's Hospital Foundation
  • Canadian Institutes of Health Research
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK052574)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Endocrinology › Escherichia coli research studies
  • Life Sciences › Immunology and Microbiology › Immunology › Complement system in diseases
  • Health Sciences › Medicine › Epidemiology › Urinary Tract Infections Management
Keywords
Shiga toxin-producing Escherichia coli, hemolytic uremic syndrome, antibiotic therapy, timing of antibiotic administration, risk of bias
MeSH terms
Anti-Bacterial Agents, Escherichia coli Infections, Hemolytic-Uremic Syndrome, Humans, Prospective Studies, Retrospective Studies, Shiga-Toxigenic Escherichia coli

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