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Antibiotic Treatment of Escherichia coli O157 Infection and the Risk of Hemolytic Uremic Syndrome, Minnesota

Smith, Kirk E. DVM, PhD*; Wilker, Peter R. PhD, MPH*; Reiter, Paul L. PhD, MPH*; Hedican, Erin B. MPH*; Bender, Jeff B. DVM, MS; Hedberg, Craig W. PhD, MPH

The Pediatric Infectious Disease Journal: January 2012 - Volume 31 - Issue 1 - p 37–41
doi: 10.1097/INF.0b013e31823096a8
Original Studies

Background: Infection with Escherichia coli O157 (O157) can lead to the development of hemolytic uremic syndrome (HUS). Treating O157 infections with antibiotics is a possible risk factor for HUS development; however, previous studies evaluating this relationship have yielded conflicting results. The objective of this study was to further evaluate this issue.

Methods: An age-matched case-case comparison study comprising Minnesota residents less than 20 years of age with culture-confirmed O157 infection who did (n = 66) or did not (n = 129) subsequently develop HUS was conducted. Subjects were identified through statewide surveillance activities by the Minnesota Department of Health from 1996 to 2002.

Results: Overall antibiotic treatment was not associated with the development of HUS. Self-reported vomiting and female gender were significantly associated with the development of HUS. After adjustment for illness severity and gender, subjects who developed HUS were more likely to have been treated only with bactericidal antibiotics within the first 3 days (adjusted matched odds ratio [OR], 12.4; 95% confidence interval [CI], 1.4–110.3) or within the first 7 days (OR, 18.0; 95% CI, 1.9–170.9) after the onset of diarrhea. In particular, the use of β-lactams (penicillins or cephalosporins) in the first 3 days after diarrhea onset was also significant after adjustment (OR, 11.3; 95% CI, 1.2–106.7).

Conclusions: Individuals infected with O157 infection presenting with a more severe illness were at an increased risk of developing HUS. The use of bactericidal antibiotics, particularly β-lactams, to treat O157 infection was associated with the subsequent development of HUS.

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From the *Acute Disease Investigation and Control Section, Minnesota Department of Health, St. Paul, MN; †College of Veterinary Medicine, University of Minnesota, St. Paul, MN; and ‡School of Public Health, University of Minnesota, Minneapolis, MN.

Accepted for publication August 1, 2011.

Supported in part with funding provided through a cooperative agreement (U50/CCU511190) with the Centers for Disease Control and Prevention as part of the Emerging Infections Program, Foodborne Diseases Active Surveillance Network (FoodNet). The authors have no additional funding or conflicts of interest to disclose..

Address for correspondence: Kirk E. Smith, DVM, PhD, Minnesota Department of Health, 625 Robert St N, PO Box 64975, St. Paul, MN 55164. E-mail:

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© 2012 Lippincott Williams & Wilkins, Inc.