Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: case-control study

Autor: Jan, Menne, Martin, Nitschke, Robert, Stingele, Mariam, Abu-Tair, Jan, Beneke, Jörn, Bramstedt, Jan P, Bremer, Reinhard, Brunkhorst, Veit, Busch, Reinhard, Dengler, Günther, Deuschl, Klaus, Fellermann, Helmut, Fickenscher, Christoph, Gerigk, Alexander, Goettsche, Jobst, Greeve, Carsten, Hafer, Friedrich, Hagenmüller, Hermann, Haller, Stefan, Herget-Rosenthal, Bernd, Hertenstein, Christina, Hofmann, Melanie, Lang, Jan T, Kielstein, Ulrich C, Klostermeier, Johannes, Knobloch, Markus, Kuehbacher, Ulrich, Kunzendorf, Hendrik, Lehnert, Michael P, Manns, Tobias F, Menne, Tobias N, Meyer, Claus, Michael, Thomas, Münte, Christine, Neumann-Grutzeck, Jens, Nuernberger, Hermann, Pavenstaedt, Leyla, Ramazan, Lutz, Renders, Jonas, Repenthin, Wolfgang, Ries, Axel, Rohr, Lars Christian, Rump, Ola, Samuelsson, Friedhelm, Sayk, Bernhard M W, Schmidt, Sabine, Schnatter, Harald, Schöcklmann, Stefan, Schreiber, Cay U, von Seydewitz, Jürgen, Steinhoff, Sylvia, Stracke, Sebastian, Suerbaum, Andreas, van de Loo, Martin, Vischedyk, Karin, Weissenborn, Peter, Wellhöner, Monika, Wiesner, Sebastian, Zeissig, Jürgen, Büning, Mario, Schiffer, Tanja, Kuehbacher, Karl W, Kroencke
Rok vydání: 2012
Předmět:
Male
medicine.medical_treatment
Antibiotics
Gastroenterology
Disease Outbreaks
Mice
Germany
Child
Escherichia coli Infections
Aged
80 and over
Plasmapheresis
General Medicine
Middle Aged
Eculizumab
Combined Modality Therapy
Anti-Bacterial Agents
Diarrhea
Treatment Outcome
Enterohemorrhagic Escherichia coli
Disease Progression
Drug Therapy
Combination
Female
medicine.symptom
medicine.drug
Adult
medicine.medical_specialty
Adolescent
medicine.drug_class
Perforation (oil well)
Antibodies
Monoclonal
Humanized
Young Adult
Renal Dialysis
Internal medicine
medicine
Animals
Humans
Immunologic Factors
Glucocorticoids
Dialysis
Aged
Retrospective Studies
Mechanical ventilation
L-Lactate Dehydrogenase
Platelet Count
business.industry
Infant
Respiration
Artificial
Surgery
Case-Control Studies
Hemolytic-Uremic Syndrome
Multivariate Analysis
business
Abdominal surgery
Zdroj: BMJ. 345:e4565-e4565
ISSN: 1756-1833
Popis: Objective To evaluate the effect of different treatment strategies on enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome. Design Multicentre retrospective case-control study. Setting 23 hospitals in northern Germany. Participants 298 adults with enterohaemorrhagic E coli induced haemolytic uraemic syndrome. Main outcome measures Dialysis, seizures, mechanical ventilation, abdominal surgery owing to perforation of the bowel or bowel necrosis, and death. Results 160 of the 298 patients (54%) temporarily required dialysis, with only three needing treatment long term. 37 patients (12%) had seizures, 54 (18%) required mechanical ventilation, and 12 (4%) died. No clear benefit was found from use of plasmapheresis or plasmapheresis with glucocorticoids. 67 of the patients were treated with eculizumab, a monoclonal antibody directed against the complement cascade. No short term benefit was detected that could be attributed to this treatment. 52 patients in one centre that used a strategy of aggressive treatment with combined antibiotics had fewer seizures (2% v 15%, P=0.03),fewer deaths (0% v 5%, p=0.029), required no abdominal surgery, and excreted E coli for a shorter duration. Conclusions Enterohaemorrhagic E coli induced haemolytic uraemic syndrome is a severe self limiting acute condition. Our findings question the benefit of eculizumab and of plasmapheresis with or without glucocorticoids. Patients with established haemolytic uraemic syndrome seemed to benefit from antibiotic treatment and this should be investigated in a controlled trial.
Databáze: OpenAIRE
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