Prodromal Phase of Hemolytic Uremic Syndrome Related to Shiga Toxin–Producing Escherichia coli
| Autor: | Alejandro Balestracci, Ismael Toledo, Sandra Mariel Martin, Caupolican Alvarado, Luciana Meni Battaglia |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Diarrhea
medicine.medical_specialty medicine.drug_class medicine.medical_treatment Antibiotics Antiperistaltic Agents Prodromal phase 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Internal medicine medicine Humans Antibiotic use Child Shiga toxin-producing Escherichia coli Escherichia coli Infections Dialysis Retrospective Studies Shiga-Toxigenic Escherichia coli business.industry 030208 emergency & critical care medicine General Medicine Hemolytic-Uremic Syndrome Pediatrics Perinatology and Child Health Emergency Medicine Bloody diarrhea Watery diarrhea business |
| Zdroj: | Pediatric Emergency Care. 37:e625-e630 |
| ISSN: | 1535-1815 0749-5161 2000-2017 |
| DOI: | 10.1097/pec.0000000000001850 |
| Popis: | Objectives This study aimed to evaluate practice patterns during prodromal phase of hemolytic uremic syndrome related to Shiga toxin-producing Escherichia coli (STEC-HUS). Methods Trajectories of children from first symptoms until STEC-HUS admitted consecutively at our center (period 2000-2017) were retrospectively reviewed. Early recommended practices include identification of STEC infections, antibiotics and antiperistaltic avoidance, and administration of anticipatory intravenous fluids; therefore, implementation and changes over time (before and after 2011) of such interventions were assessed. In addition, early management was correlated with acute disease outcomes. Results Of 172 patients, 98 (57%) had early consults, 75 of them visit the pediatric emergency department. Those seen with watery diarrhea (n = 74) were managed as outpatients, whereas 27 of the 45 assisted with bloody diarrhea were hospitalized for diagnosis other than STEC-HUS. Stool cultures were performed in 13.4% (23/172), 18% (31/172) received antibiotics, and 12.8% (22/172) received endovenous fluids; none received antiperistaltic agents. Shiga toxin-producing E. coli infection was proven in 4% (7/172) before HUS. Rate of cultured patients and treated with intravenous fluids remained unchanged over time (P = 0.13 and P = 0.48, respectively), whereas antibiotic prescription decreased from 42.8% to 16.6% (P = 0.005). Main acute outcomes (need for dialysis, pancreatic compromise, central nervous system involvement, and death) were similar (P > 0.05) regardless of whether they received antibiotics or intravenous fluids. Conclusions During the diarrheal phase, 57% of patients consulted; three-quarters of them consulted to the pediatric emergency department. Shiga toxin-producing E. coli detection was poor, antibiotic use remained high, and anticipatory volume expansion was underused. These findings outline the critical need to improve the early management of STEC-HUS. |
| Databáze: | OpenAIRE |
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