title: Association between azithromycin therapy and duration of bacterial shedding among patients with Shiga toxin-producing enteroaggregative Escherichia coli O104:H4.
abstract: BACKGROUND
  An outbreak of Shiga toxin-producing enteroaggregative Escherichia coli (STEC O104:H4) infection with a high incidence of hemolytic uremic syndrome (HUS) occurred in Germany in May 2011. Antibiotic treatment of STEC infection is discouraged because it might increase the risk of HUS development. However, antibiotic therapy is widely used to treat enteroaggregative E coli infection. In the German outbreak, a substantial number of patients received prophylactic azithromycin treatment as part of a therapeutic regimen with the C5 antibody eculizumab.
  
  
  OBJECTIVE
  To analyze the duration of bacterial shedding in patients with STEC infection who did and did not receive oral azithromycin therapy.
  
  
  METHODS
  At a single center in Lübeck, Germany, 65 patients with STEC infection, including patients with HUS as well as STEC-infected outpatients without manifestation of HUS, were investigated between May 15 and July 26, 2011, and were monitored for a mean of 39.3 days after onset of clinical symptoms.
  
  
  METHODS
  Carriage of STEC after azithromycin therapy.
  
  
  RESULTS
  Twenty-two patients received oral azithromycin and 43 patients did not receive antibiotic treatment. Among antibiotic-treated patients, long-term STEC carriage (>28 days) was observed in 1 of 22 patients (4.5%; 95% CI, 0%-13.3%) compared with 35 of 43 patients (81.4%; 95% CI, 69.8%-93.0%) who were not treated with antibiotics (P < .001). All 22 patients receiving azithromycin treatment had at least 3 STEC-negative stool specimens after the completion of treatment, and no recurrence of STEC was observed in these patients. As proof of principle, 15 patients who initially were not treated with antibiotics and were long-term STEC carriers were treated with oral azithromycin given for 3 days and subsequently had negative stool specimens.
  
  
  CONCLUSIONS
  Treatment with azithromycin was associated with a lower frequency of long-term STEC O104:H4 carriage.
authors.affiliation: Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Nitschke
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Sayk
authors.forename: Christoph
authors.initials: C
authors.lastname: Härtel
authors.forename: Rahel Tabea
authors.initials: RT
authors.lastname: Roseland
authors.forename: Susanne
authors.initials: S
authors.lastname: Hauswaldt
authors.forename: Jürgen
authors.initials: J
authors.lastname: Steinhoff
authors.forename: Klaus
authors.initials: K
authors.lastname: Fellermann
authors.forename: Inge
authors.initials: I
authors.lastname: Derad
authors.forename: Peter
authors.initials: P
authors.lastname: Wellhöner
authors.forename: Jürgen
authors.initials: J
authors.lastname: Büning
authors.forename: Bettina
authors.initials: B
authors.lastname: Tiemer
authors.forename: Alexander
authors.initials: A
authors.lastname: Katalinic
authors.forename: Jan
authors.initials: J
authors.lastname: Rupp
authors.forename: Hendrik
authors.initials: H
authors.lastname: Lehnert
authors.forename: Werner
authors.initials: W
authors.lastname: Solbach
authors.forename: Johannes K-M
authors.initials: JK
authors.lastname: Knobloch
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017963:Azithromycin / Q000008:administration & dosage*; D057138:Bacterial Shedding / Q000187:drug effects*; D002353:Carrier State / Q000188:drug therapy; D004196:Disease Outbreaks; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006463:Hemolytic-Uremic Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D054323:Shiga-Toxigenic Escherichia coli / Q000302:isolation & purification / Q000472:pathogenicity*
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin