title: Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: case-control study.
abstract: OBJECTIVE
  To evaluate the effect of different treatment strategies on enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome.
  
  
  METHODS
  Multicentre retrospective case-control study.
  
  
  METHODS
  23 hospitals in northern Germany.
  
  
  METHODS
  298 adults with enterohaemorrhagic E coli induced haemolytic uraemic syndrome.
  
  
  METHODS
  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.
authors: Medical School Hannover, Hannover, Germany.
authors: Jan
authors: J
authors: Menne
authors: Martin
authors: M
authors: Nitschke
authors: Robert
authors: R
authors: Stingele
authors: Mariam
authors: M
authors: Abu-Tair
authors: Jan
authors: J
authors: Beneke
authors: Jörn
authors: J
authors: Bramstedt
authors: Jan P
authors: JP
authors: Bremer
authors: Reinhard
authors: R
authors: Brunkhorst
authors: Veit
authors: V
authors: Busch
authors: Reinhard
authors: R
authors: Dengler
authors: Günther
authors: G
authors: Deuschl
authors: Klaus
authors: K
authors: Fellermann
authors: Helmut
authors: H
authors: Fickenscher
authors: Christoph
authors: C
authors: Gerigk
authors: Alexander
authors: A
authors: Goettsche
authors: Jobst
authors: J
authors: Greeve
authors: Carsten
authors: C
authors: Hafer
authors: Friedrich
authors: F
authors: Hagenmüller
authors: Hermann
authors: H
authors: Haller
authors: Stefan
authors: S
authors: Herget-Rosenthal
authors: Bernd
authors: B
authors: Hertenstein
authors: Christina
authors: C
authors: Hofmann
authors: Melanie
authors: M
authors: Lang
authors: Jan T
authors: JT
authors: Kielstein
authors: Ulrich C
authors: UC
authors: Klostermeier
authors: Johannes
authors: J
authors: Knobloch
authors: Markus
authors: M
authors: Kuehbacher
authors: Ulrich
authors: U
authors: Kunzendorf
authors: Hendrik
authors: H
authors: Lehnert
authors: Michael P
authors: MP
authors: Manns
authors: Tobias F
authors: TF
authors: Menne
authors: Tobias N
authors: TN
authors: Meyer
authors: Claus
authors: C
authors: Michael
authors: Thomas
authors: T
authors: Münte
authors: Christine
authors: C
authors: Neumann-Grutzeck
authors: Jens
authors: J
authors: Nuernberger
authors: Hermann
authors: H
authors: Pavenstaedt
authors: Leyla
authors: L
authors: Ramazan
authors: Lutz
authors: L
authors: Renders
authors: Jonas
authors: J
authors: Repenthin
authors: Wolfgang
authors: W
authors: Ries
authors: Axel
authors: A
authors: Rohr
authors: Lars Christian
authors: LC
authors: Rump
authors: Ola
authors: O
authors: Samuelsson
authors: Friedhelm
authors: F
authors: Sayk
authors: Bernhard M W
authors: BM
authors: Schmidt
authors: Sabine
authors: S
authors: Schnatter
authors: Harald
authors: H
authors: Schöcklmann
authors: Stefan
authors: S
authors: Schreiber
authors: Cay U
authors: CU
authors: von Seydewitz
authors: Jürgen
authors: J
authors: Steinhoff
authors: Sylvia
authors: S
authors: Stracke
authors: Sebastian
authors: S
authors: Suerbaum
authors: Andreas
authors: A
authors: van de Loo
authors: Martin
authors: M
authors: Vischedyk
authors: Karin
authors: K
authors: Weissenborn
authors: Peter
authors: P
authors: Wellhöner
authors: Monika
authors: M
authors: Wiesner
authors: Sebastian
authors: S
authors: Zeissig
authors: Jürgen
authors: J
authors: Büning
authors: Mario
authors: M
authors: Schiffer
authors: Tanja
authors: T
authors: Kuehbacher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D003131:Combined Modality Therapy; D003967:Diarrhea / Q000382:microbiology; D004196:Disease Outbreaks; D018450:Disease Progression; D004359:Drug Therapy, Combination; D054324:Enterohemorrhagic Escherichia coli; D004927:Escherichia coli Infections / Q000097:blood / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D005260:Female; D005858:Germany / Q000453:epidemiology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006463:Hemolytic-Uremic Syndrome / Q000097:blood / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000627:therapeutic use*; D007223:Infant; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D051379:Mice; D008875:Middle Aged; D015999:Multivariate Analysis; D010956:Plasmapheresis / Q000379:methods; D010976:Platelet Count; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; D007155:Immunologic Factors; C481642:eculizumab; D007770:L-Lactate Dehydrogenase