title: Infections in pediatric postdiarrheal hemolytic uremic syndrome: factors associated with identifying shiga toxin-producing Escherichia coli.
abstract: OBJECTIVE
  To describe pathogens identified through routine clinical practice and factors associated with identifying Shiga toxin-producing Escherichia coli (STEC) infection in patients with postdiarrheal hemolytic uremic syndrome (DHUS).
  
  
  METHODS
  Population-based active surveillance.
  
  
  METHODS
  Hospitals in the FoodNet surveillance areas from 2000 through 2010.
  
  
  METHODS
  Children younger than 18 years with DHUS.
  
  
  METHODS
  Testing for STEC and demographic and clinical characteristics.
  
  
  METHODS
  Percentage of patients with evidence of infection with likely HUS-causing agents and associations between exposures and evidence of STEC infection.
  
  
  RESULTS
  Of 617 patients, 436 (70.7%) had evidence of infection with likely HUS-causing agents: STEC O157 (401 patients), non-O157 STEC (21 patients), O157 and non-O157 STEC (1 patient), Streptococcus pneumoniae (11 patients), and other pathogens (2 patients). Among patients without microbiological evidence of STEC, 76.9% of those tested had serologic evidence of STEC infection. Children more likely to have evidence of STEC infections included those patients tested for STEC less than 4 days after diarrhea onset, 12 months or older (71.6% vs 27.8% if <12 months of age), with infections as part of an outbreak (94.3% vs 67.3%), with bloody diarrhea (77.2% vs 40.4%), with onset during June through September (76.9% vs 60.1%), with a leukocyte count greater than 18 000/μL (to convert to ×10(9)/L, multiply by 0.001) (75.7% vs 65.3%), or with only moderate anemia (hemoglobin 7.0 g/dL [to convert to grams per liter, multiply by 10] or hematocrit greater than 20% [to convert to a proportion of 1, multiply by 0.01]) (75.1% vs 66.3%). However, many of these associations were weaker among children with thorough STEC testing.
  
  
  CONCLUSIONS
  Early stool collection for E coli O157 culture and Shiga toxin testing of all children with possible bacterial enteric infection will increase detection of STEC strains causing HUS. In the absence of microbiological evidence of STEC, serologic testing should be performed.
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. rmody@cdc.gov
authors.forename: Rajal K
authors.initials: RK
authors.lastname: Mody
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Luna-Gierke
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Jones
authors.forename: Nicole
authors.initials: N
authors.lastname: Comstock
authors.forename: Sharon
authors.initials: S
authors.lastname: Hurd
authors.forename: Joni
authors.initials: J
authors.lastname: Scheftel
authors.forename: Sarah
authors.initials: S
authors.lastname: Lathrop
authors.forename: Glenda
authors.initials: G
authors.lastname: Smith
authors.forename: Amanda
authors.initials: A
authors.lastname: Palmer
authors.forename: Nancy
authors.initials: N
authors.lastname: Strockbine
authors.forename: Deborah
authors.initials: D
authors.lastname: Talkington
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Mahon
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hoekstra
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Griffin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications / Q000453:epidemiology / Q000382:microbiology*; D004927:Escherichia coli Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D019453:Escherichia coli O157 / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D017053:Infection Control; D008297:Male; D011008:Pneumococcal Infections / Q000150:complications / Q000175:diagnosis; D062486:Public Health Surveillance; D012307:Risk Factors; D012698:Serologic Tests; D054323:Shiga-Toxigenic Escherichia coli / Q000302:isolation & purification*; D014481:United States / Q000453:epidemiology