title: Best supportive care and therapeutic plasma exchange with or without eculizumab in Shiga-toxin-producing E. coli O104:H4 induced haemolytic-uraemic syndrome: an analysis of the German STEC-HUS registry.
abstract: BACKGROUND
  May 22nd marks the beginning of a Shiga-toxin-producing Escherichia coli (STEC) O104:H4 outbreak in Northern Germany. By its end on 27 July, it had claimed 53 deaths among 2987 STEC and 855 confirmed haemolytic-uraemic syndrome (HUS) cases.
  
  
  METHODS
  To describe short-term effectiveness of best supportive care (BSC), therapeutic plasma exchange (TPE) and TPE with eculizumab (TPE-Ecu) in 631 patients with suspected HUS treated in 84 hospitals in Germany, Sweden and the Netherlands using the web-based registry of the DGfN (online since 27 May).
  
  
  RESULTS
  Of 631 entries, 491 fulfilled the definition of HUS (median age 46 years; 71% females). The median (inter-quartile range) hospital stay was 22 (14-31) days. Two hundred and eighty-one (57%) patients underwent dialysis and 114 (23%) mechanical ventilation. Fifty-seven patients received BSC, 241 TPE and 193 TPE-Ecu. Treatment strategy was dependent on disease severity (laboratory signs of haemolysis, thrombocytopenia, peak creatinine level, need for dialysis, neurological symptoms, frequency of seizures) which was lower in BSC than in TPE and TPE-Ecu patients. At study endpoint (hospital discharge or death), the median creatinine was lower in BSC [1.1 mg/dL (0.9-1.3)] than in TPE [1.2 mg/dL (1.0-1.5), P < 0.05] and TPE-Ecu [1.4 mg/dL (1.0-2.2), P < 0.001], while need for dialysis was not different between BSC (0.0%, n = 0), TPE (3.7%; n = 9) and TPE-Ecu (4.7%, n = 9). Seizures were absent in BSC and rare in TPE (0.4%; n = 1) and TPE-Ecu (2.6%; n = 5) patients. Total hospital mortality in HUS patients was 4.1% (n = 20) and did not differ significantly between the TPE and TPE-Ecu groups.
  
  
  CONCLUSIONS
  Despite frequent renal impairment, advanced neurological disorders and severe respiratory failure, short-term outcome was better than expected when compared with previous reports. Within the limitations of a retrospective registry analysis, our data do not support the notion of a short-term benefit of Ecu in comparison to TPE alone in the treatment of STEC-HUS. A randomized trial comparing BSC, TPE and Ecu seems to be prudent and necessary prior to establishing new treatment guidelines for STEC-HUS.
authors.affiliation: Hannover Medical School, Hannover, Germany.
authors.forename: Jan T
authors.initials: JT
authors.lastname: Kielstein
authors.forename: Gernot
authors.initials: G
authors.lastname: Beutel
authors.forename: Susanne
authors.initials: S
authors.lastname: Fleig
authors.forename: Jürgen
authors.initials: J
authors.lastname: Steinhoff
authors.forename: Tobias N
authors.initials: TN
authors.lastname: Meyer
authors.forename: Carsten
authors.initials: C
authors.lastname: Hafer
authors.forename: Uwe
authors.initials: U
authors.lastname: Kuhlmann
authors.forename: Jörn
authors.initials: J
authors.lastname: Bramstedt
authors.forename: Ulf
authors.initials: U
authors.lastname: Panzer
authors.forename: Martin
authors.initials: M
authors.lastname: Vischedyk
authors.forename: Veit
authors.initials: V
authors.lastname: Busch
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ries
authors.forename: Steffen
authors.initials: S
authors.lastname: Mitzner
authors.forename: Stefan
authors.initials: S
authors.lastname: Mees
authors.forename: Sylvia
authors.initials: S
authors.lastname: Stracke
authors.forename: Jens
authors.initials: J
authors.lastname: Nürnberger
authors.forename: Peter
authors.initials: P
authors.lastname: Gerke
authors.forename: Monika
authors.initials: M
authors.lastname: Wiesner
authors.forename: Bernd
authors.initials: B
authors.lastname: Sucke
authors.forename: Miriam
authors.initials: M
authors.lastname: Abu-Tair
authors.forename: Andreas
authors.initials: A
authors.lastname: Kribben
authors.forename: Norbert
authors.initials: N
authors.lastname: Klause
authors.forename: Ralf
authors.initials: R
authors.lastname: Schindler
authors.forename: Frank
authors.initials: F
authors.lastname: Merkel
authors.forename: Sabine
authors.initials: S
authors.lastname: Schnatter
authors.forename: Eiske M
authors.initials: EM
authors.lastname: Dorresteijn
authors.forename: Ola
authors.initials: O
authors.lastname: Samuelsson
authors.forename: Reinhard
authors.initials: R
authors.lastname: Brunkhorst
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D058872:Epidemics; D004927:Escherichia coli Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D012042:Registries; D012189:Retrospective Studies; D054323:Shiga-Toxigenic Escherichia coli / Q000472:pathogenicity*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C481642:eculizumab