title: Clinical features of critically ill patients with Shiga toxin-induced hemolytic uremic syndrome.
abstract: OBJECTIVE
  In Spring 2011, an unprecedented outbreak of Shiga toxin-producing Escherichia coli serotype O104:H4-associated hemolytic uremic syndrome occurred in Northern Germany. The aim of this study was to describe the clinical characteristics, treatments, and outcomes of critically ill patients with Shiga toxin-producing E. coli-associated hemolytic uremic syndrome during this outbreak.
  
  
  METHODS
  Multicenter, retrospective, observational study of critically ill adult patients with Shiga toxin-producing E. coli-associated hemolytic uremic syndrome in six hospitals in Hamburg, Germany, between May 2011 and August 2011.
  
  
  RESULTS
  During the study period, 106 patients with Shiga toxin-producing E. coli-associated hemolytic uremic syndrome were admitted to eight ICUs. The median age was 40 years (range, 18-83) with a female:male ratio of 3:1. The median time from onset of clinical symptoms to hospital admission was 3 days and from hospital to ICU admission an additional 3 days. A total of 101 patients (95.3%) had acute renal failure and 78 (73.6%) required renal replacement therapy. Intubation and mechanical ventilation were required in 38 patients (35.8%) and noninvasive ventilation was required in 17 patients (16.0%). The median duration of invasive ventilation was 7 days (range, 1-32 days) and the median ICU stay was 10 days (range, 1-45 days). Fifty-one patients (48.1%) developed sepsis; of these 51 patients, 27 (25.4%) developed septic shock. Seventy patients (66.0%) developed severe neurological symptoms. Ninety-seven patients (91.5%) were treated with plasma exchange and 50 patients (47.2%) received eculizumab (monoclonal anti-C5 antibody). The mortality rate was 4.7%. Mild residual neurological symptoms were present in 21.7% of patients at ICU discharge, and no patient required renal replacement therapy 6 months after ICU admission.
  
  
  CONCLUSIONS
  During the 2011 Shiga toxin-producing E. coli-associated hemolytic uremic syndrome outbreak in Germany, critical illness developed rapidly after hospital admission, often in young women. The infection was associated with severe neurological and renal symptoms, requiring mechanical ventilation and renal replacement therapy in a substantial proportion of patients. Overall, recovery was much better than expected.
authors: Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Stephan A
authors: SA
authors: Braune
authors: Dominic
authors: D
authors: Wichmann
authors: Marie C
authors: MC
authors: von Heinz
authors: Axel
authors: A
authors: Nierhaus
authors: Heinrich
authors: H
authors: Becker
authors: Tobias N
authors: TN
authors: Meyer
authors: Gerd P
authors: GP
authors: Meyer
authors: Matthias
authors: M
authors: Müller-Schulz
authors: Jens
authors: J
authors: Fricke
authors: Andreas
authors: A
authors: de Weerth
authors: Wilhelm-W
authors: WW
authors: Hoepker
authors: Jens
authors: J
authors: Fiehler
authors: Tim
authors: T
authors: Magnus
authors: Christian
authors: C
authors: Gerloff
authors: Ulf
authors: U
authors: Panzer
authors: Rolf A K
authors: RA
authors: Stahl
authors: Karl
authors: K
authors: Wegscheider
authors: Stefan
authors: S
authors: Kluge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D004927:Escherichia coli Infections / Q000150:complications / Q000453:epidemiology; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000150:complications / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000628:therapy; D022621:Shiga Toxin / Q000633:toxicity*; D055815:Young Adult
chemical_list: D022621:Shiga Toxin