title: Treatment of Shiga toxin-producing Escherichia coli infections.
abstract: The management of Shiga toxin-producing Escherichia coli (STEC) infections is reviewed. Certain management practices optimize the likelihood of good outcomes, such as avoidance of antibiotics during the pre-hemolytic uremic syndrome phase, admission to hospital, and vigorous intravenous volume expansion using isotonic fluids. The successful management of STEC infections is based on recognition that a patient might have an STEC infection, and appropriate use of the microbiology laboratory. The timeliness of STEC identification cannot be overemphasized, because it avoids therapies prompted by inappropriate additional testing and directs the clinician to focus on effective management strategies. The opportunities during STEC infections to avert the worst outcomes are brief, and this article emphasizes practical matters relevant to making a diagnosis, anticipating the trajectory of illness, and optimizing care.
authors.affiliation: Division of Nephrology, Department of Pediatrics, Washington University School of Medicine, 660 South Euclid, St Louis, MO 63110, USA.
authors.forename: T Keefe
authors.initials: TK
authors.lastname: Davis
authors.forename: Ryan
authors.initials: R
authors.lastname: McKee
authors.forename: David
authors.initials: D
authors.lastname: Schnadower
authors.forename: Phillip I
authors.initials: PI
authors.lastname: Tarr
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000077324:Crystalloid Solutions; D004927:Escherichia coli Infections / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005440:Fluid Therapy / Q000379:methods*; D006463:Hemolytic-Uremic Syndrome / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage; D054323:Shiga-Toxigenic Escherichia coli / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions
keywords: Antibiotics; Escherichia coli O157:H7; Hemolytic uremic syndrome; Microbiologic diagnosis; Shiga-toxin