title: Treatment of enterohemorrhagic Escherichia coli-induced hemolytic uremic syndrome (eHUS).
abstract: Treatment of enterohemorrhagic Escherichia coli-induced hemolytic uremic syndrome (eHUS) still mostly relies on supportive intensive care regimens. Antibiotic treatment, as administered to eHUS patients during the 2011 O104:H4 outbreak, may reduce the shedding period, but this may apply only to this particular strain. In any case, there is no evidence for a beneficial use in the diarrheal phase and earlier warnings that antibiotic therapy at this stage may actually increase the likelihood of HUS remain unrefuted. Plasma exchange, a frequently chosen therapy in acute atypical HUS, was not beneficial for the outbreak patients and a prospective study of 274 pediatric eHUS patients even indicates a poorer long-term outcome. As eHUS is a disease where complement plays a pathophysiological role and individual beneficial treatments had been published, eculizumab was broadly administered during the outbreak, in particular to severely ill patients. The equally good outcome of treated versus untreated patients obviously does not allow a clear-cut statement, but rather points toward an advantageous use, at least for the severe cases. Although the role of complement should not be overestimated, the use of a complement blocker--not necessarily being a therapeutic option for uncomplicated eHUS--in severe disease may actually make the difference between favorable or detrimental outcome.
authors.affiliation: Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Würzner
authors.affiliation: Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Riedl
authors.affiliation: Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Rosales
authors.affiliation: Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Orth-Höller
mesh_terms: D000327:Adsorption; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D051056:Complement Inactivating Agents / Q000627:therapeutic use*; D003165:Complement System Proteins; D004196:Disease Outbreaks; D054324:Enterohemorrhagic Escherichia coli; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D005858:Germany; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D006801:Humans; D009154:Mutation; D010951:Plasma Exchange; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D051056:Complement Inactivating Agents; D003165:Complement System Proteins