title: Disease severity of Shiga toxin-producing E. coli O157 and factors influencing the development of typical haemolytic uraemic syndrome: a retrospective cohort study, 2009-2012.
abstract: OBJECTIVE
  Assess the disease severity of Shiga toxin-producing Escherichia coli (STEC) O157 infection and factors influencing the development of typical haemolytic uraemic syndrome (tHUS).
  
  
  METHODS
  A retrospective cohort study using data collected through routine surveillance questionnaires between 2009 and 2012.
  
  
  METHODS
  3323 symptomatic cases of STEC O157.
  
  
  METHODS
  Incidence of human STEC O157 and tHUS, proportion of cases reporting bloody diarrhoea, hospitalisation, tHUS and death. Odds of progression to tHUS and predicted percentage chance of developing tHUS based on case demographics, STEC O157 strain characteristics and clinical symptoms.
  
  
  RESULTS
  From 2009 to 2012, 3323 cases of symptomatic STEC O157 with completed questionnaires were reported, of which 172 developed tHUS (5.18%). Being aged 1-4 years (OR 8.65, 95% CI 5.01 to 14.94, p=0.004) or female (OR 1.61, 95% CI 1.12 to 2.30, p=0.009), being infected with phage type (PT) 21/28 (OR 2.07, 95% CI 1.25 to 3.42, p=0.005) or PT 2 (OR 2.18, 95% CI 1.06 to 4.50, p=0.034), receiving β-lactam antibiotics (OR 4.08, 95% CI 1.43 to 11.68, p=0.009) and presenting with vomiting (OR 3.16, 95% CI 2.16 to 4.62, p<0.001) or bloody diarrhoea (OR 2.10, 95% CI 1.38 to 3.20, p=0.001) were found to be significant risk factors for progression to tHUS. The predicted percentage chance of developing tHUS varied from under 1% to 50% if all risk factors were present.
  
  
  CONCLUSIONS
  The data from this study indicate the use of β-lactam antibiotics should be avoided in suspected cases of STEC infection in all age groups, particularly in those under the age of 5.
authors.affiliation: Gastrointestinal, Emerging and Zoonotic Infections Department, Public Health England, Centre for Infectious Disease Surveillance and Control, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Launders
authors.affiliation: Gastrointestinal, Emerging and Zoonotic Infections Department, Public Health England, Centre for Infectious Disease Surveillance and Control, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Byrne
authors.affiliation: Gastrointestinal Bacterial Reference Unit, Public Health England, Centre for Infectious Disease Surveillance and Control, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Jenkins
authors.affiliation: Gastrointestinal, Emerging and Zoonotic Infections Department, Public Health England, Centre for Infectious Disease Surveillance and Control, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Harker
authors.affiliation: Statistics, Modelling and Economics Unit, Public Health England, Centre for Infectious Disease Surveillance and Control, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Charlett
authors.affiliation: Gastrointestinal, Emerging and Zoonotic Infections Department, Public Health England, Centre for Infectious Disease Surveillance and Control, London, UK.
authors.forename: G K
authors.initials: GK
authors.lastname: Adak
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004739:England / Q000453:epidemiology; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D054323:Shiga-Toxigenic Escherichia coli; D055815:Young Adult; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams
keywords: MICROBIOLOGY
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