title: Shiga Toxin-Producing Escherichia coli Infection, Antibiotics, and Risk of Developing Hemolytic Uremic Syndrome: A Meta-analysis.
abstract: Antibiotic administration to individuals with Shiga toxin-producing Escherichia coli (STEC) infection remains controversial. We assessed if antibiotic administration to individuals with STEC infection is associated with development of hemolytic uremic syndrome (HUS).
  
  
  
  The analysis included studies published up to 29 April 2015, that provided data from patients (1) with STEC infection, (2) who received antibiotics, (3) who developed HUS, and (4) for whom data reported timing of antibiotic administration in relation to HUS. Risk of bias was assessed; strength of evidence was adjudicated. HUS was the primary outcome. Secondary outcomes restricted the analysis to low-risk-of-bias studies employing commonly used HUS criteria. Pooled estimates of the odds ratio (OR) were obtained using random-effects models.
  
  
  
  Seventeen reports and 1896 patients met eligibility; 8 (47%) studies were retrospective, 5 (29%) were prospective cohort, 3 (18%) were case-control, and 1 was a trial. The pooled OR, including all studies, associating antibiotic administration and development of HUS was 1.33 (95% confidence interval [CI], .89-1.99; I(2) = 42%). The repeat analysis including only studies with a low risk of bias and those employing an appropriate definition of HUS yielded an OR of 2.24 (95% CI, 1.45-3.46; I(2) = 0%).
  
  
  
  Overall, use of antibiotics was not associated with an increased risk of developing HUS; however, after excluding studies at high risk of bias and those that did not employ an acceptable definition of HUS, there was a significant association. Consequently, the use of antibiotics in individuals with STEC infections is not recommended.
authors.affiliation: Section of Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute.|Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Canada.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Freedman
authors.affiliation: Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Canada.
authors.forename: Jianling
authors.initials: J
authors.lastname: Xie
authors.affiliation: Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Canada.
authors.forename: Madisen S
authors.initials: MS
authors.lastname: Neufeld
authors.affiliation: University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, United Kingdom.
authors.forename: William L
authors.initials: WL
authors.lastname: Hamilton
authors.affiliation: Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hartling
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Phillip I
authors.initials: PI
authors.lastname: Tarr
authors.forename: Alberto
authors.initials: A
authors.lastname: Nettel-Aguirre
authors.forename: Anderson
authors.initials: A
authors.lastname: Chuck
authors.forename: Bonita
authors.initials: B
authors.lastname: Lee
authors.forename: David
authors.initials: D
authors.lastname: Johnson
authors.forename: Gillian
authors.initials: G
authors.lastname: Currie
authors.forename: James
authors.initials: J
authors.lastname: Talbot
authors.forename: Jason
authors.initials: J
authors.lastname: Jiang
authors.forename: Jim
authors.initials: J
authors.lastname: Dickinson
authors.forename: Jim
authors.initials: J
authors.lastname: Kellner
authors.forename: Judy
authors.initials: J
authors.lastname: MacDonald
authors.forename: Larry
authors.initials: L
authors.lastname: Svenson
authors.forename: Linda
authors.initials: L
authors.lastname: Chui
authors.forename: Marie
authors.initials: M
authors.lastname: Louie
authors.forename: Martin
authors.initials: M
authors.lastname: Lavoie
authors.forename: Mohamed
authors.initials: M
authors.lastname: Eltorki
authors.forename: Otto
authors.initials: O
authors.lastname: Vanderkooi
authors.forename: Raymond
authors.initials: R
authors.lastname: Tellier
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
authors.forename: Steven
authors.initials: S
authors.lastname: Drews
authors.forename: Tim
authors.initials: T
authors.lastname: Graham
authors.forename: Xiao-Li
authors.initials: XL
authors.lastname: Pang
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006463:Hemolytic-Uremic Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D011446:Prospective Studies; D012189:Retrospective Studies; D054323:Shiga-Toxigenic Escherichia coli / Q000187:drug effects / Q000472:pathogenicity
chemical_list: D000900:Anti-Bacterial Agents
keywords: Escherichia coli; Shiga toxin; antibiotics; hemolytic uremic syndrome; meta-analysis