TY  - JOUR
T1  - Infections in pediatric postdiarrheal hemolytic uremic syndrome: Factors associated with identifying shiga toxin–producing escherichia coli
AU  - Mody RK, Luna-Gierke RE, Jones TF, et al
Y1  - 2012/10/01
N1  - 10.1001/archpediatrics.2012.471
JO  - Archives of Pediatrics & Adolescent Medicine
SP  - 902
EP  - 909
VL  - 166
IS  - 10
N2  - Objective 
                  To describe pathogens identified through routine clinical practice and factors associated with identifying Shiga toxin–producing Escherichia coli (STEC) infection in patients with postdiarrheal hemolytic uremic syndrome (D+HUS).Design 
                  Population-based active surveillance.Setting 
                  Hospitals in the FoodNet surveillance areas from 2000 through 2010.Participants 
                  Children younger than 18 years with D+HUS.Main Exposures 
                  Testing for STEC and demographic and clinical characteristics.Main Outcome Measures 
                  Percentage of patients with evidence of infection with likely HUS-causing agents and associations between exposures and evidence of STEC infection.Results 
                  Of 617 patients, 436 (70.7%) had evidence of infection with likely HUS-causing agents: STEC O157 (401 patients), non-O157 STEC (21 patients), O157 and non-O157 STEC (1 patient), Streptococcus pneumoniae (11 patients), and other pathogens (2 patients). Among patients without microbiological evidence of STEC, 76.9% of those tested had serologic evidence of STEC infection. Children more likely to have evidence of STEC infections included those patients tested for STEC less than 4 days after diarrhea onset, 12 months or older (71.6% vs 27.8% if <12 months of age), with infections as part of an outbreak (94.3% vs 67.3%), with bloody diarrhea (77.2% vs 40.4%), with onset during June through September (76.9% vs 60.1%), with a leukocyte count greater than 18 000/μL (to convert to ×109/L, multiply by 0.001) (75.7% vs 65.3%), or with only moderate anemia (hemoglobin >7.0 g/dL [to convert to grams per liter, multiply by 10] or hematocrit greater than 20% [to convert to a proportion of 1, multiply by 0.01]) (75.1% vs 66.3%). However, many of these associations were weaker among children with thorough STEC testing.Conclusions 
                  Early stool collection for E coli O157 culture and Shiga toxin testing of all children with possible bacterial enteric infection will increase detection of STEC strains causing HUS. In the absence of microbiological evidence of STEC, serologic testing should be performed.
SN  - 1072-4710
M3  - doi: 10.1001/archpediatrics.2012.471
UR  - http://dx.doi.org/10.1001/archpediatrics.2012.471
ER  -