Association between azithromycin therapy and duration of bacterial shedding among patients with Shiga toxin-producing enteroaggregative Escherichia coli O104:H4
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Association between azithromycin therapy and duration of bacterial shedding among patients with Shiga toxin-producing enteroaggregative Escherichia coli O104:H4. / Nitschke, Martin; Sayk, Friedhelm; Härtel, Christoph; Roseland, Rahel Tabea; Hauswaldt, Susanne; Steinhoff, Jürgen; Fellermann, Klaus; Derad, Inge; Wellhöner, Peter; Büning, Jürgen; Tiemer, Bettina; Katalinic, Alexander; Rupp, Jan; Lehnert, Hendrik; Solbach, Werner; Knobloch, Johannes K-M.
In: JAMA-J AM MED ASSOC, Vol. 307, No. 10, 14.03.2012, p. 1046-52.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Association between azithromycin therapy and duration of bacterial shedding among patients with Shiga toxin-producing enteroaggregative Escherichia coli O104:H4
AU - Nitschke, Martin
AU - Sayk, Friedhelm
AU - Härtel, Christoph
AU - Roseland, Rahel Tabea
AU - Hauswaldt, Susanne
AU - Steinhoff, Jürgen
AU - Fellermann, Klaus
AU - Derad, Inge
AU - Wellhöner, Peter
AU - Büning, Jürgen
AU - Tiemer, Bettina
AU - Katalinic, Alexander
AU - Rupp, Jan
AU - Lehnert, Hendrik
AU - Solbach, Werner
AU - Knobloch, Johannes K-M
PY - 2012/3/14
Y1 - 2012/3/14
N2 - CONTEXT: An outbreak of Shiga toxin-producing enteroaggregative Escherichia coli (STEC O104:H4) infection with a high incidence of hemolytic uremic syndrome (HUS) occurred in Germany in May 2011. Antibiotic treatment of STEC infection is discouraged because it might increase the risk of HUS development. However, antibiotic therapy is widely used to treat enteroaggregative E coli infection. In the German outbreak, a substantial number of patients received prophylactic azithromycin treatment as part of a therapeutic regimen with the C5 antibody eculizumab.OBJECTIVE: To analyze the duration of bacterial shedding in patients with STEC infection who did and did not receive oral azithromycin therapy.DESIGN, SETTING, AND PATIENTS: At a single center in Lübeck, Germany, 65 patients with STEC infection, including patients with HUS as well as STEC-infected outpatients without manifestation of HUS, were investigated between May 15 and July 26, 2011, and were monitored for a mean of 39.3 days after onset of clinical symptoms.MAIN OUTCOME MEASURE: Carriage of STEC after azithromycin therapy.RESULTS: Twenty-two patients received oral azithromycin and 43 patients did not receive antibiotic treatment. Among antibiotic-treated patients, long-term STEC carriage (>28 days) was observed in 1 of 22 patients (4.5%; 95% CI, 0%-13.3%) compared with 35 of 43 patients (81.4%; 95% CI, 69.8%-93.0%) who were not treated with antibiotics (P < .001). All 22 patients receiving azithromycin treatment had at least 3 STEC-negative stool specimens after the completion of treatment, and no recurrence of STEC was observed in these patients. As proof of principle, 15 patients who initially were not treated with antibiotics and were long-term STEC carriers were treated with oral azithromycin given for 3 days and subsequently had negative stool specimens.CONCLUSION: Treatment with azithromycin was associated with a lower frequency of long-term STEC O104:H4 carriage.
AB - CONTEXT: An outbreak of Shiga toxin-producing enteroaggregative Escherichia coli (STEC O104:H4) infection with a high incidence of hemolytic uremic syndrome (HUS) occurred in Germany in May 2011. Antibiotic treatment of STEC infection is discouraged because it might increase the risk of HUS development. However, antibiotic therapy is widely used to treat enteroaggregative E coli infection. In the German outbreak, a substantial number of patients received prophylactic azithromycin treatment as part of a therapeutic regimen with the C5 antibody eculizumab.OBJECTIVE: To analyze the duration of bacterial shedding in patients with STEC infection who did and did not receive oral azithromycin therapy.DESIGN, SETTING, AND PATIENTS: At a single center in Lübeck, Germany, 65 patients with STEC infection, including patients with HUS as well as STEC-infected outpatients without manifestation of HUS, were investigated between May 15 and July 26, 2011, and were monitored for a mean of 39.3 days after onset of clinical symptoms.MAIN OUTCOME MEASURE: Carriage of STEC after azithromycin therapy.RESULTS: Twenty-two patients received oral azithromycin and 43 patients did not receive antibiotic treatment. Among antibiotic-treated patients, long-term STEC carriage (>28 days) was observed in 1 of 22 patients (4.5%; 95% CI, 0%-13.3%) compared with 35 of 43 patients (81.4%; 95% CI, 69.8%-93.0%) who were not treated with antibiotics (P < .001). All 22 patients receiving azithromycin treatment had at least 3 STEC-negative stool specimens after the completion of treatment, and no recurrence of STEC was observed in these patients. As proof of principle, 15 patients who initially were not treated with antibiotics and were long-term STEC carriers were treated with oral azithromycin given for 3 days and subsequently had negative stool specimens.CONCLUSION: Treatment with azithromycin was associated with a lower frequency of long-term STEC O104:H4 carriage.
KW - Adult
KW - Aged
KW - Anti-Bacterial Agents
KW - Azithromycin
KW - Bacterial Shedding
KW - Carrier State
KW - Disease Outbreaks
KW - Escherichia coli Infections
KW - Female
KW - Germany
KW - Hemolytic-Uremic Syndrome
KW - Humans
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - Shiga-Toxigenic Escherichia coli
KW - Journal Article
U2 - 10.1001/jama.2012.264
DO - 10.1001/jama.2012.264
M3 - SCORING: Journal article
C2 - 22416100
VL - 307
SP - 1046
EP - 1052
JO - JAMA-J AM MED ASSOC
JF - JAMA-J AM MED ASSOC
SN - 0098-7484
IS - 10
ER -
