Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome:case-control study

TY - JOUR

T1 - Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome:case-control study

AU - Menne, Jan

AU - Nitschke, Martin

AU - Stingele, Robert

AU - Abu-Tair, Mariam

AU - Beneke, Jan

AU - Bramstedt, Jörn

AU - Bremer, Jan P

AU - Brunkhorst, Reinhard

AU - Busch, Veit

AU - Dengler, Reinhard

AU - Deuschl, Günther

AU - Fellermann, Klaus

AU - Fickenscher, Helmut

AU - Gerigk, Christoph

AU - Goettsche, Alexander

AU - Greeve, Jobst

AU - Hafer, Carsten

AU - Hagenmüller, Friedrich

AU - Haller, Hermann

AU - Herget-Rosenthal, Stefan

AU - Hertenstein, Bernd

AU - Hofmann, Christina

AU - Lang, Melanie

AU - Kielstein, Jan T

AU - Klostermeier, Ulrich C

AU - Knobloch, Johannes K.-M.

AU - Kuehbacher, Markus

AU - Kunzendorf, Ulrich

AU - Lehnert, Hendrik

AU - Manns, Michael P

AU - Menne, Tobias F

AU - Meyer, Tobias N

AU - Michael, Claus

AU - Münte, Thomas

AU - Neumann-Grutzeck, Christine

AU - Nuernberger, Jens

AU - Pavenstaedt, Hermann

AU - Ramazan, Leyla

AU - Renders, Lutz

AU - Repenthin, Jonas

AU - Ries, Wolfgang

AU - Rohr, Axel

AU - Rump, Lars Christian

AU - Samuelsson, Ola

AU - Sayk, Friedhelm

AU - Schmidt, Bernhard M W

AU - Schnatter, Sabine

AU - Schöcklmann, Harald

AU - Schreiber, Stefan

AU - von Seydewitz, Cay U

AU - Steinhoff, Jürgen

AU - Stracke, Sylvia

AU - Suerbaum, Sebastian

AU - van de Loo, Andreas

AU - Vischedyk, Martin

AU - Weissenborn, Karin

AU - Wellhöner, Peter

AU - Wiesner, Monika

AU - Zeissig, Sebastian

AU - Büning, Jürgen

AU - Schiffer, Mario

AU - Kuehbacher, Tanja

AU - EHEC-HUS consortium

PY - 2012/7/19

Y1 - 2012/7/19

N2 - OBJECTIVE: To evaluate the effect of different treatment strategies on enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome.DESIGN: Multicentre retrospective case-control study.SETTING: 23 hospitals in northern Germany.PARTICIPANTS: 298 adults with enterohaemorrhagic E coli induced haemolytic uraemic syndrome.MAIN OUTCOME MEASURES: Dialysis, seizures, mechanical ventilation, abdominal surgery owing to perforation of the bowel or bowel necrosis, and death.RESULTS: 160 of the 298 patients (54%) temporarily required dialysis, with only three needing treatment long term. 37 patients (12%) had seizures, 54 (18%) required mechanical ventilation, and 12 (4%) died. No clear benefit was found from use of plasmapheresis or plasmapheresis with glucocorticoids. 67 of the patients were treated with eculizumab, a monoclonal antibody directed against the complement cascade. No short term benefit was detected that could be attributed to this treatment. 52 patients in one centre that used a strategy of aggressive treatment with combined antibiotics had fewer seizures (2% v 15%, P = 0.03), fewer deaths (0% v 5%, p = 0.029), required no abdominal surgery, and excreted E coli for a shorter duration.CONCLUSIONS: Enterohaemorrhagic E coli induced haemolytic uraemic syndrome is a severe self limiting acute condition. Our findings question the benefit of eculizumab and of plasmapheresis with or without glucocorticoids. Patients with established haemolytic uraemic syndrome seemed to benefit from antibiotic treatment and this should be investigated in a controlled trial.

AB - OBJECTIVE: To evaluate the effect of different treatment strategies on enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome.DESIGN: Multicentre retrospective case-control study.SETTING: 23 hospitals in northern Germany.PARTICIPANTS: 298 adults with enterohaemorrhagic E coli induced haemolytic uraemic syndrome.MAIN OUTCOME MEASURES: Dialysis, seizures, mechanical ventilation, abdominal surgery owing to perforation of the bowel or bowel necrosis, and death.RESULTS: 160 of the 298 patients (54%) temporarily required dialysis, with only three needing treatment long term. 37 patients (12%) had seizures, 54 (18%) required mechanical ventilation, and 12 (4%) died. No clear benefit was found from use of plasmapheresis or plasmapheresis with glucocorticoids. 67 of the patients were treated with eculizumab, a monoclonal antibody directed against the complement cascade. No short term benefit was detected that could be attributed to this treatment. 52 patients in one centre that used a strategy of aggressive treatment with combined antibiotics had fewer seizures (2% v 15%, P = 0.03), fewer deaths (0% v 5%, p = 0.029), required no abdominal surgery, and excreted E coli for a shorter duration.CONCLUSIONS: Enterohaemorrhagic E coli induced haemolytic uraemic syndrome is a severe self limiting acute condition. Our findings question the benefit of eculizumab and of plasmapheresis with or without glucocorticoids. Patients with established haemolytic uraemic syndrome seemed to benefit from antibiotic treatment and this should be investigated in a controlled trial.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Animals

KW - Anti-Bacterial Agents

KW - Antibodies, Monoclonal, Humanized

KW - Case-Control Studies

KW - Child

KW - Combined Modality Therapy

KW - Diarrhea

KW - Disease Outbreaks

KW - Disease Progression

KW - Drug Therapy, Combination

KW - Enterohemorrhagic Escherichia coli

KW - Escherichia coli Infections

KW - Female

KW - Germany

KW - Glucocorticoids

KW - Hemolytic-Uremic Syndrome

KW - Humans

KW - Immunologic Factors

KW - Infant

KW - L-Lactate Dehydrogenase

KW - Male

KW - Mice

KW - Middle Aged

KW - Multivariate Analysis

KW - Plasmapheresis

KW - Platelet Count

KW - Renal Dialysis

KW - Respiration, Artificial

KW - Retrospective Studies

KW - Treatment Outcome

KW - Young Adult

KW - Journal Article

KW - Multicenter Study

KW - Research Support, Non-U.S. Gov't

KW - Validation Studies

M3 - SCORING: Journal article

C2 - 22815429

VL - 345

SP - e4565

JO - BMJ-BRIT MED J

JF - BMJ-BRIT MED J

SN - 0959-535X

ER -