Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: case-control study.
BMJ
; 345: e4565, 2012 Jul 19.
Article
em En
| MEDLINE
| ID: mdl-22815429
ABSTRACT
OBJECTIVE:
To evaluate the effect of different treatment strategies on enterohaemorrhagic Escherichia coli O104H4 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 OUTCOMEMEASURES:
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.
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
/
2_ODS3
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3_ND
/
4_TD
Base de dados:
MEDLINE
Assunto principal:
Surtos de Doenças
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Infecções por Escherichia coli
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Escherichia coli Êntero-Hemorrágica
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Anticorpos Monoclonais Humanizados
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Síndrome Hemolítico-Urêmica
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Fatores Imunológicos
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Antibacterianos
Tipo de estudo:
Observational_studies
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Risk_factors_studies
Limite:
Aged80
País/Região como assunto:
Europa
Idioma:
En
Revista:
BMJ
Ano de publicação:
2012
Tipo de documento:
Article