Management of Shiga toxin producing Escherichia coli-infected children: A multi-national, multi-specialty survey.

ABSTRACT

AIM: Research has highlighted the potential role that hydration status may play in predicting outcomes in Shiga toxin-producing Escherichia coli (STEC)-infected children. Because little is known about the management of STEC-infected children in the pre-haemolytic uremic syndrome phase, we compared paediatric emergency medicine and nephrologist-stated management approaches to STEC-infected children. METHODS: Members of the Pediatric Emergency Research Canada (PERC; n = 228), the Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC; n = 221) and the Canadian Association of Pediatric Nephrologists (CAPN; n = 66) were surveyed. Five individualised e-mail requests containing a link to a 42-question web-based survey were sent to eligible participants. RESULTS: Of 496 potentially eligible participants, 276 (56%) submitted complete survey responses. In children with classic features of STEC infection, baseline haemoglobin/haematocrit is obtained by 54% of PERC, 41% of PEM CRC and 83% of CAPN members (P < 0.001), and baseline renal function is obtained by 51% of PERC, 38% of PEM CRC and 83% of CAPN members (P < 0.001). Intravenous fluids are more often recommended by nephrologists (28%) compared with PEM physicians (7%), P < 0.001. In children with known E. coli O157H7 infection, nephrologists more commonly recommend clinical follow-up (P = 0.003), complete blood counts (P < 0.001) and renal function/electrolyte testing (P < 0.001). Intravenous fluid administration and admission are more commonly recommended by nephrologists (P = 0.03 and P < 0.001, respectively). CONCLUSION: Compared with paediatric nephrologists, paediatric emergency medicine physicians are less likely to perform baseline and follow-up blood tests and to administer intravascular volume expansion in children at risk of, and with confirmed, E. coli O157H7 infection.