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      Strength of the association between antibiotic use and hemolytic uremic syndrome following Escherichia coli O157:H7 infection varies with case definition

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      International Journal of Medical Microbiology

      Elsevier BV

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          Abstract

          <div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d955602e170">Background:</h5> <p id="P1">The veracity of the association between antibiotic use and hemolytic uremic syndrome (HUS) caused by <i>Escherichia coli</i> O157:H7 has been a topic of debate. We postulated that criteria used to define HUS affect this association. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d955602e178">Methods:</h5> <p id="P2">We reviewed 471 hospitalized <i>E. coli</i> O157:H7 cases reported in Washington State, 2005–2014, to determine HUS status by various case definitions and antibiotic treatment. We used age-adjusted logistic regression models to estimate the effect of treatment on HUS status according to four common, but heterogeneous, definitions: the Council of State and Territorial Epidemiologists (CSTE) definition, hematology-focused and age-focused definitions from the literature, and hospital diagnosis. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d955602e186">Results:</h5> <p id="P3">Inter-annual variation in antibiotic use was high, but no meaningful change in antibiotic use was observed over this ten-year period. Thirteen percent of cases &lt;18 years-old received antibiotics, compared to 54% of cases ≥18 years-old. The CSTE, hematology-focused, agefocused, and hospital diagnosis definitions identified 149, 57, 74, and 89 cases of HUS, respectively. The association between antibiotic treatment and HUS varied by definition: CSTE odds ratio (OR) 1.57 [95% confidence interval (CI) 0.98, 2.55]; hematology-focused OR 1.73 (95% CI 0.83, 3.54); age-focused OR 2.29 (95% CI 1.20, 4.39); and hospital diagnosis OR 1.94 (95% CI 1.01, 3.72). </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d955602e191">Conclusions:</h5> <p id="P4">Each definition yielded an estimate of the association in the direction of increased risk of HUS with antibiotics. While the range of OR point estimates was relatively small, confidence intervals for two HUS definitions crossed the null and two did not, potentially altering the inference an investigator makes. Discrepant reports of the association between antibiotic use and HUS in the literature might be due in part to the choice of HUS definition, and a consistent definition of HUS should be adopted for research and public health purposes. </p> </div>

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          Author and article information

          Journal
          International Journal of Medical Microbiology
          International Journal of Medical Microbiology
          Elsevier BV
          14384221
          October 2018
          October 2018
          : 308
          : 7
          : 921-926
          Article
          10.1016/j.ijmm.2018.06.009
          6287940
          30257808
          © 2018

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