Background Children with gastrointestinal infections causedby Escherichia coli O157:H7 are at risk for the hemolytic–uremicsyndrome. Whether antibiotics alter this risk is unknown.
Methods We conducted a prospective cohort study of 71 childrenyounger than 10 years of age who had diarrhea caused by E. coliO157:H7 to assess whether antibiotic treatment in these childrenaffects the risk of the hemolytic–uremic syndrome andto assess the influence of confounding factors on this outcome.Estimates of relative risks were adjusted for possible confoundingeffects with the use of logistic-regression analysis.
Results Among the 71 children, 9 (13 percent) received antibioticsand the hemolytic–uremic syndrome developed in 10 (14percent). Five of these 10 children had received antibiotics.Factors significantly associated with the hemolytic–uremicsyndrome were a higher initial white-cell count (relative risk,1.3; 95 percent confidence interval, 1.1 to 1.5), evaluationwith stool culture soon after the onset of illness (relativerisk, 0.3; 95 percent confidence interval, 0.2 to 0.8), andtreatment with antibiotics (relative risk, 14.3; 95 percentconfidence interval, 2.9 to 70.7). The clinical and laboratorycharacteristics of the 9 children who received antibiotics andthe 62 who did not receive antibiotics were similar. In a multivariateanalysis that was adjusted for the initial white-cell countand the day of illness on which stool was obtained for culture,antibiotic administration remained a risk factor for the developmentof the hemolytic–uremic syndrome (relative risk, 17.3;95 percent confidence interval, 2.2 to 137).
Conclusions Antibiotic treatment of children with E. coli O157:H7infection increases the risk of the hemolytic–uremic syndrome.
Source Information
From Children's Hospital and Regional Medical Center and the University of Washington School of Medicine, Seattle. Presented in part at the 35th United States–Japan Cholera and Related Diarrheal Diseases Conference, Baltimore, December 3–5, 1999.
Address reprint requests to Dr. Tarr at the Division of Gastroenterology, CH-24, Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105, or at tarr{at}u.washington.edu.
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