The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections
The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections
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DOI：
10.1056/nejm200006293422601
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发表时间：
2000-06-29
影响因子：
158.5
通讯作者：
Tarr, PI
中科院分区：
文献类型：
--
作者：
Wong, CS;Jelacic, S;Tarr, PI
背景：大肠杆菌O 157：H7引起的胃肠道感染的儿童有发生溶血性尿毒症综合征的风险。方法：我们对71名年龄小于10岁的儿童进行了一项前瞻性队列研究，这些儿童患有由大肠杆菌引起的腹泻。大肠杆菌O 157：H7，以评估这些儿童的抗生素治疗是否影响溶血性尿毒症综合征的风险，并评估混杂因素对这一结果的影响。估计的相对风险进行了调整，可能的混杂效应与使用逻辑回归analysis.Results：在71名儿童，9（13%）接受抗生素和溶血性尿毒症综合征的发展，在10（14%）。这10名儿童中有5名接受了抗生素治疗。与溶血性尿毒症综合征显著相关的因素是较高的初始白细胞计数（相对危险度，1.3; 95%置信区间，1.1至1.5），发病后不久进行粪便培养评估（相对危险度，0.3; 95%置信区间，0.2至0.8），和抗生素治疗（相对危险度，14.3; 95%置信区间，2.9至70.7）。9名接受抗生素治疗的儿童和62名未接受抗生素治疗的儿童的临床和实验室特征相似。在一项多变量分析中，对初始白细胞计数和患病当天粪便进行培养进行了调整，抗生素治疗仍然是溶血性尿毒症综合征发生的危险因素（相对危险度为17.3; 95%置信区间为2.2 - 137）。大肠杆菌O 157：H7感染增加溶血性尿毒症综合征的风险。（N Engl J Med 2000;342：1930-6.）（C）2000年，马萨诸塞州医学会。
Background: Children with gastrointestinal infections caused by Escherichia coli O157:H7 are at risk for the hemolytic-uremic syndrome. Whether antibiotics alter this risk is unknown.Methods: We conducted a prospective cohort study of 71 children younger than 10 years of age who had diarrhea caused by E. coli O157:H7 to assess whether antibiotic treatment in these children affects the risk of the hemolytic-uremic syndrome and to assess the influence of confounding factors on this outcome. Estimates of relative risks were adjusted for possible confounding effects with the use of logistic-regression analysis.Results: Among the 71 children, 9 (13 percent) received antibiotics and the hemolytic-uremic syndrome developed in 10 (14 percent). Five of these 10 children had received antibiotics. Factors significantly associated with the hemolytic-uremic syndrome were a higher initial white-cell count (relative risk, 1.3; 95 percent confidence interval, 1.1 to 1.5), evaluation with stool culture soon after the onset of illness (relative risk, 0.3; 95 percent confidence interval, 0.2 to 0.8), and treatment with antibiotics (relative risk, 14.3; 95 percent confidence interval, 2.9 to 70.7). The clinical and laboratory characteristics of the 9 children who received antibiotics and the 62 who did not receive antibiotics were similar. In a multivariate analysis that was adjusted for the initial white-cell count and the day of illness on which stool was obtained for culture, antibiotic administration remained a risk factor for the development of 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:H7 infection increases the risk of the hemolytic-uremic syndrome. (N Engl J Med 2000;342:1930-6.) (C)2000, Massachusetts Medical Society.