The role of antimicrobial
therapy for Shiga toxin-producing Escherichia coli (STEC)
infection has not been clearly defined. A prospective study identified
antibiotic use as a significant risk factor for subsequent development of haemolytic-uraemic syndrome (HUS). However, early treatment with
fosfomycin, a bacteriostatic
antibiotic, resulted in a significantly decreased risk of HUS. The aim of this study was to evaluate a role of
fosfomycin therapy in the development of HUS in children who contracted STEC
infection. The study included 118 children who contracted a STEC
infection between 1997 and 2013. A pre-defined questionnaire was utilised to collect patient information regarding age, sex, presenting symptoms (
fever,
abdominal pain, diarrhoea and bloody stool), results of stool culture examination, initial results of white blood cell counts and
C-reactive protein (CRP), use of
antibiotics, the timing of introduction of
antibiotics, and complications including HUS. Of the 118 patients, 64 were diagnosed with HUS and the remaining 54 did not develop HUS. Multivariate analysis showed that three independent factors (age, initial values of CRP and use of
fosfomycin) were significantly associated with the occurrence of HUS; of particular note, the adjusted odds ratio for use of
fosfomycin was 0.15 (95% confidence interval 0.05-0.45). Use of
fosfomycin within the first 5 days of illness may decrease the development of STEC-related HUS in children.