Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis: a meta-analysis.

Abstract

CONTEXT:

The use of antibiotics for treatment of Escherichia coli O157:H7 infection has become controversial since a recent small study found that it may increase the risk of hemolytic uremic syndrome (HUS). However, other larger studies have reported a protective effect or no association.

OBJECTIVE:

To determine whether antibiotic therapy for E coli O157:H7 enteritis increases the risk of HUS.

DATA SOURCES:

PubMed and MEDLINE computer searches were performed for studies published from January 1983 to February 2001 using the key words hemolytic uremic syndrome, risk factor, antibiotics, and Escherichia coli O157:H7. Reference lists of relevant publications were reviewed, and 12 experts in the field were contacted to identify additional reports. No language restrictions were applied to the search.

STUDY SELECTION:

Studies were included if they reported a series of patients with documented E coli O157:H7 enteritis, some of whom developed HUS; had clear definitions of HUS; and had adequate data delineating the relationship between antibiotic therapy and the occurrence of HUS. Nine of the 26 identified studies fulfilled these criteria.

DATA EXTRACTION:

Two authors (N.S. and A.S.) independently reviewed each report identified by the searches and recorded predetermined information relevant to the inclusion criteria. A pooled odds ratio was calculated using a fixed-effects model, with assessment of heterogeneity among the studies.

DATA SYNTHESIS:

The pooled odds ratio was 1.15 (95% confidence interval, 0.79-1.68), indicating that there does not appear to be an increased risk of HUS with antibiotic treatment of E coli O157:H7 enteritis. Incomplete reporting of data in individual studies precluded adjustment for severity of illness.

CONCLUSION:

Our meta-analysis did not show a higher risk of HUS associated with antibiotic administration. A randomized trial of adequate power, with multiple distinct strains of E coli O157:H7 represented, is needed to conclusively determine whether antibiotic treatment of E coli O157:H7 enteritis increases the risk of HUS.

• Authors: Nasia Safdar, Adnan Said, Ronald E Gangnon, Dennis G Maki
• Journal: JAMA (JAMA) Vol. 288 Issue 8 Pg. 996-1001 (Aug 28 2002) ISSN: 0098-7484 [Print] United States
• PMID: 12190370 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (therapeutic use)
• Enteritis (complications, drug therapy, microbiology)
• Escherichia coli Infections (complications, drug therapy)
• Escherichia coli O157
• Hemolytic-Uremic Syndrome (epidemiology, etiology, microbiology)
• Humans
• Risk Factors
• Severity of Illness Index