Rajal K. Mody, Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
Robert M. Hoekstra, Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
Magdalena Kendall Scott, Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
John Dunn, Tennessee Department of Health, Nashville, TN 37243, USA
Kirk Smith, Minnesota Department of Health, Saint Paul, MN 55164, USA
Melissa Tobin-D'Angelo, Georgia Department of Public Health, Atlanta, GA 30303, USA
Beletshachew Shiferaw, Oregon Public Health Division, Portland, OR 97232, USA
Katie Wymore, California Emerging Infections Program, Oakland, CA 94612, USA
Paula Clogher, Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT 06510, USA
Amanda Palmer, Maryland Department of Health, Baltimore, MD 21201, USA
Nicole Comstock, Colorado Department of Public Health and Environment, Denver, CO 80246, USA
Kari Burzlaff, New York State Department of Health Emerging Infections Program, Albany, NY 14202, USA
Sarah Lathrop, New Mexico Emerging Infections Program, School of Medicine, University of New Mexico, Albuquerque, NM 87106, USA
Sharon Hurd, Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT 06510, USA
Patricia M. Griffin, Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA

Document Type

Article

Publication Date

9-21-2021

Abstract

Treatment of Shiga toxin-producing Escherichia coli O157 (O157) diarrhea with antimicrobials might alter the risk of hemolytic uremic syndrome (HUS). However, full characterization of which antimicrobials might affect risk is lacking, particularly among adults. To inform clinical management, we conducted a case-control study of residents of the FoodNet surveillance areas with O157 diarrhea during a 4-year period to assess antimicrobial class-specific associations with HUS among persons with O157 diarrhea. We collected data from medical records and patient interviews. We measured associations between treatment with agents in specific antimicrobial classes during the first week of diarrhea and development of HUS, adjusting for age and illness severity. We enrolled 1308 patients; 102 (7.8%) developed confirmed HUS. Antimicrobial treatment varied by age: <5 years (12.6%), 5-14 (11.5%), 15-39 (45.4%), ≥40 (53.4%). Persons treated with a β-lactam had higher odds of developing HUS (OR 2.80, CI 1.14-6.89). None of the few persons treated with a macrolide developed HUS, but the protective association was not statistically significant. Exposure to "any antimicrobial" was not associated with increased odds of HUS. Our findings confirm the risk of β-lactams among children with O157 diarrhea and extends it to adults. We observed a high frequency of inappropriate antimicrobial treatment among adults. Our data suggest that antimicrobial classes differ in the magnitude of risk for persons with O157 diarrhea.

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