Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: Case-control study

Menne J, Nitschke M, Stingele R, Abu-Tair M, Beneke J, Bramstedt J, Bremer JP, Brunkhorst R, Busch V, Dengler R, Deuschl G, Fellermann K, Fickenscher H, Gerigk C, Goettsche A, Greeve J, Hafer C, Hagenmueller F, Haller H, Herget-Rosenthal S, Hertenstein B, Hofmann C, Lang M, Kielstein JT, Klostermeier UC, Knobloch J, Kuehbacher M, Kunzendorf U, Lehnert H, Manns MP, Menne TF, Meyer TN, Michael C, Muente T, Neumann-Grutzeck C, Nuernberger J, Pavenstaedt H, Ramazan L, Renders L, Repenthin J, Ries W, Rohr A, Rump LC, Samuelsson O, Sayk F, Schmidt BMW, Schnatter S, Schoecklmann H, Schreiber S, Von Seydewitz CU, Steinhoff J, Stracke S, Suerbaum S, Van De Loo A, Vischedyk M, Weissenborn K, Wellhoener P, Wiesner M, Zeissig S, Buening J, Schiffer M, Kuehbacher T (2012)

Publication Type: Journal article

Publication year: 2012

Journal

Book Volume: 345

Article Number: e4565

Journal Issue: 7869

DOI: 10.1136/bmj.e4565

Abstract

Objective: To evaluate the effect of different treatment strategies on enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome. Design: Multicentre retrospective case-control study. Setting: 23 hospitals in northern Germany. Participants: 298 adults with enterohaemorrhagic E coli induced haemolytic uraemic syndrome. Main outcome measures: Dialysis, seizures, mechanical ventilation, abdominal surgery owing to perforation of the bowel or bowel necrosis, and death. Results: 160 of the 298 patients (54%) temporarily required dialysis, with only three needing treatment long term. 37 patients (12%) had seizures, 54 (18%) required mechanical ventilation, and 12 (4%) died. No clear benefit was found from use of plasmapheresis or plasmapheresis with glucocorticoids. 67 of the patients were treated with eculizumab, a monoclonal antibody directed against the complement cascade. No short term benefit was detected that could be attributed to this treatment. 52 patients in one centre that used a strategy of aggressive treatment with combined antibiotics had fewer seizures (2% v 15%, P=0.03), fewer deaths (0% v 5%, p=0.029), required no abdominal surgery, and excreted E coli for a shorter duration. Conclusions: Enterohaemorrhagic E coli induced haemolytic uraemic syndrome is a severe self limiting acute condition. Our findings question the benefit of eculizumab and of plasmapheresis with or without glucocorticoids. Patients with established haemolytic uraemic syndrome seemed to benefit from antibiotic treatment and this should be investigated in a controlled trial.

Authors with CRIS profile

Involved external institutions

Asklepios Kliniken Germany (DE) Asklepios Klinik Altona Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Diakonissenkrankenhaus Flensburg Germany (DE) FernUniversität in Hagen Germany (DE) HELIOS Kliniken Germany (DE) Newcastle upon Tyne Hospitals NHS Foundation Trust United Kingdom (GB) Universitätsklinikum Münster Germany (DE) St. Vincenz-Krankenhaus Germany (DE) Klinikum Bremen-Mitte Germany (DE) Universität Greifswald Germany (DE) Katholisches Marienkrankenhaus Germany (DE) Heinrich-Heine-Universität Düsseldorf Germany (DE) Evangelisches Krankenhaus Bielefeld Germany (DE) Klinikum Ernst von Bergmann Germany (DE) Klinikum Region Hannover Germany (DE) Klinikum Bremerhaven-Reinkenheide Germany (DE) Klinikum Oldenburg Germany (DE) Rotes Kreuz Krankenhaus Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Sahlgrenska University Hospital / Sahlgrenska Universitetssjukhuset Sweden (SE)

How to cite

APA:

Menne, J., Nitschke, M., Stingele, R., Abu-Tair, M., Beneke, J., Bramstedt, J.,... Kuehbacher, T. (2012). Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: Case-control study. British Medical Journal, 345(7869). https://doi.org/10.1136/bmj.e4565

MLA:

Menne, Jan, et al. "Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: Case-control study." British Medical Journal 345.7869 (2012).

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