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Case-management protocol for bloody diarrhea as a model to reduce the clinical impact of Shiga toxin-producing Escherichia coli infections. Experience from Southern Italy.
Eur J Clin Microbiol Infect Dis. 2020 Mar; 39(3):539-547.EJ

Abstract

To describe an operating protocol for bloody diarrhea (BD) in a pediatric population as a rapid response to a public health threat represented by an excess of pediatric HUS cases in the Apulia region (Southern Italy) starting from 2013. The protocol was set up with the goal of correct clinical management of Shiga toxin-producing Escherichia coli (STEC) infections, reductions in subsequent cases of hemolytic uremic syndrome (HUS), and improved short- and long-term disease outcomes. The protocol consisted of rapid hospitalization of children with bloody diarrhea (BD), hematochemical laboratory tests every 12-24 hours, and prompt laboratory diagnosis of STEC. No antibiotics were recommended until diagnosis. Children positive for STEC infections underwent early vigorous volume expansion. In June-December 2018, 438 children with BD were hospitalized, of which 53 (12.1%) had a STEC infection. The most common serogroups were O26 (36.1%), O111 (23.0%), and O157 (14.8%). Thirty-one samples carried the stx2 gene. Four cases evolved into HUS (7.5%), all with favorable outcome despite neurological involvement in two cases. Prompt and accurate laboratory diagnosis of STEC infections is of the utmost importance in patients with BD for correct clinical management. The strict adherence to the protocol could reduce the progression rate of STEC infections to HUS and prevents complications. Enhanced BD surveillance may help reduce cases of pediatric HUS in Southern Italy.

Authors+Show Affiliations

Department of Biomedical Sciences and Human Oncology, Hygiene Unit, University of Bari Aldo Moro, P.zza G. Cesare 11, 70124, Bari, Italy.Pediatric Nephrology and Dialysis Unit, Pediatric Hospital "Giovanni XXIII", Bari, Italy.Department of Biomedical Sciences and Human Oncology, Neonatal Intensive Care Unit, University of Bari Aldo Moro, Bari, Italy.Pediatric Nephrology and Dialysis Unit, Pediatric Hospital "Giovanni XXIII", Bari, Italy.Pediatric Nephrology and Dialysis Unit, Pediatric Hospital "Giovanni XXIII", Bari, Italy.Pediatric Nephrology and Dialysis Unit, Pediatric Hospital "Giovanni XXIII", Bari, Italy.Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy.Department of Biomedical Sciences and Human Oncology, Hygiene Unit, University of Bari Aldo Moro, P.zza G. Cesare 11, 70124, Bari, Italy.Food Safety, Nutrition and Veterinary Public Health Department, Istituto Superiore di Sanità, Rome, Italy.Department of Biomedical Sciences and Human Oncology, Hygiene Unit, University of Bari Aldo Moro, P.zza G. Cesare 11, 70124, Bari, Italy. maria.chironna@uniba.it.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31776873

Citation

Loconsole, Daniela, et al. "Case-management Protocol for Bloody Diarrhea as a Model to Reduce the Clinical Impact of Shiga Toxin-producing Escherichia Coli Infections. Experience From Southern Italy." European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology, vol. 39, no. 3, 2020, pp. 539-547.
Loconsole D, Giordano M, Laforgia N, et al. Case-management protocol for bloody diarrhea as a model to reduce the clinical impact of Shiga toxin-producing Escherichia coli infections. Experience from Southern Italy. Eur J Clin Microbiol Infect Dis. 2020;39(3):539-547.
Loconsole, D., Giordano, M., Laforgia, N., Torres, D., Santangelo, L., Carbone, V., Parisi, A., Quarto, M., Scavia, G., & Chironna, M. (2020). Case-management protocol for bloody diarrhea as a model to reduce the clinical impact of Shiga toxin-producing Escherichia coli infections. Experience from Southern Italy. European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology, 39(3), 539-547. https://doi.org/10.1007/s10096-019-03755-0
Loconsole D, et al. Case-management Protocol for Bloody Diarrhea as a Model to Reduce the Clinical Impact of Shiga Toxin-producing Escherichia Coli Infections. Experience From Southern Italy. Eur J Clin Microbiol Infect Dis. 2020;39(3):539-547. PubMed PMID: 31776873.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Case-management protocol for bloody diarrhea as a model to reduce the clinical impact of Shiga toxin-producing Escherichia coli infections. Experience from Southern Italy. AU - Loconsole,Daniela, AU - Giordano,Mario, AU - Laforgia,Nicola, AU - Torres,Diletta, AU - Santangelo,Luisa, AU - Carbone,Vincenza, AU - Parisi,Antonio, AU - Quarto,Michele, AU - Scavia,Gaia, AU - Chironna,Maria, AU - ,, Y1 - 2019/11/27/ PY - 2019/08/14/received PY - 2019/10/27/accepted PY - 2019/11/30/pubmed PY - 2020/10/10/medline PY - 2019/11/29/entrez KW - Bloody diarrhea KW - Early volume expansion KW - Hemolytic uremic syndrome KW - Shiga toxin-producing Escherichia coli SP - 539 EP - 547 JF - European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology JO - Eur J Clin Microbiol Infect Dis VL - 39 IS - 3 N2 - To describe an operating protocol for bloody diarrhea (BD) in a pediatric population as a rapid response to a public health threat represented by an excess of pediatric HUS cases in the Apulia region (Southern Italy) starting from 2013. The protocol was set up with the goal of correct clinical management of Shiga toxin-producing Escherichia coli (STEC) infections, reductions in subsequent cases of hemolytic uremic syndrome (HUS), and improved short- and long-term disease outcomes. The protocol consisted of rapid hospitalization of children with bloody diarrhea (BD), hematochemical laboratory tests every 12-24 hours, and prompt laboratory diagnosis of STEC. No antibiotics were recommended until diagnosis. Children positive for STEC infections underwent early vigorous volume expansion. In June-December 2018, 438 children with BD were hospitalized, of which 53 (12.1%) had a STEC infection. The most common serogroups were O26 (36.1%), O111 (23.0%), and O157 (14.8%). Thirty-one samples carried the stx2 gene. Four cases evolved into HUS (7.5%), all with favorable outcome despite neurological involvement in two cases. Prompt and accurate laboratory diagnosis of STEC infections is of the utmost importance in patients with BD for correct clinical management. The strict adherence to the protocol could reduce the progression rate of STEC infections to HUS and prevents complications. Enhanced BD surveillance may help reduce cases of pediatric HUS in Southern Italy. SN - 1435-4373 UR - https://cancerres.unboundmedicine.com/medline/citation/31776873/Case_management_protocol_for_bloody_diarrhea_as_a_model_to_reduce_the_clinical_impact_of_Shiga_toxin_producing_Escherichia_coli_infections__Experience_from_Southern_Italy_ L2 - https://dx.doi.org/10.1007/s10096-019-03755-0 DB - PRIME DP - Unbound Medicine ER -