LESSONS LEARNED IN THE MANAGEMENT OF HEMOLYTIC-UREMIC SYNDROME IN CHILDREN

Escherichia coli 0.157:H7 is a Serious and common human pathogen that can cause diarrhea, hemorrhagic colitis, and the hemolytic uremic synd rome (HUS). During a massive outbreak of infection with E coil 0157:H7 in January 1993 in Washington State; more than 600 people, mostly chi ldren, acquired symptomatic infection, and 37 were hospitalized with H US at Children's Hospital and Medical Center in Seattle, and six at ot her hospitals in Washington. Twenty-one (57%) required dialysis. Ninet een (51%) had significant extrarenal pathology: gastrointestinal in 14 patients (38%), cardiovascular in 13 (35%), pulmonary in 9 (24%), and neurological in 6 (16%). Most patients were managed nonoperatively, b ut three required total abdominal colectomy and one a left colectomy. No child had perforation. Three patients died, all of whom had multisy stem disease. The authors recommend (1) that all patients with bloody diarrhea undergo microbiological evaluation for E coil 0157:H7 before any surgical intervention; (2) avoidance of antibiotics and antimotili ty agents in patients with proven or suspected infection with E coil 0 157:H7 until the safety and efficacy of such interventions have been e stablished in controlled trials; (3) that patients with E coli 0157:H7 infections be evaluated for microangiopathic changes consistent with HUS in the week after onset of diarrhea; (4) nasogastric suction for s evere symptoms, and frequent abdominal evaluations, tests (electrolyte s/amylase), and roentgenograms to exclude treatable abdominal disorder s; and (5) institution of hemodialysis for oliguria/anuria, acidosis, or rising creatinine. The authors recommend surgical exploration for t oxic megacolon, colonic perforation, acidosis unresponsive to dialysis , or recurrent signs of obstruction or colonic stricture. Copyright (C ) 1995 by W.B. Saunders Company