Effect of early fosfomycin treatment on prevention of hemolytic uremic syndrome accompanying Escherichia coli O157 : H7 infection

Objective: To clarify the effect of early fosfomycin treatment, an antimicr obial agent in common use in Japan, on children with E. coli O157 with the aim of preventing hemolytic uremic syndrome (HUS). Patients and methods: De sign: Non-randomized prospective study for development of HUS among inpatie nts with E. coli O157. Setting. The hospitals where the 292 inpatients were treated. Cases. A total of 292 inpatients aged six to eleven years with E. coli O157 infection, 36 (12.3%) of whom were HUS cases. Results: Most of t he HUS inpatients (91.7%) developed this complication between the sixth and ninth day of illness. We therefore analyzed the effects of antimicrobial t herapy, especially that of fosfomycin, on prevention of HUS within the firs t five days of illness, because fosfomycin was the most frequently used (88 .0%). To clarify the effect of fosfomycin alone on prevention of HUS, we ca rried out an analysis using the data for 130 inpatients who received fosfom ycin alone or did not receive any antimicrobial agents, within the first fi ve days of illness, multivariate analysis, controlled for age, gender and p resence of fever, showed that all adjusted odds ratios for the development of HUS with the use of fosfomycin within the first three days of illness we re less than 1.0, with the use of fosfomycin on the second day of illness a chieving statistical significance (adjusted OR, 0.09; 95%C1, 0.01 - 0.79). Furthermore, inpatients who took fosfomycin within the first two days of il lness developed HUS significantly less often than those who did not (adjust ed OR, 0.15; 95%C1, 0.03 - 0.78). On the other hand, fosfomycin therapy on and after the third day of illness was not associated with the prevention o f HUS. Conclusion: The early use of fosfomycin within the first two days of illness might prevent the development of HUS.