Management of Shiga toxin producing Escherichia coli-infected children: A multi-national, multi-specialty survey

J Paediatr Child Health. 2018 Apr;54(4):390-397. doi: 10.1111/jpc.13778. Epub 2017 Nov 7.

Abstract

Aim: Research has highlighted the potential role that hydration status may play in predicting outcomes in Shiga toxin-producing Escherichia coli (STEC)-infected children. Because little is known about the management of STEC-infected children in the pre-haemolytic uremic syndrome phase, we compared paediatric emergency medicine and nephrologist-stated management approaches to STEC-infected children.

Methods: Members of the Pediatric Emergency Research Canada (PERC; n = 228), the Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC; n = 221) and the Canadian Association of Pediatric Nephrologists (CAPN; n = 66) were surveyed. Five individualised e-mail requests containing a link to a 42-question web-based survey were sent to eligible participants.

Results: Of 496 potentially eligible participants, 276 (56%) submitted complete survey responses. In children with classic features of STEC infection, baseline haemoglobin/haematocrit is obtained by 54% of PERC, 41% of PEM CRC and 83% of CAPN members (P < 0.001), and baseline renal function is obtained by 51% of PERC, 38% of PEM CRC and 83% of CAPN members (P < 0.001). Intravenous fluids are more often recommended by nephrologists (28%) compared with PEM physicians (7%), P < 0.001. In children with known E. coli O157:H7 infection, nephrologists more commonly recommend clinical follow-up (P = 0.003), complete blood counts (P < 0.001) and renal function/electrolyte testing (P < 0.001). Intravenous fluid administration and admission are more commonly recommended by nephrologists (P = 0.03 and P < 0.001, respectively).

Conclusion: Compared with paediatric nephrologists, paediatric emergency medicine physicians are less likely to perform baseline and follow-up blood tests and to administer intravascular volume expansion in children at risk of, and with confirmed, E. coli O157:H7 infection.

Keywords: Shiga-toxigenic Escherichia coli; child; infection; surveys and questionnaires.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Blood Chemical Analysis
  • Canada
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Diagnostic Techniques and Procedures
  • Escherichia coli Infections / diagnosis
  • Escherichia coli Infections / therapy*
  • Escherichia coli O157* / isolation & purification
  • Feces / microbiology
  • Female
  • Health Care Surveys
  • Hemolytic-Uremic Syndrome
  • Humans
  • Infant
  • Male
  • Nephrologists*
  • Pediatric Emergency Medicine*
  • Pediatricians
  • Practice Patterns, Physicians'*
  • Risk Factors
  • Young Adult