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Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis: a meta-analysis Safdar N; Said A; Gangnon RE; Maki DGJAMA 2002[Aug]; 288 (8): 996-1001CONTEXT: The use of antibiotics for treatment of Escherichia coli O157:H7 infection has become controversial since a recent small study found that it may increase the risk of hemolytic uremic syndrome (HUS). However, other larger studies have reported a protective effect or no association. OBJECTIVE: To determine whether antibiotic therapy for E coli O157:H7 enteritis increases the risk of HUS. DATA SOURCES: PubMed and MEDLINE computer searches were performed for studies published from January 1983 to February 2001 using the key words hemolytic uremic syndrome, risk factor, antibiotics, and Escherichia coli O157:H7. Reference lists of relevant publications were reviewed, and 12 experts in the field were contacted to identify additional reports. No language restrictions were applied to the search. STUDY SELECTION: Studies were included if they reported a series of patients with documented E coli O157:H7 enteritis, some of whom developed HUS; had clear definitions of HUS; and had adequate data delineating the relationship between antibiotic therapy and the occurrence of HUS. Nine of the 26 identified studies fulfilled these criteria. DATA EXTRACTION: Two authors (N.S. and A.S.) independently reviewed each report identified by the searches and recorded predetermined information relevant to the inclusion criteria. A pooled odds ratio was calculated using a fixed-effects model, with assessment of heterogeneity among the studies. DATA SYNTHESIS: The pooled odds ratio was 1.15 (95% confidence interval, 0.79-1.68), indicating that there does not appear to be an increased risk of HUS with antibiotic treatment of E coli O157:H7 enteritis. Incomplete reporting of data in individual studies precluded adjustment for severity of illness. CONCLUSION: Our meta-analysis did not show a higher risk of HUS associated with antibiotic administration. A randomized trial of adequate power, with multiple distinct strains of E coli O157:H7 represented, is needed to conclusively determine whether antibiotic treatment of E coli O157:H7 enteritis increases the risk of HUS.|*Escherichia coli O157[MESH]|Anti-Bacterial Agents/*therapeutic use[MESH]|Enteritis/complications/drug therapy/*microbiology[MESH]|Escherichia coli Infections/*complications/*drug therapy[MESH]|Hemolytic-Uremic Syndrome/*epidemiology/etiology/microbiology[MESH]|Humans[MESH]|Risk Factors[MESH]|Severity of Illness Index[MESH] |
