TY - JOUR
T1 - Antibiotic treatment of verocytotoxin-producing Escherichia coli (VTEC) infection
T2 - a systematic review and a proposal
AU - Agger, Morten
AU - Scheutz, Flemming
AU - Villumsen, Steen
AU - Mølbak, Kåre
AU - Petersen, Andreas Munk
N1 - © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: [email protected].
PY - 2015/9
Y1 - 2015/9
N2 - OBJECTIVES: A consensus has existed on not to treat verocytotoxin-producing Escherichia coli (VTEC)-infected individuals with antibiotics because of possible subsequent increased risk of developing haemolytic uraemic syndrome (HUS). The aim of this systematic review is to clarify the risk associated with antibiotic treatment during acute VTEC infection and in chronic VTEC carrier states.METHODS: A systematic search in PubMed identified 1 meta-analysis, 10 clinical studies and 22 in vitro/in vivo studies.RESULTS: Four clinical studies found an increased risk of HUS, four studies found no altered risk of HUS and two studies found a protective effect of antibiotics. In vitro and clinical studies suggest that DNA synthesis inhibitors should be avoided, whereas evidence from in vitro studies indicates that certain protein and cell wall synthesis inhibitors reduce the release of toxins from VTEC isolates. Overall, these studies provide a more nuanced view of the diversity of responses by VTEC strains to antibiotics.CONCLUSIONS: Based on these data, as well as data from the Danish cohort of registered VTEC infections, we propose that antibiotic treatment with protein and cell wall synthesis inhibitors can be considered when specific criteria regarding patient group, serotype, virulence profile and duration of disease are met.
AB - OBJECTIVES: A consensus has existed on not to treat verocytotoxin-producing Escherichia coli (VTEC)-infected individuals with antibiotics because of possible subsequent increased risk of developing haemolytic uraemic syndrome (HUS). The aim of this systematic review is to clarify the risk associated with antibiotic treatment during acute VTEC infection and in chronic VTEC carrier states.METHODS: A systematic search in PubMed identified 1 meta-analysis, 10 clinical studies and 22 in vitro/in vivo studies.RESULTS: Four clinical studies found an increased risk of HUS, four studies found no altered risk of HUS and two studies found a protective effect of antibiotics. In vitro and clinical studies suggest that DNA synthesis inhibitors should be avoided, whereas evidence from in vitro studies indicates that certain protein and cell wall synthesis inhibitors reduce the release of toxins from VTEC isolates. Overall, these studies provide a more nuanced view of the diversity of responses by VTEC strains to antibiotics.CONCLUSIONS: Based on these data, as well as data from the Danish cohort of registered VTEC infections, we propose that antibiotic treatment with protein and cell wall synthesis inhibitors can be considered when specific criteria regarding patient group, serotype, virulence profile and duration of disease are met.
KW - Anti-Bacterial Agents
KW - Escherichia coli Infections
KW - Hemolytic-Uremic Syndrome
KW - Humans
KW - Shiga-Toxigenic Escherichia coli
KW - Treatment Outcome
U2 - 10.1093/jac/dkv162
DO - 10.1093/jac/dkv162
M3 - Journal article
C2 - 26093376
SN - 0305-7453
VL - 70
SP - 2440
EP - 2446
JO - Journal of Antimicrobial Chemotherapy
JF - Journal of Antimicrobial Chemotherapy
IS - 9
ER -