1. Clinical Features of Critically Ill Patients With Shiga Toxin–Induced Hemolytic Uremic Syndrome
- Author
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Tobias N. Meyer, Matthias Müller-Schulz, Karl Wegscheider, Stefan Kluge, Jens Fiehler, Marie C. von Heinz, Andreas de Weerth, Wilhelm-W. Hoepker, Jens Fricke, Ulf Panzer, Christian Gerloff, Stephan Braune, Gerd P. Meyer, Heinrich Becker, Dominic Wichmann, Tim Magnus, Rolf A.K. Stahl, and Axel Nierhaus
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Critical Illness ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,Shiga Toxin ,Sepsis ,Young Adult ,Internal medicine ,medicine ,Humans ,Renal replacement therapy ,Escherichia coli Infections ,Aged ,Retrospective Studies ,Aged, 80 and over ,Mechanical ventilation ,biology ,Septic shock ,business.industry ,Mortality rate ,Retrospective cohort study ,Shiga toxin ,Length of Stay ,Middle Aged ,Eculizumab ,medicine.disease ,Respiration, Artificial ,Renal Replacement Therapy ,Intensive Care Units ,Hemolytic-Uremic Syndrome ,biology.protein ,Female ,business ,medicine.drug - Abstract
Objective In Spring 2011, an unprecedented outbreak of Shiga toxin-producing Escherichia coli serotype O104:H4-associated hemolytic uremic syndrome occurred in Northern Germany. The aim of this study was to describe the clinical characteristics, treatments, and outcomes of critically ill patients with Shiga toxin-producing E. coli-associated hemolytic uremic syndrome during this outbreak. Design, setting, and patients Multicenter, retrospective, observational study of critically ill adult patients with Shiga toxin-producing E. coli-associated hemolytic uremic syndrome in six hospitals in Hamburg, Germany, between May 2011 and August 2011. Measurements and main results During the study period, 106 patients with Shiga toxin-producing E. coli-associated hemolytic uremic syndrome were admitted to eight ICUs. The median age was 40 years (range, 18-83) with a female:male ratio of 3:1. The median time from onset of clinical symptoms to hospital admission was 3 days and from hospital to ICU admission an additional 3 days. A total of 101 patients (95.3%) had acute renal failure and 78 (73.6%) required renal replacement therapy. Intubation and mechanical ventilation were required in 38 patients (35.8%) and noninvasive ventilation was required in 17 patients (16.0%). The median duration of invasive ventilation was 7 days (range, 1-32 days) and the median ICU stay was 10 days (range, 1-45 days). Fifty-one patients (48.1%) developed sepsis; of these 51 patients, 27 (25.4%) developed septic shock. Seventy patients (66.0%) developed severe neurological symptoms. Ninety-seven patients (91.5%) were treated with plasma exchange and 50 patients (47.2%) received eculizumab (monoclonal anti-C5 antibody). The mortality rate was 4.7%. Mild residual neurological symptoms were present in 21.7% of patients at ICU discharge, and no patient required renal replacement therapy 6 months after ICU admission. Conclusions During the 2011 Shiga toxin-producing E. coli-associated hemolytic uremic syndrome outbreak in Germany, critical illness developed rapidly after hospital admission, often in young women. The infection was associated with severe neurological and renal symptoms, requiring mechanical ventilation and renal replacement therapy in a substantial proportion of patients. Overall, recovery was much better than expected.
- Published
- 2013