Wong et al. conclude in Clinical Infectious Disease that for every four children infected with E. coli O157:H7 treated with antibiotics, one will develop hemolytic uremic syndrome (HUS). The authors state antibiotic use during E. coli O157:H7 infections is associated with a higher rate of subsequent HUS, and should be avoided.

The authors enrolled children infected with E. coli O157:H7 in this prospective cohort study in five states over 9.5 years within one week of the onset of diarrhea. The primary and secondary outcomes were HUS (hematocrit < 30% with smear evidence of hemolysis, platelet count < 150 x 103/mm3, and serum creatinine concentration > upper limit of normal for age) and oligoanuric HUS. Univariate and multivariable and ordinal multinomial regression analyses were used to test associations between factors apparent during the first week of illness and outcomes.

Of the 259 children analyzed, 36 (14%) developed HUS. Univariate analysis demonstrated that children who received antibiotics during the diarrhea phase more frequently developed HUS than those who did not (36% vs. 12%, p=0.001). The higher rate of HUS was observed across all antibiotic classes used. In multivariable analysis, a higher leukocyte count (aOR 1.10; 95%CI 1.03, 1.19), vomiting (aOR 3.05; 95%CI 1.23-7.56), and exposure to antibiotics (aOR 3.62; 95% CI 1.23-10.6) during the first week of onset of illness were each independently associated with development of HUS. Multinomial ordinal logistic regression confirmed that initial leukocyte count and antibiotic use were independently associated HUS, and, additionally, these variables were each associated with the development of oligoanuric HUS.

Risk Factors for the Hemolytic Uremic Syndrome in Children Infected with Escherichia coli O157:H7: a Multivariable Analysis
http://cid.oxfordjournals.org/content/early/2012/03/16/cid.cis299.abstract

Two children and one adult in the Maple Rapids area of Michigan have become infected with E. coli bacteria.



This story from the Morning Sun is a little all over the place, but does report that two children have developed hemolytic uremic syndrome as a result of the infections and have been hospitalized.

“This strain of E.coli is very potent and troublesome,” said Dr. Robert Graham, medical director for the Mid-Michigan District Health Department. “We urge everyone to take precautions to prevent becoming infected by this germ. What’s troublesome is that these last three cases aren’t the only ones to have this particular strain of E. coli.



Graham said that during the summer, three other cases of the same strain were reported. Those people had attended the Clinton County Fair and that strain of E. coli came from a meat packing company called McNeese, located in the thumb.

From the I-wish-I-hadn’t-said-that files, Terry Brady, a spokesperson with Pennsylvania’s Department of Conservation and Natural Resources said Monday that the lake at Cowans Gap State Park remained open, despite links to three cases of E. coli O157. “The beaches are open and actually there was a good turnout today. A link to the park has not been established."

The lake was closed Tuesday afternoon, as the number of people, primarily children, confirmed to have contracted E. coli O157:H7 rose to six, with an additional three suspect cases.

At least three of the infected have developed hemolytic uremic syndrome, including a 3-year-old Mercersburg girl who has been hospitalized since Wednesday, and a 12-year-old Chambersburg boy, who is now recovering after spending his birthday in the hospital.

Spokesman Brady said in an email Tuesday night that the closing of the lake at Cowans Gap is a precautionary measure "to protect the public's health and safety until the investigation can be completed."

He said the decision was made after interviews showed that swimming in the lake before becoming ill was a common factor between all individuals.

Over the weekend, Nikki Gordon, a friend of the three-year-old’s family and another family friend, Amanda Stauffer, came up with the idea for a Facebook group to raise support. As of Friday evening, the group had 955 members, featuring hundreds of well wishes and regular updates on the girl's condition.

Through her Facebook group, Stauffer has heard from several other people who say their children got sick after swimming in the lake at Cowans Gap, she said. They include a 6-year-old girl, a 15-month-old boy and several children who apparently suffered "mild symptoms" but did not require hospitalization.

"All of these kids have one thing in common, and it's Cowans Gap. The only thing we do know is that they were all there," Stauffer said.
 

German health officials identified imported cucumbers from Spain Thursday as the source of a two-week E. coli O104 outbreak that has killed at least four people and made more than 100 others ill.

Three of four contaminated cucumbers analyzed by the Hamburg Institute for Hygiene and the Environment came from Spain, said the state health minister for Hamburg, Cornelia Pruefer-Storcks.

Cucumbers from the affected producers have been pulled from shelves and officials have told people to stop eating cucumbers. The country of origin of the other cucumber is not yet known.