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Background Shiga toxin–producing Escherichia coli (STEC) infections are leading causes of pediatric acute renal failure. Identifying hemolytic uremic syndrome (HUS) risk factors is needed to guide care. Methods We conducted a multicenter, historical cohort study to identify features associated with development of HUS (primary outcome) and need for renal replacement therapy (RRT) (secondary outcome) in STEC-infected children without HUS at initial presentation. Children aged <18 years who submitted STEC-positive specimens between January 2011 and December 2015 at a participating study institution were eligible. Results Of 927 STEC-infected children, 41 (4.4%) had HUS at presentation; of the remaining 886, 126 (14.2%) developed HUS. Predictors (all shown as odds ratio [OR] with 95% confidence interval [CI]) of HUS included younger age (0.77 [.69–.85] per year), leukocyte count ≥13.0 × 103/μL (2.54 [1.42–4.54]), higher hematocrit (1.83 [1.21–2.77] per 5% increase) and serum creatinine (10.82 [1.49–78.69] per 1 mg/dL increase), platelet count <250 × 103/μL (1.92 [1.02–3.60]), lower serum sodium (1.12 [1.02–1.23 per 1 mmol/L decrease), and intravenous fluid administration initiated ≥4 days following diarrhea onset (2.50 [1.14–5.46]). A longer interval from diarrhea onset to index visit was associated with reduced HUS risk (OR, 0.70 [95% CI,.54–.90]). RRT predictors (all shown as OR [95% CI]) included female sex (2.27 [1.14–4.50]), younger age (0.83 [.74–.92] per year), lower serum sodium (1.15 [1.04–1.27] per mmol/L decrease), higher leukocyte count ≥13.0 × 103/μL (2.35 [1.17–4.72]) and creatinine (7.75 [1.20–50.16] per 1 mg/dL increase) concentrations, and initial intravenous fluid administration ≥4 days following diarrhea onset (2.71 [1.18–6.21]). Conclusions The complex nature of STEC infection renders predicting its course a challenge. Risk factors we identified highlight the importance of avoiding dehydration and performing close clinical and laboratory monitoring. [ABSTRACT FROM AUTHOR]

Objectives Children with acute bloody diarrhea are at risk of being infected with Shiga toxin–producing Escherichia coli (STEC) and of progression to hemolytic uremic syndrome. Our objective was to identify clinical and laboratory factors associated with STEC infection in children who present with acute bloody diarrhea. Methods We performed a prospective cohort study of consecutive children younger than 18 years who presented with acute (<2-week duration) bloody diarrhea between August 1, 2013, and August 1, 2014. We excluded patients with a chronic gastrointestinal illness and/or an obvious noninfectious source of bloody stool. We obtained a standardized history and study laboratory tests, performed physical examinations, and recorded patient outcomes. Results Of the 135 eligible patients, 108 were enrolled; 27 declined consent. The median patient age was 3 years, and 56% were male. Ten (9%) patients tested positive for STEC (E coli O157:H7, n = 8; E coli O111, n = 1; E coli O103, n = 1), and 62 had negative stool culture results. Children infected with STEC were older (8.5 vs 3 years, respectively) (P <.001) and more likely to have abdominal tenderness (83% vs 17%, respectively) than those in the other groups. D-Dimer concentrations had a 70% sensitivity and 55% specificity for differentiating children with STEC from those with another cause of bloody diarrhea and 75% sensitivity and 70% specificity in differentiating children with a bacterial etiology from those with negative stool culture results. Conclusion Clinical assessment and laboratory data cannot reliably exclude the possibility that children with bloody diarrhea have an STEC infection and are at consequent risk of developing hemolytic uremic syndrome. Abnormal D-dimer concentrations (>0.5 μg/mL) were insufficiently sensitive and specific for distinguishing patients with STEC from those with another bacterial cause of bloody diarrhea. However, this marker might be useful in identifying children whose bloody diarrhea is caused by a bacterial enteric pathogen. [ABSTRACT FROM AUTHOR]