Thomas Diana E, Elliott Elizabeth J
Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, Australia.
BMC Public Health. 2013 Sep 3;13:799. doi: 10.1186/1471-2458-13-799.
Hemolytic Uremic Syndrome (HUS) may follow infection with Shiga-toxin-producing organisms, principally E. coli O157: H7 (STEC), causing high morbidity and mortality. Our aim was to identify interventions to prevent diarrhea-associated HUS.
Systematic search of the literature for relevant systematic reviews (SRs), randomised controlled trials (RCTs) and public health guidelines.
Of 1097 animal and 762 human studies, 18 animal studies (2 SRs, 2 reviews, plus 14 RCTs) and 6 human studies (3 SRs, plus 3 RCTs) met inclusion criteria. E. coli O157: H7 Type III secreted protein vaccination decreased fecal E. coli O157 shedding in cattle (P = 0.002). E. coli O157: H7 siderophore receptor and porin proteins (SRP) vaccines reduced fecal shedding in cows (OR 0.42 (95% CI 0.25 to 0.73) and increased anti-E. coli 0157: H7 SRP antibodies in their calves (P < 0.001). Bacterin vaccines had no effect. Probiotic or sodium chlorate additives in feeds reduced fecal E. coli O157 load as did improved farm hygiene (P < 0.05). Solarization of soil reduced E. coli O157: H7 contamination in the soil (P < 0.05). In an RCT examining the role of antibiotic treatment of E. coli O157: H7 diarrhea, HUS rates were similar in children treated with Trimethoprim-sulfamethoxazole and controls (RR 0.57; 95% CI 0.11 to 2.81). In another RCT, HUS rates were similar in children receiving Synsorb-Pk and placebo (RR 0.93; 95% CI 0.39 to 2.22). In one SR, hand washing reduced diarrhea by 39% in institutions (IRR 0.61; 95% CI 0.40 to 0.92) and 32% in community settings (IRR 0.68; 95% CI 0.52 to 0.90) compared to controls. Guidelines contained recommendations to prevent STEC transmission from animals and environments to humans, including appropriate food preparation, personal hygiene, community education, and control of environmental contamination, food and water quality.
Animal carriage of STEC is decreased by vaccination and improved farm practices. Treatment of STEC diarrhea with antibiotics and toxin-binders did not prevent HUS. Public health interventions are the key to preventing STEC-associated diarrhea and HUS.
溶血尿毒综合征（HUS）可能继发于产志贺毒素生物体的感染，主要是大肠杆菌O157：H7（STEC），可导致高发病率和死亡率。我们的目的是确定预防腹泻相关性HUS的干预措施。
系统检索文献以查找相关的系统评价（SRs）、随机对照试验（RCTs）和公共卫生指南。
在1097项动物研究和762项人体研究中，18项动物研究（2项SRs、2篇综述以及14项RCTs）和6项人体研究（3项SRs以及3项RCTs）符合纳入标准。大肠杆菌O157：H7Ⅲ型分泌蛋白疫苗接种可减少牛粪便中大肠杆菌O157的排出（P = 0.002）。大肠杆菌O157：H7铁载体受体和孔蛋白疫苗（SRP）可减少奶牛粪便排出（比值比0.42（95%可信区间0.25至0.73）），并增加其犊牛抗大肠杆菌O157：H7 SRP抗体（P < 0.001）。菌苗疫苗无效。饲料中添加益生菌或氯酸钠以及改善农场卫生状况均可降低粪便中大肠杆菌O157的负荷（P < 0.05）。土壤日晒可减少土壤中大肠杆菌O157：H7的污染（P < 0.05）。在一项关于大肠杆菌O157：H7腹泻抗生素治疗作用的RCT中，接受甲氧苄啶 - 磺胺甲恶唑治疗的儿童与对照组的HUS发生率相似（相对危险度0.57；95%可信区间0.11至2.81）。在另一项RCT中，接受Synsorb - Pk和安慰剂的儿童HUS发生率相似（相对危险度0.93；95%可信区间0.39至2.22）。在一项SR中，与对照组相比，洗手可使机构内腹泻减少39%（发病率比值比0.61；95%可信区间0.40至0.92），社区环境中腹泻减少32%（发病率比值比0.68；95%可信区间0.52至0.90）。指南包含预防STEC从动物和环境传播给人类的建议，包括适当的食品制备、个人卫生、社区教育以及环境污染、食品和水质控制。
通过疫苗接种和改善农场做法可减少STEC在动物中的携带。用抗生素和毒素结合剂治疗STEC腹泻并不能预防HUS。公共卫生干预措施是预防STEC相关性腹泻和HUS的关键。
