Washington University School of Medicine, St. Louis, Missouri.
J Pediatric Infect Dis Soc. 2018 Aug 17;7(3):e116-e122. doi: 10.1093/jpids/piy025.
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.
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.
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.
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.
患有急性血性腹泻的儿童有感染产志贺毒素大肠杆菌（STEC）并发展为溶血性尿毒症综合征的风险。我们的目的是确定与急性血性腹泻就诊的儿童中 STEC 感染相关的临床和实验室因素。
我们对 2013 年 8 月 1 日至 2014 年 8 月 1 日期间连续出现急性（<2 周）血性腹泻的 18 岁以下连续儿童进行了前瞻性队列研究。我们排除了患有慢性胃肠道疾病和/或明显非传染性血性粪便来源的患者。我们获得了标准化的病史和研究实验室检查结果，进行了体格检查并记录了患者的结局。
在 135 名符合条件的患者中，有 108 名患者入选；27 名患者拒绝同意。中位患者年龄为 3 岁，56%为男性。10 名（9%）患者的 STEC 检测呈阳性（E coli O157：H7，n = 8；E coli O111，n = 1；E coli O103，n = 1），62 名患者的粪便培养结果为阴性。感染 STEC 的儿童年龄较大（分别为 8.5 岁和 3 岁）（P<0.001），且更可能出现腹痛（分别为 83%和 17%）。D-二聚体浓度对区分 STEC 与其他原因引起的血性腹泻患儿的敏感性为 70%，特异性为 55%；对区分细菌性病因与粪便培养阴性患儿的敏感性为 75%，特异性为 70%。
临床评估和实验室数据不能可靠地排除患有血性腹泻的儿童感染 STEC 的可能性，并且存在继发溶血性尿毒症综合征的风险。异常的 D-二聚体浓度（>0.5μg/mL）对于区分 STEC 与其他细菌性血性腹泻病因的患儿敏感性和特异性均不足。但是，该标志物可能有助于识别由细菌性肠道病原体引起血性腹泻的患儿。
