Tarr Phillip I, Freedman Stephen B
Division of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital & Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Curr Opin Gastroenterol. 2022 Jan 1;38(1):30-38. doi: 10.1097/MOG.0000000000000798.
There has been much debate about treating Shiga toxin-producing Escherichia coli (STEC) infections with antibiotics. No data convincingly demonstrate that antibiotics are better than no antibiotic treatment at all, and many studies suggest antibiotics increase the risk of developing the hemolytic uremic syndrome (HUS). This topic is timely, because emerging technology enables rapid identification of STEC-infected patients, and we anticipate questions about management will increase. This review is designed to familiarize readers with the series of observations that underlie our recommendations.
The long debate over antibiotics in STEC infections appears resolved by gradually accruing information that show that antibiotics do not benefit infected patients. In fact, they are associated with an increased likelihood of developing HUS. A meta-analysis published in 2016 demonstrated that low risk of bias studies find a clear association between antibiotic use and development of HUS. Subsequent publications do not refute these findings.
In high-income countries, antibiotics should not routinely be given to patients with acute diarrhea unless testing demonstrates a pathogen for which antibiotics are indicated, and STEC infection has been excluded. Future work to prevent HUS should focus on preventing primary infections, and mitigating extraintestinal consequences of STEC gut infections.
关于使用抗生素治疗产志贺毒素大肠杆菌（STEC）感染一直存在诸多争议。没有数据能令人信服地证明抗生素治疗优于不进行任何抗生素治疗，而且许多研究表明抗生素会增加溶血尿毒综合征（HUS）的发病风险。这个话题很及时，因为新兴技术能够快速识别STEC感染患者，而且我们预计关于治疗管理的问题将会增多。本综述旨在让读者熟悉构成我们建议基础的一系列观察结果。
关于STEC感染中抗生素使用的长期争论似乎因逐渐积累的信息而得到解决，这些信息表明抗生素对感染患者并无益处。事实上，它们与HUS发病可能性增加有关。2016年发表的一项荟萃分析表明，低偏倚风险研究发现抗生素使用与HUS发生之间存在明确关联。后续发表的文章并未反驳这些发现。
在高收入国家，除非检测显示有需要使用抗生素治疗的病原体且已排除STEC感染，否则不应常规给予急性腹泻患者抗生素治疗。未来预防HUS的工作应侧重于预防原发性感染，以及减轻STEC肠道感染的肠外后果。
