Dato Letizia, Mancuso Maria Cristina, Daprai Laura, Ria Thomas, Rossetti Daniele, Callegaro Annapaola, Ardissino Gianluigi
Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy.
Center for HUS Prevention, Control and Management, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
Pediatr Nephrol. 2025 Aug 23. doi: 10.1007/s00467-025-06930-y.
Hemolytic uremic syndrome (HUS) associated with Shiga toxin-producing Escherichia coli (STEC) infection remains a major individual and public health challenge throughout the world causing substantial personal, social, and economic burdens. In Western countries, bloody diarrhea (BD) in children is related to STEC infection in at least 6% of cases (rising to 15-20% in summer). This infection may turn into STEC-HUS in about 15% of patients. The widespread use of molecular microbiology leads to the diagnosis of STEC infection before the onset of HUS in an increasing number of patients. The anticipation of the diagnosis creates a window of preventive and/or therapeutic opportunities that include rehydration of dehydrated patients and/or volume expansion that have both proven to mitigate the severity of HUS. Traditionally, antibiotics are not recommended in STEC infections, but recent data suggest a promising potential preventive role for bacteriostatic agents (e.g., azithromycin), if they are given early in the course of the infection. It is recommended to test all children with BD for Shiga toxin (Stx) encoding genes, actively infuse Stx-positive patients with isotonic crystalloid solutions and carefully monitor them with urine dipstick for hemoglobinuria to early identify those who might eventually develop HUS. The suggested approach will increase the detection of STEC-infected patients thus enhancing our knowledge of the mechanisms of disease spreading. The early diagnosis of STEC infection combined with the mentioned therapeutic opportunities will hopefully decrease the number of children suffering from HUS, its case fatality rate and/or improve its short- and long-term outcomes.
与产志贺毒素大肠杆菌（STEC）感染相关的溶血性尿毒症综合征（HUS）仍然是全球主要的个人和公共卫生挑战，造成了巨大的个人、社会和经济负担。在西方国家，儿童血性腹泻（BD）至少6%的病例与STEC感染有关（夏季升至15%-20%）。这种感染在约15%的患者中可能会发展为STEC-HUS。分子微生物学的广泛应用使得越来越多的患者在HUS发病前就被诊断出STEC感染。诊断的提前为预防和/或治疗创造了机会窗口，包括对脱水患者进行补液和/或扩容，这两者都已被证明可减轻HUS的严重程度。传统上，STEC感染不推荐使用抗生素，但最近的数据表明，如果在感染过程早期给予抑菌剂（如阿奇霉素），可能具有潜在的预防作用。建议对所有患有BD的儿童进行志贺毒素（Stx）编码基因检测，对Stx阳性患者积极输注等渗晶体溶液，并使用尿试纸仔细监测血红蛋白尿，以便早期识别那些最终可能发展为HUS的患者。所建议的方法将增加STEC感染患者的检测率，从而增强我们对疾病传播机制的了解。STEC感染的早期诊断与上述治疗机会相结合，有望减少患HUS的儿童数量、降低其病死率和/或改善其短期和长期预后。
