Article Text
Abstract
Objectives Haemolytic uraemic syndrome (HUS) following Shiga toxin-producing Escherichia coli (STEC) infection is the the most common cause of acute renal failure among children in the UK. This study explored differential progression from STEC to HUS by social, demographic and clinical risk factors.
Methods We undertook a retrospective cohort study linking two datasets. We extracted data on paediatric STEC and HUS cases identified in the Public Health England National Enhanced Surveillance System for STEC and British Paediatric Surveillance Unit HUS surveillance from 1 October 2011 to 31 October 2014. Using logistic regression, we estimated the odds of HUS progression by risk factors.
Results 1059 paediatric STEC cases were included in the study, of which 207 (19.55%, 95% CI 17% to 22%) developed HUS. In the fully adjusted model, the odds of progression to HUS were highest in those aged 1–4 years (OR 4.93, 95% CI 2.30 to 10.56, compared with 10–15 years), were infected with an Shiga toxin (stx) 2-only strain (OR 5.92, 95% CI 2.49 to 14.10), were prescribed antibiotics (OR 8.46, 95% CI 4.71 to 15.18) and had bloody diarrhoea (OR 3.56, 95% CI 2.04 to 6.24) or vomiting (OR 4.47, 95% CI 2.62 to 7.63), but there was no association with progression to HUS by socioeconomic circumstances or rurality.
Conclusion Combining data from an active clinical surveillance system for HUS with the national enhanced STEC surveillance system suggests that 20% of diagnosed paediatric STEC infections in England resulted in HUS. No relationship was found with socioeconomic status or rurality of cases, but differences were demonstrated by age, stx type and presenting symptoms.
- epidemiology
- infectious diseases
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Footnotes
Contributors All authors contributed to the conception and design of the study. LB, CJ and BA collated and curated the dataset and provided guidance on the interpretation of data. NA performed the analyses with guidance from AC, LB, BB, JH and DT-R. NA, JH, DTR, MV, SOB and MW drafted the manuscript, which was critically revised by all authors. All authors approved the final version of the manuscript. NA submitted the manuscript. JH and DTR are joint senior authors.
Funding The research was funded by the National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections at the University of Liverpool in partnership with Public Health England, in collaboration with University of East Anglia, University of Oxford and the Quadram Institute. NA is based at the University of Liverpool and Public Health England.
Disclaimer The views expressed are those of the author(s) and not necessarily those of the National Health Service, the National Institute for Health Research, the Department of Health and Social Care or Public Health England.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical approval was originally obtained for the main study (ref: 11/LO/1412). As of October 2010, haemolytic uraemic syndrome is a statutory reportable condition, and this study falls under the existing Health Protection Agency (now Public Health England) permissions under Section 251 of the NHS Act 2006. In addition, we received a favourable ethical opinion from the South East Coast—Surrey Research Ethics Committee (15/LO/2138) on 1 December 2015 covering the use of this dataset for this study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.