Haemolytic uraemic syndrome, E. coli O157 infection, and antimicrobial therapy – clinical management in the face of scientific uncertainty

The use of antimicrobial agents in the management of patients with E. coli O157 infection is controversial. Verocytotoxigenic Escherichia coli (VTEC), including E. coli O157:H7, is an important cause of gastrointestinal illness. Infection typically presents as a diarrhoeal illness, often with bloody stools. In approximately 8% of patients with E. coli O157:H7, infection progresses to hemolytic-uraemic syndrome (HUS), a life threatening condition characterised by microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. HUS is also associated with VTEC belonging to other E. coli serogroups, although less common than in E. coli O157.