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<p>Hemolytic uremic syndrome associated with Shiga toxin-producing <i>Escherichia coli</i> (STEC-HUS) infection is a major individual and public health challenge, and the leading cause of acute kidney injury in children. In Western countries, HUS complicates about 15% of STEC infections, which are responsible for acute bloody diarrhea (ABD) in at least 6–7% of cases in children (rising to over 15% during late summer). The widespread use of molecular microbiology techniques enables the diagnosis of STEC infection before HUS onset in an increasing number of patients, creating a potential window of preventive and therapeutic opportunities. Given the rapid progression of the disease, all children with ABD should be tested for Shiga toxin (Stx) encoding genes as early as possible. Stx-positive patients should then be closely monitored for HUS development by urine dipstick, to detect hemoglobinuria.</p><p>This proactive diagnostic approach creates the opportunity to anticipate the application of measures that have already been proven to mitigate the severity of HUS, among which stands the early and generous fluid administration, but most importantly opens a window to explore preventive and therapeutic interventions. In detail, even though antibiotics are not historically recommended in STEC infections, recent data suggest a promising potential preventive role for bacteriostatic agents (e.g., azithromycin) during the initial stages of the infection.</p><p>The aim of the present contribution is to share this approach to ABD and STEC infection as endorsed by the Italian scientific societies actively engaged in this area (AMCLI, SIGENP, SIMEUP, SIN, SIP, SIPPS, SITIP) through an intersocietal consensus. The goal is to promote the early diagnosis of STEC infection nationwide, thereby improving our understanding of the mechanisms of disease spreading, and hopefully reduce the rate of progression to HUS, its case fatality rate and possibly improve both short- and long-term outcomes.</p>

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Inter-society consensus on the management of acute bloody diarrhea and shiga toxin-producing Escherichia Coli infection in the molecular microbiology era

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月27日

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  • Gianluigi Ardissino,
  • Rino Agostiniani,
  • Simone Vasilij Benatti,
  • Silvia Bonardi,
  • Milena Brasca,
  • Maurizio Brigotti,
  • Annapaola Callegaro,
  • Francesca Centrone,
  • Maria Chironna,
  • Pierangelo Clerici,
  • Laura Daprai,
  • Letizia Dato,
  • Giulia Debertolis,
  • Lucia Decastelli,
  • Lidia Decembrino,
  • Luca De Nicola,
  • Giuseppe Di Mauro,
  • Federica Folli,
  • Liliana Gabrielli,
  • Alessandra Gazzola,
  • Edoardo La Porta,
  • Marina Nadia Losio,
  • Andrea Lo Vecchio,
  • Mario Luini,
  • Chiara Francesca Magistrali,
  • Maria Cristina Mancuso,
  • Carmelita Marcantoni,
  • Stefano Morabito,
  • Giangiacomo Nicolini,
  • Lorenzo Norsa,
  • Andrea Pasini,
  • Claudia Picozzi,
  • Nicola Principi,
  • Claudio Romano,
  • Maria Lorena Ruzza,
  • Stefania Zampogna

摘要

Hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC-HUS) infection is a major individual and public health challenge, and the leading cause of acute kidney injury in children. In Western countries, HUS complicates about 15% of STEC infections, which are responsible for acute bloody diarrhea (ABD) in at least 6–7% of cases in children (rising to over 15% during late summer). The widespread use of molecular microbiology techniques enables the diagnosis of STEC infection before HUS onset in an increasing number of patients, creating a potential window of preventive and therapeutic opportunities. Given the rapid progression of the disease, all children with ABD should be tested for Shiga toxin (Stx) encoding genes as early as possible. Stx-positive patients should then be closely monitored for HUS development by urine dipstick, to detect hemoglobinuria.

This proactive diagnostic approach creates the opportunity to anticipate the application of measures that have already been proven to mitigate the severity of HUS, among which stands the early and generous fluid administration, but most importantly opens a window to explore preventive and therapeutic interventions. In detail, even though antibiotics are not historically recommended in STEC infections, recent data suggest a promising potential preventive role for bacteriostatic agents (e.g., azithromycin) during the initial stages of the infection.

The aim of the present contribution is to share this approach to ABD and STEC infection as endorsed by the Italian scientific societies actively engaged in this area (AMCLI, SIGENP, SIMEUP, SIN, SIP, SIPPS, SITIP) through an intersocietal consensus. The goal is to promote the early diagnosis of STEC infection nationwide, thereby improving our understanding of the mechanisms of disease spreading, and hopefully reduce the rate of progression to HUS, its case fatality rate and possibly improve both short- and long-term outcomes.