Multiple outcomes of patients with acute bloody diarrhea and suspected STEC infection

This figure portrays the impact of microbiologic testing on clinical risk assessment. Most commonly, patients with high-risk STEC infection present with bloody diarrhea (left panel). If STEC is detected but the toxin genotype is not specified (right panel, dashed yellow circle), the likelihood of Shiga toxin 2-producing E. coli is increased if the diarrhea is bloody. In regions where E. coli O157:H7 is the most common high-risk STEC, the likelihood of a high-risk STEC infection is increased (whether or not the diarrhea is bloody).

HUS: hemolytic uremic syndrome; STEC: Shiga toxin-producing Escherichia coli.

* In this situation, STEC infection is very unlikely. If diarrhea persists but within a few hours is no longer bloody, STEC infection is also very unlikely. We consider discharge if the patient's condition permits.

¶ High-risk STEC refers to E. coli that contain a gene encoding Shiga toxin 2. All E. coli O157:H7 should be assumed to contain a gene encoding Shiga toxin 2.

Δ The risk of severe disease and HUS is uncertain when Shiga toxin is detected but the genotype is not yet reported. Refer to the UpToDate topic for further details.

◊ If an STEC does not contain a gene encoding Shiga toxin 2, it is not a high-risk STEC. E. coli that contain a gene encoding Shiga toxin 1 but not Shiga toxin 2 rarely, if ever, cause HUS.

§ If an STEC is excluded, the possibility of infection caused by an STEC should no longer influence management of the patients.

Graphic 121336 Version 5.0

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Multiple outcomes of patients with acute bloody diarrhea and suspected STEC infection