Approach to management of children with known or suspected STEC infection, by day of illness

CBC: complete blood count; HUS: hemolytic uremic syndrome; IV: intravenous fluids; NSAIDs: nonsteroidal anti-inflammatory drugs; STEC: Shiga toxin-producing Escherichia coli.

* STEC should be suspected in the following circumstances:

• Acute bloody diarrhea and abdominal pain, usually in the absence of fever.
• Acute diarrhea (bloody or nonbloody) and contact with a patient with known STEC infection.
• Signs of hemolytic uremic syndrome^◊, even in the absence of diarrhea.

¶ Refer to text for discussion of criteria for inpatient care.

Δ Once circulating volume has been restored, options for preserving intravascular volume include conservative fluid management or hyperhydration (anticipatory volume expansion); refer to text for further discussion.

◊ HUS is characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (defined as a reduction in glomerular filtration rate typically presenting as an abnormally elevated serum creatinine).

§ These parameters are evaluated together. An isolated decline in hematocrit due to hemodilution is difficult to differentiate from early hemolysis due to HUS. For patients with initial dehydration, weight gain could overestimate volume restoration.

¥ The first day of diarrhea is considered the first day of illness.

‡ If, by day 9 or 10 of illness, the clinical condition has improved and the platelet count has been stable over several days, the treatment protocol may reasonably be discontinued.

† Refer to text for discussion of approach to fluid management.

** A negative stool culture is often requested prior to return to daycare, school, or other settings (eg, occupation with food preparation). We typically obtain a stool culture prior to discharge from the hospital, as this is more convenient than submitting an outpatient specimen.

¶¶ In the rare event that there is a post-discharge decrease in the platelet count, we typically readmit the patient for an additional day or two of IV fluids.