1290. Risks of Long-Term Health Outcomes of Shiga-Toxin Producing Escherichia coli Infection: An Epidemiologic Review
Session: Poster Abstract Session: Below the Diaphragm
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Shiga-toxin producing Escherichia coli(STEC) infections have been estimated to cost between $136 million and $2.4 billion per year in the United States.  However, these estimates are based on incompletely understood risks of long-term health outcomes (LTHO) after STEC infection.  Evidence-based quantification of these risks is critical for improved economic cost models, public health priority setting and policy-making. The objective of this review was to 1) identify existing peer-reviewed literature on the severity and incidence of LTHO at least six months after acute STEC infection or post-diarrheal hemolytic uremic syndrome (HUS); 2) qualitatively evaluate the strength of the evidence, and 3) identify potential data gaps.

Methods: An extensive search of the online PubMed electronic database was conducted to identify abstracts and full articles reporting primary research on LTHO from human case-control and cohort studies.  The entire literature from six major authors was also reviewed.  Following a two-stage relevance screening, a full article review was conducted by a single reviewer to qualitatively assess relevance and quality and extract data to be summarized.

Results: Of 2,270 identified articles, 80 studies were included in the review.  The majority of studies were retrospective reviews of patient records from a single center with no comparison group or systematic follow-up.  Twenty-three (29%) were from one of two cohorts: the Walkerton Health Study and the Utah HUS Registry.  Renal function and hypertension were the most studied outcomes.  Other LTHO identified included neurological dysfunction, gastrointestinal disorders, diabetes/pancreatic injury and reactive arthritis.

Conclusion: Few systematic, prospective, population-based studies with control groups exist to inform our understanding of the risks of LTHOs after STEC infection.  Much of the evidence comes from studies that were not designed to estimate risk.  Population-based studies and meta analyses are needed to better understand the incidence and risk of LTHO following STEC infection.

Evan Henke, Ph D, University Of Minnesota, Minneapolis, MN, Johnathon Aho, MD, Surgery, Mayo Clinic, Rochester, MN, Barbara Kowalcyk, Ph. D, North Carolina State University College of Agriculture and Life Sciences, Raleigh, NC, Richard Siegler, MD, University of Utah, Salt Lake City, UT and Robert Darling, MD, Otolaryngology, University of Texas Medical Branch At At Galveston, Galveston, TX


E. Henke, None

J. Aho, None

B. Kowalcyk, None

R. Siegler, None

R. Darling, None

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