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

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.

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Publication Details

Journal
˜The œItalian Journal of Pediatrics/Italian journal of pediatrics
Published
2026-04-27
DOI
https://doi.org/10.1186/s13052-026-02265-y
Primary Topic
Escherichia coli research studies
Type
article
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article

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

Giulia Debertolis, Maurizio Brigotti, Simone Vasilij Benatti, Andrea Pasini et al.
˜The œItalian Journal of Pediatrics/Italian journal of pediatrics
Escherichia coli research studies
article

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

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

Abstract

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.

˜The œItalian Journal of Pediatrics/Italian journal of pediatrics
University of Messina (IT), University of Parma (IT), AOL (United States) (US), University of Milan (IT), Istituto Superiore di Sanità (IT), Istituto Giannina Gaslini (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), University of Catania (IT), Ospedale di Bolzano (IT), Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari (IT), Ospedale San Carlo (IT), Italian Society of Physiotherapy (IT), Ospedale San Paolo (IT), Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini" (IT), Federico II University Hospital (IT), Istituto delle Scienze Neurologiche di Bologna (IT), University of Campania "Luigi Vanvitelli" (IT), Italian Association for Cancer Research (IT), Institute of Sciences of Food Production (IT), Società Italiana di Reumatologia (IT), Società Italiana di Medicina Generale (IT), Ospedale dei Bambini Vittore Buzzi (IT), Associazione Italiana Arbitri (IT), National Research Council (IT), Azienda Usl Toscana Centro (IT), Istituto Zooprofilattico Sperimentale del Piemonte Liguria e Valle d'Aosta (IT), Deleted Institution, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Bari Aldo Moro (IT), University of Bologna (IT)
Partnerships for the goals
Openalex Percentile: Top 12%
Escherichia coli research studies
DOIOpen Access PDFOpenAlex
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