Bloody diarrhoea and clinically suspected or confirmed Shiga toxin-producing Eschericia coli (STEC) infections
Prompt recognition and management of STEC infection
- Acute bloody diarrhoea, even a single episode, should prompt urgent clinical assessment, especially in children under 16.
- STEC infection should always be suspected in a child or adult with acute bloody diarrhoea even if only one episode contains blood.
- STEC infection should be considered in children or adults presenting with non-bloody diarrhoea and epidemiological risk factors for STEC infection.
- Although most STEC infections are sporadic, STEC infection should be considered even in the absence of known epidemiological risk factors.
Public Health notification
- Clinicians should promptly notify the local public health team about clinically suspected STEC cases.
Urgent clinical assessment in primary or acute care
All patients with clinically suspected STEC should undergo:
- Stool culture: a stool sample should be sent urgently, indicating bloody diarrhoea or suspected STEC infection on the request form.
- Laboratory tests: blood tests and urinalysis should be carried out.
- Infection-control measures: discuss with the patient and their carers and implement infection-control measures to prevent transmission.
Hospitalisation is indicated for patients with:
- illness or dehydration
- risk of dehydration because of frequent loose stools or vomiting
- laboratory findings suggestive of HUS.
Treatment in hospital
- Fluid therapy: early intravenous fluid therapy is recommended.
- HUS management: patients with HUS should be discussed with nephrology.
- Repeat blood tests: the frequency should be determined by clinical progress and baseline investigation results.
- Medications: antidiarrhoeal drugs and antibiotics are not recommended.
- Pain management: simple analgesics are preferred. non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided. Opiates should be used cautiously when other pain control has failed.
- Plasma exchange and eculizumab: Currently not recommended for STEC-associated HUS.
Monitoring
Patients with confirmed STEC infection should be monitored for 14 days after the onset of diarrhoea to detect potential development of HUS.