Flowchart 2: Management of acute bloody diarrhoea or clinically suspected STEC infection in adults
Bloody diarrhoea and clinically suspected or confirmed Shiga toxin-producing Eschericia coli (STEC) infections
Adults
Acute bloody diarrhoea or suspected STEC infection
Stool culture
Send urgently indicating bloody diarrhoea and/or suspicion of E. coli O157/STEC Notify local laboratory of urgent sample being sent
Initial assessment in primary care
Blood tests and urinalysis (Table 2)
Implement and advise on Infection Control Measures
Inform local public health team pending culture result. Provide patient information leaflet.
Unwell, dehydrated or high-risk clinical features
Well or mild symptoms, no high-risk clinical features
Admit to hospital. Discuss with Infection Specialist.
Consider surgical causes
Home
Await STEC results
Evidence HUS
No evidence of HUS
STEC +ve
IV fluids unless oliguria
Discuss with nephrology
IV fluids pending STEC results
Clinical reassessment
Consider IV fluids
Deteriorating renal function
No oliguria
Refer to Nephrology
Confirm STEC results
Continue IV fluids and discuss with local consultant.
Confirm STEC results
Bloods every 1-3 days. Daily urinalysis (monitor for 14 days from onset of diarrhoea)
Epidemiological risks for STEC include:
Patient in contact with:
Ruminant animals or their environment
Untreated water and private water supplies
Known or suspected case
High risk food such as undercooked meat, unpasteurised dairy products or raw veg/ salad
An outbreak of STEC infection is known or suspected.
High risk clinical features associated with HUS or increased risk HUS in STEC
Frequent bloody stools
Severe abdominal pain / cramps
Vomiting
Dehydration
Pallor
Petechiae
Oliguria
Blood and protein on dipstick
Laboratory features associated with HUS or increased risk HUS (Table 2)
low/falling platelets
high urea or creatinine
high LDH
fragmented RBC
anaemia
elevated CRP
elevated WBC