Flowchart 1: Management of acute bloody diarrhoea or clinically suspected STEC infection in children age <16 years

Age <16 years

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

Assess in Paediatrics

Blood tests (FBC +film, U+E, LFTs, LDH, CRP), urinalysis

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

IV rehydration/maintenance with 0.9% sodium chloride.

Consider surgical causes

Home

Await STEC results

Evidence HUS

No evidence of HUS

STEC +ve

IV 0.9% sodium chloride unless oliguria

Discuss with paediatric nephrology

IV 0.9% sodium chloride pending STEC results

Paediatric reassessment. Consider IV 0.9% sodium chloride

Deteriorating renal function

No oliguria

Refer to Paediatric Nephrology
Confirm STEC results

Continue IV fluids and discuss with local paediatric 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

Laboratory features associated with HUS or increased risk HUS (Table 1)