Bloody Diarrhoea and Clinically Suspected or Confirmed Shiga toxin-producing Escherichia coli (STEC) Infections
Bloody Diarrhoea and Clinically Suspected or Confirmed Shiga toxin-producing Escherichia coli (STEC) Infections: Clinical Guidance on the Assessment and Management of Children and Adults in Primary and Secondary Care
Acute bloody diarrhoea requires urgent clinical assessment especially in a child under 16 years of age.
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 also be considered in a child or adult with non-bloody diarrhoea and epidemiological risk factors for STEC infection.
Most STEC infections are sporadic and STEC infection should still be considered even in the absence of known epidemiological risk factors.
Clinically suspected cases of STEC infection should be discussed urgently with the local public health team who will advise on the appropriate public health management.
All patients with clinically suspected STEC infection should urgently:
Be assessed in primary or acute care
Have a stool sample submitted for culture indicating bloody diarrhoea on the request form
Have recommended bloods and urinalysis performed
Be notified to the local public health team
Be considered infectious and have infection control measures discussed and implemented with the individual and their carers
Patients with clinically suspected or confirmed STEC infection should be admitted to hospital if they:
are unwell or dehydrated
are at risk of dehydration due to frequent loose stools and/or persistent vomiting
have laboratory features associated with HUS
Patients admitted to hospital should be treated with early intravenous fluids, rather than oral rehydration.
Patients with evidence of HUS should be discussed with the relevant nephrology department.
The frequency of repeat blood tests should be determined by clinical progress and the results of the baseline investigations.
Anti-diarrhoeal drugs are not recommended in symptomatic treatment of STEC infection.
Pain should be managed with simple analgesia where possible. NSAIDs should be avoided and opiate analgesia should be restricted to circumstances where other pain control measures have failed.
Antibiotics are not recommended in the treatment of clinically suspected or confirmed STEC infection.
Plasma exchange is not recommended in the treatment of STEC associated HUS.
Eculizimab cannot currently be recommended for rescue therapy of STEC associated HUS as evidence is lacking for benefit in severe disease.
Where STEC infection is confirmed, patients require monitoring for potential development of HUS for 14 days following the onset of diarrhoea.