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

Summary of Recommendations:

• 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.