Study of Repetitive Intestinal Lavage in Patients With EHEC Associated Hemorrhagic Colitis
Study of Repetitive Intestinal Lavage in Patients With EHEC Associated Hemorrhagic Colitis
The investigators examined the outcome of patients with severe Enterohaemorrhagic E. Coli
 (EHEC) O104:H4 infection suffering from bloody diarrhoea that were at risk to develop
 hemolytic uremic syndrome and underwent repetitive whole bowl lavage during hospitalization.
During the 2011 German EHEC O104:H4 outbreak, centered in the area of Hamburg, 33 patients
 with EHEC associated hemorrhagic colitis were admitted to the first Department of Medicine of
 the Hamburg University medical centre.

 The first 12 patients were treated symptomatically and received intravenous rehydration up to
 three liters daily.

 Prompted by a good clinical response after whole bowel irrigation with polyethylene
 glycol-solution (PEG)in patient 13 all subsequent admitted patients (n=21) were treated with
 PEG-solution ( 2 liters on admission followed by one liter per day during the clinical
 course).

 During the hospital course blood work was obtained every day and patients were examined for
 clinical symptoms.

 Thrombocytopenia below 100.000/microliter was defined as a threshold for initiating
 therapeutic plasmapheresis to prevent the onset of hemolytic syndrome on an early stage.
Inclusion Criteria:

 -  Proven EHEC O104:H4-infection

 Presence of bloody diarrhoea + at least one of the following serological criteria:

 -  platelet count below 150x10³/ μl but greater than 100x10³/ μl, serum creatine above
 normal level for age (> 1.1 -1.3 mg/dl), Lactate dehydrogenase (LDH) > 300 IU/l,
 leukocytosis ( > 12x10³/ μl ) and elevated CRP (> 5mg/l), hemoglobin < 13.8 g/dL for
 male patients or < 12.1 g/dL for female patients, respectively or decrease in
 haptoglobin

 Exclusion Criteria:

 -  Bloody diarrhoea due to others reasons than EHEC O104:H4 infection

 -  Thrombocytopenia < 100x10³/ μl.

 -  HUS, defined as platelet count below 100x10³/ μl, anaemia or decrease in haptoglobin
 and serum creatine above normal level for age