Impact of infection by verotoxigenic Escherichia coli O157:H7 on the use of surgical services in a children's hospital.

OBJECTIVES To determine the impact of Escherichia coli O157:H7 infection in children on the need for surgical assessment in a pediatric surgical practice and whether clinical and bacteriologic variables might contribute to that need. DESIGN Examination of a case series. SETTING A tertiary-care pediatric hospital. PATIENTS Between 1990 and 1994, E. coli O157:H7 gastrointestinal infections were documented among 85 children, 29 of whom suffered from hemolytic-uremic syndrome. INTERVENTION Surgical consultation for presumed or proven complications of the infection. MAIN OUTCOME MEASURES The frequency of and reasons for surgical consultation, clinical and bacteriologic variables between patients who did or did not require surgical assessment. RESULTS Of the 85 children, 17 (20%) were assessed by the surgical service. The majority of these children were inpatients. Two required abdominal surgery. Female gender, older age and progression to hemolytic-uremic syndrome were factors associated in univariate analyses with a likelihood of need for surgical assessment; variation in bacterial genotype was not. CONCLUSION There is the potential for verotoxigenic E. coli O157:H7 infection to have a considerable impact on the utilization of pediatric surgical services.