Ated for 10 minutes at 95uC and centrifuged for 5 minutes at maximum speed (.120006g) in a microliter centrifuge. 5 mL of the supernatant were pipetted into the PCR master mix. The PCR and subsequent DNA-hybridisations were performed in accordance with the manufacturer’s instructions (GenoType EHEC, Hain Lifescience GmbH, Autophagy Nehren, Germany). The test system detects the toxin genes Shiga-toxin 1 and 2 (EHEC) and the Intimin-gene (enteropathogenic E. coli). In addition, all stool samples were tested for other enteropathogenic 
bacteria and viruses, such as other pathogenic E. coli, Clostridium, Salmonella, Shigella, Campylobacter jejuni, and Noro2/ Adeno-virus. Patients suffering from bloody diarrhoea and HUS who had three negative stool cultures for EHEC and Shiga-toxin were considered as false negative stool cultures.Fluid Management and Analgesic TherapyAll patients received an extensive intravenous substitution of fluids, up to five litres a day, depending on renal and cardiac function [22]. Metamizol, Paracetamol or Piritramid were used for analgesia; opiod-analgesics were not used to avoid inhibition of peristalsis. The majority of patients received peroral gut lavage with 1 l/d PEG-based solutions, to accelerate elimination of Shigatoxin from the bowel.Materials and Methods PatientsOn the 14th of May 2011 two patients with bloody diarrhoea were admitted to our hospital. These two patients were among the first cases of the recent EHEC outbreak reported to the RKI. During the following 41 days, a total of 61 patients with bloody and/or painful diarrhoea due 
to EHEC colitis were hospitalized at our institution. On May 19th the RKI released the first information on an EHEC infection outbreak in Germany. From this date onward, we prospectively documented standardized parameters of symptoms, clinical course, and complications of all our hospitalized patients until their discharge. Inclusion criteria were diarrhoea ( 3 stools/ 24 h) at time of admission, positive stool testing for EHEC and/or ` signs of HUS. Data on the patients history, previous medication, general and abdominal symptoms, physical findings, frequency and quality of stools, blood chemistry, ultrasonic, and radiologic findings were collected at admission, discharge, and at defined time points (onset of HUS, initiation of antibiotic treatment and plasma-separation). From 14th of May until July the 26th laboratory data of all in-patients were recorded at least every second day, in case of HUS daily. All patients gave their written consent in this study; the study protocol was approved by the ethical committee of the Chamber of Physicians Hannover (No.: 1123?011).Antibiotic TreatmentAutophagy Recommendations for the use of antibiotics in EHEC infection changed during the course of the outbreak. Initially, a potential negative influence on the course of the disease was presumed based upon uncontrolled data [16?8,23?6]. During the ongoing outbreak the German Society of Infectiology [27] pleaded for a more liberal use of antibiotics. Recommendations were altered and patients were additionally treated with daily oral administration of Rifaximin, as earlier reports demonstrated that this agent does not increase Shiga-toxin 1/2 production in vitro [24]. Patients were either treated at time of admission or for persisting EHEC colonization. In case of bacteria- associated complications, additional antibiotic treatment was initiated according to the clinical findings and the bacteriologic results.Ated for 10 minutes at 95uC and centrifuged for 5 minutes at maximum speed (.120006g) in a microliter centrifuge. 5 mL of the supernatant were pipetted into the PCR master mix. The PCR and subsequent DNA-hybridisations were performed in accordance with the manufacturer’s instructions (GenoType EHEC, Hain Lifescience GmbH, Nehren, Germany). The test system detects the toxin genes Shiga-toxin 1 and 2 (EHEC) and the Intimin-gene (enteropathogenic E. coli). In addition, all stool samples were tested for other enteropathogenic bacteria and viruses, such as other pathogenic E. coli, Clostridium, Salmonella, Shigella, Campylobacter jejuni, and Noro2/ Adeno-virus. Patients suffering from bloody diarrhoea and HUS who had three negative stool cultures for EHEC and Shiga-toxin were considered as false negative stool cultures.Fluid Management and Analgesic TherapyAll patients received an extensive intravenous substitution of fluids, up to five litres a day, depending on renal and cardiac function [22]. Metamizol, Paracetamol or Piritramid were used for analgesia; opiod-analgesics were not used to avoid inhibition of peristalsis. The majority of patients received peroral gut lavage with 1 l/d PEG-based solutions, to accelerate elimination of Shigatoxin from the bowel.Materials and Methods PatientsOn the 14th of May 2011 two patients with bloody diarrhoea were admitted to our hospital. These two patients were among the first cases of the recent EHEC outbreak reported to the RKI. During the following 41 days, a total of 61 patients with bloody and/or painful diarrhoea due to EHEC colitis were hospitalized at our institution. On May 19th the RKI released the first information on an EHEC infection outbreak in Germany. From this date onward, we prospectively documented standardized parameters of symptoms, clinical course, and complications of all our hospitalized patients until their discharge. Inclusion criteria were diarrhoea ( 3 stools/ 24 h) at time of admission, positive stool testing for EHEC and/or ` signs of HUS. Data on the patients history, previous medication, general and abdominal symptoms, physical findings, frequency and quality of stools, blood chemistry, ultrasonic, and radiologic findings were collected at admission, discharge, and at defined time points (onset of HUS, initiation of antibiotic treatment and plasma-separation). From 14th of May until July the 26th laboratory data of all in-patients were recorded at least every second day, in case of HUS daily. All patients gave their written consent in this study; the study protocol was approved by the ethical committee of the Chamber of Physicians Hannover (No.: 1123?011).Antibiotic TreatmentRecommendations for the use of antibiotics in EHEC infection changed during the course of the outbreak. Initially, a potential negative influence on the course of the disease was presumed based upon uncontrolled data [16?8,23?6]. During the ongoing outbreak the German Society of Infectiology [27] pleaded for a more liberal use of antibiotics. Recommendations were altered and patients were additionally treated with daily oral administration of Rifaximin, as earlier reports demonstrated that this agent does not increase Shiga-toxin 1/2 production in vitro [24]. Patients were either treated at time of admission or for persisting EHEC colonization. In case of bacteria- associated complications, additional antibiotic treatment was initiated according to the clinical findings and the bacteriologic results.
