{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:07:42Z","timestamp":1786122462632,"version":"build-2736575974"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"German Research Foundation","doi-asserted-by":"publisher","award":["493646873"],"award-info":[{"award-number":["493646873"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Shiga toxin\u2013producing Escherichia coli (STEC)\u2013associated hemolytic uremic syndrome (HUS) is a leading cause of pediatric acute kidney injury. Between August and October 2025, Germany experienced an outbreak of the rare STEC serotype O45:H2, comprising 53 laboratory-confirmed pediatric HUS cases. Because O45:H2-associated HUS had previously been reported only sporadically, this study characterized its clinical course and compared it with HUS caused by non-O45:H2 STEC serotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively included all pediatric STEC-HUS cases treated in Northeastern Germany during the outbreak period. Microbiological confirmation was performed through cultivation and molecular typing at the National Reference and Consulting Laboratories. Patients were classified as O45:H2 or non-O45:H2 based on serotyping and the Robert Koch Institute (RKI) O45:H2 outbreak case definition. Clinical and laboratory parameters, dialysis requirements, transfusion needs, and short-term outcomes were compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty-seven children with STEC-associated HUS were included: 18 with O45:H2 and 19 with other serotypes. Patients with O45:H2 were significantly younger (median 2.0 vs 4.0 years, P = .01), while renal impairment at onset was comparable (minimal estimated glomerular filtration rate 8.0 vs 12\u2005mL\/min\/1.73\u2005m2). Dialysis was required in 65% of patients in both groups, with a trend toward longer duration in O45:H2 cases (median 10 vs 6 days). Hematologic parameters, markers of hemolysis, transfusion needs, neurological symptoms, and intensive care treatment were similar. One child died from myocardial failure. At 3-month follow-up, kidney function had recovered well in both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>O45:H2-associated HUS was comparable in severity to non-O45:H2 STEC-HUS, while the younger age of affected children may indicate distinct host susceptibility or exposure patterns.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag433","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:38:23Z","timestamp":1784029103000},"source":"Crossref","is-referenced-by-count":0,"title":["Pediatric Hemolytic Uremic Syndrome in North-Eastern Germany During the STEC O45:H2 Outbreak in 2025: Clinical Features and Short-Term Outcomes"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6000-6791","authenticated-orcid":false,"given":"Lea M","family":"Merz","sequence":"first","affiliation":[{"name":"Department of Pediatric Nephrology, University Hospital Leipzig , Leipzig ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Doerry","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Buerger","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verena","family":"Kl\u00e4mbt","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charit\u00e9 Universit\u00e4tsmedizin Berlin\u2014Campus Virchow Klinikum , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Boeckelmann","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charit\u00e9 Universit\u00e4tsmedizin Berlin\u2014Campus Virchow Klinikum , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katalin","family":"Dittrich","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology, University Hospital Leipzig , Leipzig ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Marczak","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology, University Hospital Leipzig , Leipzig ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Pohl","sequence":"additional","affiliation":[{"name":"KfH Kidney Center for Children and Adolescents, St Georg Hospital , Leipzig ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Heyde","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology, University Hospital Carl Gustav Carus , Dresden ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keike","family":"Paulsen","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4565-6664","authenticated-orcid":false,"given":"Jens","family":"Drube","sequence":"additional","affiliation":[{"name":"Department of Pediatric Kidney, Liver, Metabolic and Neurological Diseases, Hannover Medical School , Hannover ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heimke","family":"von Osten","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital Greifswald , Greifswald ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hagen","family":"Staude","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology, University Children's Hospital Rostock , Rostock ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0649-5185","authenticated-orcid":false,"given":"Alexander","family":"Mellmann","sequence":"additional","affiliation":[{"name":"Institute of Hygiene and National Consulting Laboratory for Hemolytic Uremic Syndrome (HUS), University Hospital M\u00fcnster , M\u00fcnster ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Holle","sequence":"additional","affiliation":[{"name":"University Children's Hospital, University Hospital T\u00fcbingen , T\u00fcbingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8157-6325","authenticated-orcid":false,"given":"Christina","family":"Lang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, National Reference Center (NRC) for Salmonella and Other Enteric Pathogens, Robert Koch Institute , Branch Wernigerode ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelika","family":"Fruth","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, National Reference Center (NRC) for Salmonella and Other Enteric Pathogens, Robert Koch Institute , Branch Wernigerode ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanja","family":"Jung-Sendzik","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, Robert Koch Institute , Berlin 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