{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:19:53Z","timestamp":1791303593427,"version":"4.1.0"},"reference-count":41,"publisher":"American Society for Microbiology","issue":"6","license":[{"start":{"date-parts":[[2012,6,1]],"date-time":"2012-06-01T00:00:00Z","timestamp":1338508800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2012,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            The role of antibiotics in treatment of enterohemorrhagic\n            <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">Escherichia coli<\/jats:named-content>\n            (EHEC) infections is controversial because of concerns about triggering hemolytic-uremic syndrome (HUS) by increasing Shiga toxin (Stx) production. During the recent large EHEC O104:H4 outbreak, antibiotic therapy was indicated for some patients. We tested a diverse panel of antibiotics to which the outbreak strain is susceptible to interrogate the effects of subinhibitory antibiotic concentrations on induction of\n            <jats:italic>stx<\/jats:italic>\n            <jats:sub>2<\/jats:sub>\n            -harboring bacteriophages,\n            <jats:italic>stx<\/jats:italic>\n            <jats:sub>2<\/jats:sub>\n            transcription, and Stx2 production in this emerging pathogen. Ciprofloxacin significantly increased\n            <jats:italic>stx<\/jats:italic>\n            <jats:sub>2<\/jats:sub>\n            -harboring phage induction and Stx2 production in outbreak isolates (\n            <jats:italic>P<\/jats:italic>\n            values of &lt;0.001 to &lt;0.05), while fosfomycin, gentamicin, and kanamycin insignificantly influenced them (\n            <jats:italic>P<\/jats:italic>\n            &gt; 0.1) and chloramphenicol, meropenem, azithromycin, rifaximin, and tigecycline significantly decreased them (\n            <jats:italic>P<\/jats:italic>\n            \u2264 0.05). Ciprofloxacin and chloramphenicol significantly upregulated and downregulated\n            <jats:italic>stx<\/jats:italic>\n            <jats:sub>2<\/jats:sub>\n            transcription, respectively (\n            <jats:italic>P<\/jats:italic>\n            &lt; 0.01); the other antibiotics had insignificant effects (\n            <jats:italic>P<\/jats:italic>\n            &gt; 0.1). Meropenem, azithromycin, and rifaximin, which were used for necessary therapeutic or prophylactic interventions during the EHEC O104:H4 outbreak, as well as tigecycline, neither induced\n            <jats:italic>stx<\/jats:italic>\n            <jats:sub>2<\/jats:sub>\n            -harboring phages nor increased\n            <jats:italic>stx<\/jats:italic>\n            <jats:sub>2<\/jats:sub>\n            transcription or Stx2 production in the outbreak strain. These antibiotics might represent therapeutic options for patients with EHEC O104:H4 infection if antibiotic treatment is inevitable. We await further analysis of the epidemic to determine if usage of these agents was associated with an altered risk of developing HUS.\n          <\/jats:p>","DOI":"10.1128\/aac.06315-11","type":"journal-article","created":{"date-parts":[[2012,3,6]],"date-time":"2012-03-06T05:49:51Z","timestamp":1331012991000},"page":"3277-3282","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":186,"title":["Effects of Antibiotics on Shiga Toxin 2 Production and Bacteriophage Induction by Epidemic Escherichia coli O104:H4 Strain"],"prefix":"10.1128","volume":"56","author":[{"given":"Martina","family":"Bielaszewska","sequence":"first","affiliation":[{"name":"Institute of Hygiene and the National Consulting Laboratory for Hemolytic Uremic Syndrome, University of M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evgeny A.","family":"Idelevich","sequence":"additional","affiliation":[{"name":"Institute of Medical Microbiology, University of M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenlan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Institute of Hygiene and the National Consulting Laboratory for Hemolytic Uremic Syndrome, University of M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Bauwens","sequence":"additional","affiliation":[{"name":"Institute of Hygiene and the National Consulting Laboratory for Hemolytic Uremic Syndrome, University of M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frieder","family":"Schaumburg","sequence":"additional","affiliation":[{"name":"Institute of Medical Microbiology, University of M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Mellmann","sequence":"additional","affiliation":[{"name":"Institute of Hygiene and the National Consulting Laboratory for Hemolytic Uremic Syndrome, University of M\u00fcnster, M\u00fcnster, Germany"},{"name":"Interdisciplinary Center of Clinical Research (IZKF), University of M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Peters","sequence":"additional","affiliation":[{"name":"Institute of Medical Microbiology, University of M\u00fcnster, M\u00fcnster, Germany"},{"name":"Interdisciplinary Center of Clinical Research (IZKF), University of M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helge","family":"Karch","sequence":"additional","affiliation":[{"name":"Institute of Hygiene and the National Consulting Laboratory for Hemolytic Uremic Syndrome, University of M\u00fcnster, M\u00fcnster, Germany"},{"name":"Interdisciplinary Center of Clinical Research (IZKF), University of M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","first-page":"E12","DOI":"10.1542\/peds.100.1.e12","article-title":"Predictors of hemolytic uremic syndrome in children during a large outbreak of Escherichia coli O157:H7 infections","volume":"100","author":"Bell BP","year":"1997","unstructured":"BellBP. 1997. 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