STEC infection is a gastrointestinal illness caused by Escherichia coli that releases Shiga toxins, and it is the typical precipitating infection for hemolytic uremic syndrome [1][3]. The infection is confirmed by biological screening for Shiga toxins and STEC in stool specimens [1].
Disease overview
Bacterial Evidence-backed information EN 5/7 applicable sections · ZH 5/7 applicable sections Updated Oct 23, 2026
Shiga toxin-producing Escherichia coli (STEC) infection is a leading cause of hemolytic uremic syndrome in children and carries substantial outbreak potential [1]. Since the early 2010s, its epidemiology has shifted from predominant O157 to emerging non-O157 serogroups such as O26 and O80 in France [1]. Antibiotics are not recommended in STEC-infected individuals based on meta-analytic evidence [2].
Read the full clinical and epidemiological profile 6
The principal manifestation is diarrhea, which is bloody in roughly 60% of cases and begins after a median incubation of three days [1]. Released Shiga toxins trigger thrombogenic and inflammatory injury to microvascular endothelial cells [1]. Hemolytic uremic syndrome develops in 5–15% of infections and is marked by mechanical hemolytic anemia, thrombocytopenia, and acute renal injury [1].
STEC infection exhibits major outbreak potential and is the foremost cause of HUS in children [1]. From the early 2010s onward, a decline of the historically dominant O157 serogroup and rise of non-O157 types, particularly O26 and O80, have been observed in France [1].
Human infection occurs through ingestion of contaminated food or water, person-to-person spread, or contact with ruminants and their contaminated environments [1].
Use of antibiotics in STEC-infected persons is not recommended, as pooled low-bias evidence linked treatment to a significantly increased odds of HUS development [2]. Preclinical investigation in mice indicates that cashew gum-derived fractions can reduce STEC colonization and protect intestinal mucosa, though human preventive application remains unestablished [4].
- 1 Bruyand M et al. Hemolytic uremic syndrome due to Shiga toxin-producing Escherichia coli infection. Med Mal Infect. 2018 May. PMID: 29054297. doi: 10.1016/j.medmal.2017.09.012. PubMed: https://pubmed.ncbi.nlm.nih.gov/29054297/
- 2 Freedman SB et al. Shiga Toxin-Producing Escherichia coli Infection, Antibiotics, and Risk of Developing Hemolytic Uremic Syndrome: A Meta-analysis. Clin Infect Dis. 2016 May 15. PMID: 26917812. doi: 10.1093/cid/ciw099. PubMed: https://pubmed.ncbi.nlm.nih.gov/26917812/
- 3 Jokiranta TS et al. HUS and atypical HUS. Blood. 2017 May 25. PMID: 28416508. doi: 10.1182/blood-2016-11-709865. PubMed: https://pubmed.ncbi.nlm.nih.gov/28416508/
- 4 Chaves LS et al. Cashew gum fractions protect intestinal mucosa against shiga toxin-producing Escherichia coli infection: Characterization and insights into microbiota modulation. Int J Biol Macromol. 2025 Jun. PMID: 40324507. doi: 10.1016/j.ijbiomac.2025.143916. PubMed: https://pubmed.ncbi.nlm.nih.gov/40324507/
- A04.3
- 1A03
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