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We thank Dr Cimolai for bringing the work contained in his abstract to our attention. We are glad to know that others in the Pacific Northwest are also studying risks related to the development of HUS and TTP associated with E coli O157:H7 infections. His data further highlight the need for improved surveillance of E coli O157:H7 infections advocated in our article, since this pathogen has rapidly emerged to become one of the most common causes of bloody diarrhea in the Pacific Northwest.Dr Cimolai raises valid concerns about the inherent limitations of retrospectively collected data. Our data came from direct patient interviews corroborated, where possible, by physician and hospital records. The number of doses and routes of administration of medications were usually known, but since we do not know what duration of exposure may influence the course of E coli O157:H7 infection, we elected not to use
Ostroff SM, Kobayashi JM, Lewis JH. Epidemiology and Complications of Escherichia coli O157:H7 Infections-Reply. JAMA. 1989;262(24):3408. doi:10.1001/jama.1989.03430240042024
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