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Escherichia coli

Epidemiology: - 20% of healthy women delivering twins are colonized with ciprofloxacin resistant E coli - antibiotic exposure not identified as risk factor for colonization [5] - multistate outbreak of E coli April 2019. - 72 people from 5 states infected E. coli O103 [7] - outbreaks 2018 & 2019 from E coli-contaminated romaine lettuce Pathology: 1) endotoxin-mediated sepsis - bacteremia originates from the bowel, biliary tree or urinary tract 2) toxin-mediated enteritis a) traveler's diarrhea b) infantile diarrhea c) dysentery d) shiga toxin - E. coli O157:H7 (hemolytic uremic syndrome) 3) urinary tract infection (UTI) a) cystitis b) pyelonephritis c) largely sexually active women d) most common etiologic agent of UTI 4) abdominal abscesses 5) neonatal meningitis associated with K1 capsular antigen 6) rare disorders a) adult meningitis b) pneumonia c) endocarditis Laboratory: 1) Escherichia coli identified in isolate - Escherichia coli identified in stool - Escherichia coli identified in small intestine - gram staining is non-specific 2) Escherichia coli antigen 3) Escherichia coli toxin 4) Escherichia coli serology 5) Escherichia coli serotype 6) culture of organism from a site that is generally sterile - Escherichia coli identified by culture - enterohemorrhagic Escherichia coli identified by culture - Escherichia coli O157:H7 identified by culture - E coli O157:H7 is cultured on sorbitol agar - gram negative rod, oxidase negative 7) Escherichia coli DNA 8) Escherichia coli adherence pattern in isolate 9) extended spectrum beta lactamase (ESBL)-producing E coli 10) carbapenem-resistance (India, Pakistan) conferred by New Delhi metallo-beta-lactamase 1 (emergence in 2010) Management: 1) uncomplicated cystitis in healthy non-pregnant women - Bactrim DS, 2 tablets once 2) more severe infection a) ampicillin 3 g IV every 4 hours plus gentamicin 1 mg/kg IV every 8 hours b) ciprofloxacin 500 mg PO every 12 hours - ciprofloxacin resistance common [5] -fluoroquinolone resistance common [6] 3) 2 weeks of therapy for abscesses 4) gastroenteritis (E. coli O157:H7) a) avoid antimotility agents-> slows elimination of bacteria b) treatment with antibiotics increases risk of hemolytic-uremic syndrome 5) carbapenem for extended spectrum beta lactamase (ESBL)-producing E coli

Specific

enterohemorrhagic Escherichia coli (Shiga toxin-producing E coli)

General

Escherichia

Properties

KINGDOM: monera DIVISION: SCHIZOMYCETES

References

  1. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 226
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 498, 535
  3. Prescriber's Letter 7(8):45 2000
  4. Journal Watch 21(18):149, 2001 Mohle-Boetani JC et al, Escherichia coli O157 and Salmonella infections associated with sprouts in California, 1996-1998. Ann Intern Med 2001, 135:239 PMID: 11511138
  5. Gurnee EA et al. Gut colonization of healthy children and their mothers with pathogenic ciprofloxacin-resistant Escherichia coli. J Infect Dis 2015 Dec 15; 212:1862 PMID: 25969564 http://jid.oxfordjournals.org/content/212/12/1862 - Spellberg B and Doi Y. The rise of fluoroquinolone-resistant Escherichia coli in the community: Scarier than we thought. J Infect Dis 2015 Dec 15; 212:1853 PMID: 25969562 http://jid.oxfordjournals.org/content/212/12/1853
  6. Medical Knowledge Self Assessment Program (MKSAP) 18. American College of Physicians, Philadelphia 2018
  7. Centers for Disease Control & Prevention (CDC) Outbreak of E. coli Infections Investigation Notice. April 5, 2019 https://www.cdc.gov/ecoli/2019/o103-04-19/index.html
  8. National Institute of Allergy and Infectious Diseases (NIAID) E coli https://www.niaid.nih.gov/diseases-conditions/e-coli

Component-of

escherichia coli/streptococcus faecalis