Escherichia Coli (E Coli)

Epidemiology

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Microbiology

  • Member of Family Enterobacteriaceae (see Enterobacteriaceae, [[Enterobacteriaceae]])
  • Lactose-Fermenting Gram-Negative Rod

Carbapenem-Resistant Enterobacteriaceae (CRE)

  • Incidence: 2.93 cases/100k population [MEDLINE]
  • Organisms [MEDLINE]
    • Carbapenem-Resistant (Excluding Ertapenem)/Extended-Spectrum Cephalosporin-Resistant Escherichia Coli
    • Carbapenem-Resistant (Excluding Ertapenem)/Extended-Spectrum Cephalosporin-Resistant Enterobacter Aerogenes (see Enterobacter Aerogenes, [[Enterobacter Aerogenes]])
    • Carbapenem-Resistant (Excluding Ertapenem)/Extended-Spectrum Cephalosporin-Resistant Enterobacter Cloacae Complex (see Enterobacter Cloacae, [[Enterobacter Cloacae]])
    • Carbapenem-Resistant (Excluding Ertapenem)/Extended-Spectrum Cephalosporin-Resistant Klebsiella Pneumoniae (see Klebsiella Pneumoniae, [[Klebsiella Pneumoniae]])
    • Carbapenem-Resistant (Excluding Ertapenem)/Extended-Spectrum Cephalosporin-Resistant Klebsiella Oxytoca (see Klebsiella Oxytoca, [[Klebsiella Oxytoca]])*
  • Clinical Associations
    • Most CRE’s were isolated from a urinary source
    • Most CRE’s were associated with high prevalence of prior hospitalizations, prior indwelling devices, or discharge to a long-term care setting

Clinical Manifestations

Gastroenterologic Manifestations

Hematologic Manifestations

Cold Agglutinin Syndrome/Hemolytic Anemia (see Hemolytic Anemia, [[Hemolytic Anemia]])

Hemolytic Anemia (see Hemolytic Anemia, [[Hemolytic Anemia]])

Thrombotic Thrombocytopenic Purpura (TTP) (see Thrombotic Thrombocytopenic Purpura, [[Thrombotic Thrombocytopenic Purpura]])

  • Physiology: due to enterohemorrhagic E Coli (VTEC/STEC): due to production of verocytotoxin (shiga-like toxin)
    • Serotype O157:H7,9, 10, 11, 12: most common in US and UK
    • Serotypes O26, O111, O103, and O145: increasingly reported in Europe and other countries
    • VTEC Strains: produce predominantly verocytotoxin-1 (Stx1) and verocytotoxin-2 (Stx2)
      • Verocytotoxin-1 differs by one amino acid from Shiga toxin
      • Verocytotoxin-2 has multiple closely related variants (with 55–60% homology to verocytotoxin-1)
      • HUS is mostly caused by verocytotoxin-2-producing strains
  • Diagnosis
    • Stool Culture: may be positive for VTEC strains
    • Stool Toxin: VTEC strains may be identified
    • Serology to O-Serotype: may be diagnostic of VTEC strains
    • Renal Biopsy: glomerular thrombosis
  • Clinical
    • Incubation: 4-7 days -> abrupt onset of diarrhea (usually bloody)/abdominal pain
    • 2-10 Days Later: Microangiopathic Hemolytic Anemia/Thrombocytopenia/Acute Kidney Injury
      • Hypercoagulable state occurs prior to onset of acute kidney injury
  • Prognosis: with supportive therapy, mortality rate in children is <5%
    • Approximately 75% appear to make a full recovery when assessed up to 5 years after onset
    • Relapse is extremely rare

Pulmonary Manifestations

Renal Manifestations

  • Epididymitis (see Epididymitis, [[Epididymitis]]): predisposed by insertive anal intercourse
  • Urethritis (see Urethritis, [[Urethritis]]): predisposed by insertive anal intercourse
  • Urinary Tract Infection (UTI) (see Urinary Tract Infection, [[Urinary Tract Infection]])

Other Manifestations

  • Spinal Epidural Abscess (see Spinal Epidural Abscess, [[Spinal Epidural Abscess]]): usually associated with urinary tract infection

Treatment

Acute Skin/Skin Structure Infection

  • Ceftaroline (Teflaro, Zinfloro) (see Ceftaroline, [[Ceftaroline]])

Community-Acquired Pneumonia (CAP)

  • Ceftaroline (Teflaro, Zinfloro) (see Ceftaroline, [[Ceftaroline]])

References

  • Epidemiology of Carbapenem-Resistant Enterobacteriaceae in 7 US Communities, 2012-2013. JAMA. 2015 Oct 5:1479-1487. doi: 10.1001/jama.2015.12480 [MEDLINE]