Escherichia Coli (E Coli)
Epidemiology
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 ]
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