Urinary tract infection (UTI) – Care at Mayo Clinic

Urinary tract infection care at Mayo Clinic

Your Mayo Clinic care team

Depending on your condition, your team at Mayo Clinic may include specialists in urology, kidney disease, obstetrics and gynecology, and infectious disease who work closely together to diagnose and treat your problem.

Having all this expertise in a single place means that your care is discussed among the team, test results are available quickly, appointments are scheduled in coordination and the most highly specialized experts in the world are all working together for your health.

Pediatric expertise

For children needing testing or treatment, Mayo Clinic provides a friendly, comforting environment. Parents can stay with their children during some diagnostic tests.

Expertise and rankings

Experience

Experienced specialists at Mayo Clinic can determine the cause and recommend an effective treatment in cases of complicated or recurrent urinary tract infections. Mayo Clinic doctors treat more than 15,000 people with UTIs each year.

Leading-edge treatment

Highly skilled Mayo surgeons, including pediatric urologic surgeons, can perform minimally invasive surgery to correct recurrent problems or abnormalities in the urinary system.

Mayo Clinic in Rochester, Minn., is ranked No. 1 for urology in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Phoenix/Scottsdale, Ariz., and Mayo Clinic in Jacksonville, Fla., are ranked among the Best Hospitals in the nation for urology by U.S. News & World Report. Mayo Clinic also ranks among the Best Children’s Hospitals for urology.

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Symptoms, Treatment, Causes & Prevention

E. coli (Escherichia coli), is a type of bacteria that normally lives in your intestines. It’s also found in the gut of some animals.

Most types of E. coli are harmless and even help keep your digestive tract healthy. But some strains can cause diarrhea if you eat contaminated food or drink fouled water.

While many of us associate E. coli with food poisoning, you can also get pneumonia and urinary tract infections from different types of the bacteria. In fact, 75% to 95% of urinary tract infections are caused by E. coli. E.coli is a normal resident of the bowel, which is how it makes it way to the urinary tract.

Some versions of E. coli make you sick by making a toxin called Shiga. This toxin damages the lining of your intestine. The strains of E. coli that make the toxin are sometimes called STEC, which is short for “Shiga toxin-producing E. coli.”

One especially bad strain, O157:H7, can make you very sick. It causes abdominal cramps, vomiting, and bloody diarrhea. It is the leading cause of acute kidney failure in children. It can also cause life-threatening symptoms such as:

You should get emergency help if you have any of these symptoms.

How Do You Get Infected?

You can become infected when you swallow even a small amount of E. coli bacteria. Among the ways this can happen:

• Ground meat: You eat ground meat that carries E. coli, and the meat wasn’t cooked enough to kill the bacteria. When meat is processed, sometimes bacteria from the animals’ intestines make their way into the meat. This happens more with ground meat because it comes from more than one animal.
• Untreated milk: You drink unpasteurized milk, which hasn’t been heated to kill bacteria. E. coli can get into the milk from the cow’s udder or from milking equipment.
• Vegetables and fruit: You might eat fresh vegetables or fruit that’s been tainted by water that has the bacteria. This happens most often when manure from nearby animals mixes with the water supply.
• Other foods and beverages: You might also get E. coli from unpasteurized fruit juices and yogurt and cheese made from raw milk.
• Water: You swallow water that contains E. coli, perhaps while swimming in a pool, lake, or pond.
• Other people: You might get E. coli from another person who has it, such as a child. The bacteria can be passed to you if you clean up after an infected person and then don’t wash your hands really well before you touch your mouth.
• Animals: It can be found at petting zoos or animal exhibits at fairs.

You can also contaminate food in your own kitchen if you allow a knife or cutting board that has touched uncooked meat (like chicken) to come into contact with food that will be eaten raw (like a salad).

Symptoms

You’ll probably start to feel ill 2 to 5 days after you’ve taken in the E. coli bacteria. The most common symptoms are:

• Abdominal cramps
• Diarrhea, which may be bloody
• Nausea
• Constant fatigue

You may not have a fever. If you do, it may be slight.

Healthy people infected with E. coli usually feel better within a week. But some people have a serious complication called hemolytic uremic syndrome, which affects the kidneys. This is more likely to happen to older people and children.

Treatments

The only way your doctor can know for sure if you have an E. coli infection is to send a sample of your stool to a lab to be analyzed.

Fortunately, the infection usually goes away on its own.

For some types of E.coli associated with diarrhea, such as the watery travelers’ diarrhea, antibiotics can shorten the length of time you have symptoms and might be used in moderately severe cases.

But if you have fever or bloody diarrhea or if your doctor suspects Shiga toxin-producing E. coli, antibiotics should not be taken. They can actually increase the production of Shiga toxin and worsen your symptoms.

Continued

It’s important to rest and get plenty of fluids to replace what your body is losing through vomiting or diarrhea.

Don’t take over-the-counter medications that fight diarrhea. You don’t want to slow down your digestive system, because that will delay your body’s shedding of the infection.

When you start to feel better, stick to low-fiber foods at first such as:

Dairy products and foods that are high in fat or fiber can make your symptoms worse.

Prevention

One of the most important things you can do to protect yourself and your family against E. coli is wash your hands, particularly in these situations:

• Before you prepare food
• Before preparing bottles or food for infants or toddlers
• Before touching anything, such as a pacifier, that goes into a small child’s mouth.
• After you’ve used the bathroom or changed a diaper
• After you’ve had contact with animals, even your own pets
• After handling raw meat

Continued

You can also prevent E. coli infections by being careful about the foods that carry the greatest chance of contamination:

• Cook hamburgers until they’re 160 F inside.
• Drink only pasteurized milk, juice, and cider.
• Wash all of your produce before you eat it. Be especially careful to get dirt off leafy greens such as lettuce and spinach.

In your kitchen, a couple of simple rules will help keep you safe:

Wash: Clean knives, counters, and cutting boards with hot, soapy water after raw meat has touched them.

Keep raw and cooked separate: Use different cutting boards for food that you eat raw, such as vegetables and fruit. Don’t put cooked meat back on the same plate you used for raw meat without washing the plate first.

When you’re swimming, try not to swallow the water, whether it’s a pool, a lake, or the ocean. It may be tainted with E. coli from feces.

E. coli and Urinary Tract Infections (UTIs)

Urinary tract infections, or UTIs for short, are the most common type of bacterial infection diagnosed today. (1) And the most common bacteria to cause these infections are Escherichia coli, aka E. coli. In fact, E. coli is responsible for more than 85 percent of all urinary tract infections, according to research published in March 2012 in the journal Emerging Infectious Diseases. (2) (Bacteria including Staphylococcus saprophyticus, Pseudomonas aeruginosa, and Klebsiella pneumoniae are also behind some UTIs.)

Worldwide, 150 million people are affected by UTIs each year, and about 10.5 million of those individuals are in the United States, according to research published in May 2015 in the journal Nature Reviews Microbiology. (3) Women get urinary tract infections up to 30 times more often than men do, with up to 60 percent of women getting a UTI at least once in their lives. (1,4)

The Different Parts of the Urinary Tract, and Those More Prone to Infection

The urinary system is well designed and can often keep E. coli and other types of microscopic invaders at bay. For instance, urinating usually does an excellent job of flushing out lingering bacteria from the urethra before it causes any issues. (3) But when this defense fails, bacteria such as E. coli enters the urinary tract (which is made up of the kidneys, ureters, bladder, and urethra), multiplies, and then a urinary tract infection can develop. (5)

While any part of the urinary tract can be impacted, most E. coli–caused UTIs occur in the lower urinary tract, which includes the bladder (where urine is stored) and the urethra (the tube urine passes through to leave the body). A UTI that resides in the bladder is called cystitis; one that resides in the urethra is called urethritis. (5)

E. coli infection: Symptoms, causes, and treatment

Escherichia coli (E. coli) is a bacterium commonly found in the gut of warm-blooded organisms.

Most strains of E. coli are not harmful but are part of the healthful bacterial flora in the human gut. However, some types can cause illness in humans, including diarrhea, abdominal pain, fever, and sometimes vomiting.

E. coli O157:H7 is one of the strains, and produces a toxin known as Shiga. It is one of the most powerful toxins, and it can cause an intestinal infection.

Some 265,000 Shiga toxin-producing E. coli (STEC) infections occur each year in the United States (U.S.). Around 36 percent of these are probably caused by E. coli O157:H7. When a foodborne outbreak occurs, it usually involves a shiga toxin-producing E. coli.

Most people recover within 6 to 8 days, but it can be life-threatening in infants and people with a weakened immune system.

Some other types of E. coli infection can lead to urinary tract infections, respiratory illness, pneumonia, and other illnesses like meningitis.

Fast facts on

E. coli

Fast facts on E. coli

• E. coli refers to a wide range of bacteria that can cause various diseases, including pneumonia, urinary tract infections, and diarrhea.
• Most strains of E. coli are harmless to humans.
• Some strains of E. coli infection can include nausea, vomiting, and fever.
• In susceptible individuals, certain types of E. coli infection can lead to kidney failure
• Following hygiene rules helps prevent its spread

Share on PinterestE. coli infects the intestine and causes symptoms that range from non-presenting to severe.

Symptoms of infection with E. coli 0157 typically appear 3 to 4 days after being exposed to the bacteria. However, symptoms may appear as early as 24 hours or as late as 1 week later.

These can include:

• abdominal pain or severe abdominal cramping, often starting suddenly
• watery diarrhea, beginning a few hours after the pain begins
• bright red bloody stools around a day later, resulting from the toxin’s damage to the intestines
• nausea and, in some cases, vomiting
• in some cases, fever, usually below 101 degrees Fahrenheit
• fatigue, resulting from dehydration and the loss of fluids and electrolytes

Some people have no noticeable symptoms, but they can spread the infection to others.

There is no cure for E. coli O157:H7. It has to resolve itself. Antibiotics are not advised. They may increase the risk of HUS.

Patients should get plenty of rest and drink a lot of water to prevent dehydration.

Over-the-counter (OTC) medications for diarrhea are not recommended, as they can slow down the digestive system, undermining the body’s ability to eliminate the toxins efficiently.

E. coli bacteria are a common cause of urine infections, for example, cystitis. The exit of the urinary tract is near the anus, and so the bacteria can spread from the GI tract to the urinary tract.

Wiping from front to back can help reduce the risk.

Most strains of E. coli are harmless, but some produce a toxin that makes humans sick.

The group of E. coli that includes 0157:H7 produces a potent toxin called Shiga. This toxin can harm the lining of the small intestine.

Humans can become infected by:

Swallowing contaminated water: Tap water in the US is treated and contains chlorine, but some E. coli outbreaks have been caused by contaminated municipal water supplies.

Private wells can be a source of infection, as can some lakes and swimming pools.

Travelers to places where water may be untreated should be careful when drinking water, using ice or eating vegetables washed in water of uncertain origin.

Swallowing contaminated food: Possible sources include undercooked ground beef, unpasteurized milk, juice, cider, or cheese, alfalfa sprouts or raw vegetables.

Infected people who work in restaurants and do not wash their hands properly after going to the toilet can spread the infection to customers and other members of staff.

Person-to-person contact: Good hand hygiene is important in stopping the spread of infection.

Contact with animals: Bacteria can spread in farms, petting zoos, and fairs.

Risk factors

Some people who are more likely to be affected by E. coli– related illness.

People with a weakened immune system are more prone to complications. This includes patients with AIDS, those taking immunosuppressive medications, and people receiving chemotherapy.

Patients with decreased stomach acid, either due to stomach surgery or medicines that lower stomach acid, have a higher risk of infection.

Young children and older people have a higher risk of developing serious illness and complications.

Most people make a full recovery within a week.

However, around 10 percent of people are at risk of developing hemolytic uremic syndrome (HUS). These are mostly young children and older people.

HUS is characterized by hemolysis, or a breakup of red blood cells. This can cause anemia, a low platelet count, and kidney failure.

Platelets, the blood cells responsible for blood clotting, clump together within the small blood vessels of the kidneys, resulting in reduced blood flow, or ischemia.

This can eventually lead to kidney failure. Decreased platelets increase the risk of bleeding problems.

Patients with these clots can also develop central nervous system (CNS) problems that affect the brain and spinal cord.

This can lead to seizures, paralysis, brain swelling, and coma. It is fatal in 3 to 5 percent of cases.

Acute kidney failure among infants and young children is usually caused by HUS.

HUS usually starts about 5 to 8 days after the onset of diarrhea. It is a medical emergency, and requires hospital treatment.

Share on PinterestDrinking plenty of water to avoid dehydration is crucial during an E. coli infection.

The doctor will identify the signs, ask about symptoms, and send a stool sample to a lab for analysis.

The sample must be taken within 48 hours after the bloody diarrhea starts.

Some tips can help prevent infection with E. Coli and other pathogens.

These include:

• cooking meat well, especially ground meat
• drinking pasteurized milk, apple juice, and cider, rather than unpasteurized
• washing vegetables, especially leafy green ones
• ensuring that cutlery and crockery are thoroughly washed with warm, soapy water
• storing meat and non-meat foods separately, and using separate cutting boards
• following good hand-hygiene practices

Good hand hygiene involves washing hands thoroughly with warm water and soap regularly, and especially after using the bathroom, after changing diapers, before and after preparing foods, and after touching animals

What is It, How Does it Cause Infection, Symptoms & Causes

Overview

E. coli is a rod-shaped bacteria.

What is

E. coli?

Escherichia coli (E. coli) is a bacteria that normally lives in the intestines of both healthy people and animals. In most cases, this bacteria is harmless. It helps digest the food you eat. However, certain strains of E. coli can cause symptoms including diarrhea, stomach pain and cramps and low-grade fever. Some E. coli infections can be dangerous.

What does

E. coli look like?

E. coli is a rod-shaped bacterium of the Enterobacteriaceae family. It can live in environments with or without air. These bacteria live in the intestines of healthy people and warm-blooded animals.

How many strains of

E. coli cause diarrhea?

Six different strains of E. coli are known to cause diarrhea. These strains are:

• Shiga toxin-producing E. coli (STEC): This is the bacteria most commonly known for E. coli food contamination. This strain is also called enterohemorrhagic E. coli (EHEC) and verocytotoxin-producing E. coli (VTEC).
• Enterotoxigenic E. coli (ETEC): This strain is commonly known as a cause of travelers’ diarrhea.
• Enteroaggregative E. coli (EAEC).
• Enteroinvasive E. coli (EIEC).
• Enteropathogenic E. coli (EPIC).
• Diffusely adherent E. coli (DAEC).

How does

E. coli make you sick?

The most familiar strains of E. coli that make you sick do so by producing a toxin called Shiga. This toxin damages the lining of your small intestine and causes your diarrhea. These strains of E. coli are also called Shiga toxin-producing E. coli (STEC). The STEC that is most well-known in North America and most often referred to is E. coli O157:H7, or just E. coli O157

There are other types of STEC that are called non-O157 STEC. These strains cause similar illness to the O157 strain but are less likely to lead to serious complications.

Who can get infected with

E. coli?

Anyone who comes into contact with a disease-causing strain of E. coli can become infected. People who are at greatest risk are:

• The very young (newborns and children).
• The elderly.
• People who have weakened immune systems (for example, those with cancer, diabetes, HIV, and women who are pregnant).
• People who travel to certain countries.

How common are

E. coli infections?

According to the Centers for Disease Control, about 265,000 STEC infections occur in the United States each year. The STEC O157 strain causes about 36% of these infections and non-O157 STEC strains cause the rest. The actual number of infections is thought to be even higher because many people do not go to their healthcare provider for their illness, many don’t provide a stool sample for testing and many labs do not test for non-O157 STEC strains.

Symptoms and Causes

What are the symptoms of an

E. coli infection?

People who get infections with the STEC strain of E. coli can have the following symptoms:

• Stomach pains and cramps.
• Diarrhea that may range from watery to bloody.
• Fatigue.
• Loss of appetite or nausea.
• Vomiting.
• Low fever < 101 °F/ 38.5 °C (not all people have this symptom).

How soon do symptoms of

E. coli infection develop?

You usually develop symptoms of a STEC infection within three to five days after drinking or eating foods contaminated with this E. coli bacteria. However, you could have symptoms as early as one day after exposure up to about 10 days later.

How long do symptoms of

E. coli infection last? When will I feel better?

Your symptoms can last from five to seven days.

Other than diarrhea, are there serious illnesses caused by STEC strains of

E. coli?

Most cases of E. coli infections are mild and do not cause a serious health risk. Cases resolve on their own with rest and drinking plenty of fluids. However, some strains can cause severe symptoms and even life-threatening complications, such as hemolytic uremic syndrome, which can lead to kidney failure and death.

What is hemolytic uremic syndrome?

Some people, especially children age five and under, who become infected with a STEC infection (the O157:H7 strain) develop a condition called hemolytic uremic syndrome (HUS). In this condition, toxins in your intestines from STEC cause diarrhea, travel into your bloodstream, destroy red blood cells and damage your kidneys. This potentially life-threatening illness develops in about 5% to 10% of people who are infected with STEC.

Early symptoms of HUS include:

• Diarrhea (usually bloody).
• Fever.
• Stomach pain.
• Vomiting.

As disease progresses, symptoms include:

• Decreased urination, blood in urine.
• Feeling tired.
• Pale-looking skin.
• Easy bruising.
• Fast heart rate.
• Lightheadedness.
• Sleepiness, confusion, seizures.
• Kidney failure.

If you develop severe diarrhea (lasting longer than three days or you can’t stay hydrated) or if you have bloody diarrhea, go to the hospital for emergency care. HUS, if it develops, occurs an average of 7 days after your first symptoms occur. It is treated with IV fluids, blood transfusions and dialysis (for a short period of time).

What causes an

E. coli infection?

Technically, you develop an E. coli infection by ingesting (taking in by mouth) certain strains of E. coli bacteria. The bacteria travel down your digestive tract, releases a destructive toxin, called the Shiga toxin, which damages the lining of your small intestine. The growing infection causes your symptoms.

How did I get infected with

E. coli?

You come into contact and swallow E. coli by eating contaminated food, drinking contaminated water or by touching your mouth with your hands that are contaminated with E. coli bacteria.

Contaminated foods

• Meats: Meats become contaminated with E. coli during the slaughtering process, when E. coli in animal intestines gets onto cuts of meat and especially when meat from more than one animal is ground together. If you eat undercooked meat (E. coli is killed when meat is thoroughly cooked), you can become infected with E. coli.
• Unpasteurized (raw) milk: E. coli on a cow’s udder and/or the milking equipment can get into the milk. Drinking contaminated raw milk can lead to an E. coli infection because it hasn’t been heated to kill the bacteria.
• Unpasteurized apple cider and other unpasteurized juices.
• Soft cheeses made from raw milk.
• Fruits and veggies: Crops growing near animal farms can become contaminated when E. coli-containing animal poop combines with rainwater and the runoff enters produce fields and lands on the produce. If you don’t thoroughly wash off the produce, E. coli enters your body when you eat these foods.

Contaminated water

• E. coli in poop from both animals and humans can end up in all types of water sources including ponds, lakes, streams, rivers, wells, swimming pools/kiddie pools and even in local city water supplies that have not been disinfected. If you swallow contaminated water, you could get sick.

Contaminated hands

• You can swallow E. coli when it transfers from your hands directly to your mouth or onto the food you are eating. E. coli gets on your hands from touching poop (an invisible amount can be on your hands). You can get poop on your hands after changing your baby’s diapers, after having a bowel movement and not washing your hands completely, petting zoo or farm animals (many animals roll in or otherwise get E. coli from poop on their fur) or from poop on the hands of other people infected with disease-causing E. coli.

Is

E. coli contagious?

When you hear the word “contagious,” you might immediately think of a cold or the flu – illnesses you can get from breathing in bacteria or viruses lingering in the air of a sick person’s cough or sneeze.

E. coli isn’t an airborne illness. It’s usually spread by eating contaminated food or drinking contaminated water that contains illness-producing strains of E. coli. (Remember not all strains of E. coli are harmful.)

E. coli can, however, be contagious and spread from person to person by the “oral-fecal route.” This means that harmful strains of E. coli are spread when people don’t wash their hands thoroughly with soap and water after they use the bathroom or otherwise touch poop (after changing baby diapers or older person’s incontinence undergarments, or petting zoo or farm animals that may have soiled fur) and they touch other people. People then get the invisible E. coli on their hands and swallow it when it is transferred from their hands to the food they eat or from putting their fingers in their mouth. E. coli spreads from person to person this way in settings such as day care centers and nursing homes.

Diagnosis and Tests

How is an

E. coli infection diagnosed?

STEC infections are diagnosed by sending a sample of your poop to a laboratory. Many labs can test for both STEC O157 and non-O157 STEC bacterial infections.

What steps are involved in getting a stool sample to my healthcare provider?

Call your healthcare provider’s office. They may have you come in for an office visit and give you a sterile stool collection cup and specific directions to follow for how to collect a stool sample. They may also email specific instructions for collecting a sample at home.

Some general instructions for collecting a stool sample at home include:

• First, wash your hands with soap and water.
• If it’s possible to urinate (pee) before setting up for the stool collection, do so. You don’t want to get urine in your stool sample if you can help it.
• To collect diarrhea, tape a plastic bag to the toilet seat. You only need to collect a small amount – a couple tablespoons.
• Place the plastic bag into a clean (washed and dried) plastic container and seal with lid.
• Wash your hands with soap and water.
• Write your name and date on the container, place within another bag, wash your hands again and deliver to your healthcare provider on the same day you collect your sample. If you can’t deliver your sample immediately, you can store it in your refrigerator for up to 24 hours.
• Do not collect the sample from the toilet bowl. Do not mix in toilet paper, soap or water.

When will I get the results back from my stool sample?

Most laboratories report back the results within two to four days. Your healthcare provider will call you with the results as soon as they become available or you may be notified of your results electronically if you have an online medical record set up with your doctor or healthcare facility.

Management and Treatment

How is an

E. coli infection treated?

Fortunately, most E. coli infections go away on their own. You can help yourself manage E. coli infection by drinking plenty of fluids to replace what you’ve lost through diarrhea and/or vomiting. Also, get as much rest as possible.

Antibiotics are usually not given for STEC O157 infection because they can make your illness worse and put you at risk for hemolytic uremic syndrome (HUS). Also, don’t take any medicines to stop diarrhea (such as bismuth subsalicylate [Pepto-Bismol®, Kaopectate®] or loperamide [Imodium®]), because it could keep the E. coli bacteria in your body and increase your chance of HUS.

You should start to feel better about five to seven days from the time you first developed symptoms.

When should I see a healthcare provider about an

E. coli infection?

See your healthcare provider about an E. coli infection if:

You have diarrhea for more than three days and:

• You can’t keep any fluids down.
• You have blood in your poop.
• You are feeling very tired.
• You have many bouts of vomiting.
• You have a fever higher than 102 °F.
• You are not peeing (urinating) a lot.
• You are losing pink color in cheeks and inside your lower eyelids.

Prevention

How can I prevent or avoid an

E. coli infection?

The most important thing you can do to protect against E. coli infection is to wash your hands – frequently. Always wash your hands thoroughly before and after cooking and after handling raw meat or poultry.

Wash your hands after using the restroom, changing diapers or after contact with animals.

If you’ve been infected with E. coli, scrub your hands vigorously with soap and clean under your fingernails where bacteria can get caught. Dry your hands with paper towels instead of cloth towels to avoid transferring bacteria.

You can also reduce your risk of an E. coli infection by following these food preparation and cooking tips.

When thawing meats:

• Don’t defrost frozen meat unwrapped on the counter.
• Keep frozen meat in a separate plastic bag (for example, a plastic grocery bag) when thawing.

When prepping foods:

• Don’t rinse meat before cooking. It’s not necessary. Washing the meat could spread bacterial to nearby surfaces, utensils and other food.
• Use a plastic or ceramic cutting board to cut raw meat. These materials can be cleaned more easily and thoroughly than wooden cutting boards.
• Don’t “cross-contaminate” a prepping surface. If you had raw meat or chicken on a prepping surface, such as a cutting board, wash it thoroughly with soap and hot water before putting another type of food (such as a raw vegetable) on it. Better yet, use different cutting boards for the foods you are preparing.
• Rinse all raw fruits and vegetables under cold running water before eating them. It’s ok to scrub firm produce but don’t use detergent or soap.

When cooking and serving meats:

• Cook all meat well (undercooked meat is another source of E. coli contamination). Cooking foods well kills bacteria.
• Use a food thermometer when cooking meat, and cook all meat and other foods to the safe temperatures recommended by the United States Department of Agriculture (see references for link).
• Don’t put a cooked hamburger on a plate that had raw ground beef or any other raw meat on it.
• Refrigerate leftovers right away.

Outlook / Prognosis

What can I expect if I have an

E. coli infection?

It’s important to keep in mind that most strains of E. coli are harmless. They live naturally in your intestinal tract and help digest your food. Sometimes, however, you may eat food or drink water that is contaminated with illness-causing E. coli. Sometimes a mild E. coli infection will cause a brief bout of diarrhea. Other strains of E. coli, the Shiga toxin-producing E. coli (STEC), cause bloody diarrhea, vomiting, stomach pain and cramps. If you are otherwise healthy, you should recover from an E. coli infection within about a week without any treatment.

Although hemolytic uremic syndrome (HUS) is a serious complication, it is rare and occurs in about 5% to 10% of people. With early treatment and proper care, people can recover from HUS.

Living With

How long does

E. coli survive outside the body?

E. coli can survive outside the body from hours to months. It can live in soil for about 130 days. E. coli survives in river water for 27 days and in cattle slurry for 10 days. On stainless steel, E. coli was shown to survive for more than 60 days. It survives for at least 12 hours on wooden cutting boards.

Many factors affect how long E. coli can live outside the body including temperature, presence of water, availability of nutrients, pH and solar radiation.

How does

E. coli cause a urinary tract infection?

Urinary tract infections are sometimes caused when E. coli from your gastrointestinal tract get into your urinary tract. This can happen more easily in women because the anus (where poop exits your body) is located close to the urethra (the tube from which urine exits the body). E. coli bacteria can travel up the urethra to the bladder and even up to the ureters and kidneys. You may have been told – if you are a woman – to always “wipe from front to back.” This is so you don’t accidently spread E. coli bacteria from your anus to your urethra.

The most common urinary tract infections caused by E. coli are a bladder infection (cystitis), infection of the urethra (urethritis) and kidney infection.

Are there better food choices I can make as I start to feel better after an

E. coli infection?

Drink clear liquids, such as broths, clear sodas and water. Stick with bland, low-fiber foods like toast, rice, plain crackers and applesauce. Stay away from high-fiber foods, fatty foods and dairy products.

When can I return to work or school if I’ve been infected with

E. coli?

Check with your healthcare provider. If your infection was part of a local outbreak, your local state health department may have specific instructions about when it’s safe to be around groups of people.

A note from Cleveland Clinic

The best and easiest way to avoid getting an E. coli infection is to frequently wash your hands with soap and water. Wash your hands before and after handling foods (including prepping, cooking and serving foods), after using the bathroom, after touching animals (especially farm or zoo animals), after changing diapers and after shaking hands or being touched by others (you never know what their hands have touched). Washing your hands can not only prevent contracting E. coli, but also many other infectious disease that are spread from person to person. Make frequent hand washing a new habit.

Keep in mind that most strains of E. coli are harmless. Even if you do come down with the STEC O157 strain, your symptoms will resolve on their own within five to seven days. Drink plenty of fluids to stay hydrated and get plenty of rest.

Do call your healthcare provider if you have diarrhea (and especially bloody diarrhea) for more than three days, have trouble keeping fluids down and have continuous bouts of vomiting and have a fever. These symptoms could mean you are developing serious complications that could lead to kidney failure.

E. Coli Infection From Food or Water

Topic Overview

What is an

E. coli infection?

E. coli ( Escherichia coli) is the name of a germ, or bacterium, that lives in the digestive tracts of humans and animals.

There are many types of E. coli, and most of them are harmless. But some can cause bloody diarrhea. Some strains of E. coli bacteria may also cause severe anemia or kidney failure, which can lead to death.

Other strains of E. coli can cause urinary tract infections or other infections.

What causes an

E. coli intestinal infection?

You get an E. coli infection by coming into contact with the feces, or stool, of humans or animals. This can happen when you drink water or eat food that has been contaminated by feces.

E. coli in food

E. coli can get into meat during processing. If the infected meat is not cooked to 160°F (71°C), the bacteria can survive and infect you when you eat the meat. This is the most common way people in the United States become infected with E. coli. Any food that has been in contact with raw meat can also become infected.

Other foods that can be infected with E. coli include:

• Raw milk or dairy products. Bacteria can spread from a cow’s udders to its milk. Check the labels on dairy products to make sure they contain the word “pasteurized.” This means the food has been heated to destroy bacteria.
• Raw fruits and vegetables, such as lettuce, alfalfa sprouts, or unpasteurized apple cider or other unpasteurized juices that have come in contact with infected animal feces.

E. coli in water

Human or animal feces infected with E. coli sometimes get into lakes, pools, and water supplies. People can become infected when a contaminated city or town water supply has not been properly treated with chlorine or when people accidentally swallow contaminated water while swimming in a lake, pool, or irrigation canal.

E. coli from person-to-person contact

The bacteria can also spread from one person to another, usually when an infected person does not wash his or her hands well after a bowel movement. E. coli can spread from an infected person’s hands to other people or to objects.

What are the symptoms?

The main symptoms of an E. coli intestinal infection are:

• Bloody diarrhea.
• Stomach cramps.
• Nausea and vomiting.

Some people do not notice any symptoms. Children are more likely than adults to have symptoms. Symptoms usually start 3 or 4 days after you come in contact with the E. coli.

Most people get better in about a week. They often don’t see a doctor and don’t know that E. coli caused their problems.

When E. coli causes serious problems with the blood or kidneys, symptoms include:

• Pale skin.
• A fever.
• Weakness.
• Bruising.
• Passing only small amounts of urine.

How is an

E. coli intestinal infection diagnosed?

Your doctor may suspect that you have an E. coli infection after he or she asks you questions and does an exam. Your stool will probably be tested for E. coli.

How is it treated?

E. coli infection usually goes away on its own. Your main treatment is to make yourself comfortable and drink sips of water. Diarrhea causes the body to lose more water than usual. This can lead to dehydration, which is especially dangerous for babies and older adults. Taking frequent, small sips of water will help prevent dehydration.

If you have bloody diarrhea that may be from an E. coli infection, do not take diarrhea medicine or antibiotics. These medicines can slow down the digestion process, allowing more time for your body to absorb the poisons made by the E. coli. Call your doctor instead.

In some people, E. coli infection causes serious problems with the blood and kidneys. These people may need blood transfusions or dialysis. Dialysis is a treatment that helps filter waste products from the blood when the kidneys aren’t working right.

How do you prevent an

E. coli intestinal infection?

Food and water that are infected with E. coli germs look and smell normal. But there are some things you can do to prevent infection:

• Cook ground beef to at least 160°F (71°C).
• In the kitchen, wash your hands with hot, soapy water often, especially after you touch raw meat.
• Wash any tools or kitchen surfaces that have touched raw meat.
• Use only pasteurized milk, dairy, and juice products.
• Use only treated, or chlorinated, drinking water.
• When you travel to countries that may have unsafe drinking water, don’t use ice or drink tap water. Avoid raw fruits and vegetables, except those with skin that you peel yourself.
• Wash your hands often, and always wash them after you use the bathroom or change diapers.

Symptoms

Children are more likely than adults to develop symptoms of an E. coli infection. Most people with the infection will have:

• Severe stomach cramps and stomach tenderness.
• Diarrhea, watery at first, but often becoming very bloody.
• Nausea and vomiting.

Some people who are infected with the bacteria do not notice any symptoms. They may spread the bacteria to others without knowing it.

There are many conditions with symptoms similar to those of E. coli intestinal infection. Diagnosis of E. coli infection can be complicated by the fact that most bacterial infections that cause diarrhea are accompanied by a high fever. If you have no fever or only a mild fever, your doctor may suspect that something other than bacteria is causing your symptoms.

Bloody diarrhea is common in confirmed cases of E. coli intestinal infection, but the bacteria also should be considered a possible cause of non-bloody diarrhea.

For more information on when to call a doctor about non-bloody diarrhea, see:

Symptoms of E. coli infection usually end in about a week with no further problems. But severe blood and kidney problems may occur within 2 weeks after the onset of diarrhea. These problems can cause kidney failure and sometimes long-term disability or death in some children and older adults.

Exams and Tests

The medical evaluation for diarrhea that may be caused by disease-causing E. coli bacteria usually starts with a physical examination and a medical history.

During the medical history, your doctor will ask questions about your symptoms, such as:

• When did diarrhea begin, how long has it lasted, and how frequent are bowel movements?
• Is there blood in the diarrhea? If so, how much?
• Have you had chills or a fever?
• Have you had any abdominal cramps, nausea, or vomiting?
• Do you feel tired or irritable?
• Have you fainted or felt lightheaded?

Infection with E. coli is easily mistaken for other conditions with similar symptoms, such as other infectious diseases.

A doctor may suspect you have E. coli infection if you have been exposed to the bacteria. During the medical history, your doctor may ask if you have:

• Been in a day care center, school, nursing home, or other adult care institution.
• Eaten recently at a restaurant.
• Consumed any undercooked meat or unpasteurized milk, dairy products, or juice.
• Had contact with anyone with recent or ongoing diarrhea.
• Traveled recently.
• Used antibiotics recently.

During the physical examination, a doctor will usually:

• Take your temperature.
• Take your blood pressure and determine your pulse rate.
• Look at your skin color to see whether you are unusually pale.
• Check your stomach for tenderness.
• Perform a rectal exam to find out whether you have blood in your stool.

Doctors who suspect E. coli infection will order a type of stool culture that detects strains of E. coli. Because the bacteria can leave the body in only a few days, the sample should be obtained as soon as possible after symptoms appear.

Other tests are sometimes used when the diagnosis is unclear, but these are not yet widely available.

If a child or older adult is diagnosed with E. coli infection, he or she may be watched for development of severe blood or kidney problems. Monitoring requires blood and urine tests to measure essential elements of blood and body fluids.

Treatment Overview

Treatment of infection with disease-causing E. coli bacteria involves managing complications—mainly dehydration caused by diarrhea.

If you develop symptoms of severe blood or kidney problems, such as anemia or kidney failure, your treatment may include:

• Careful regulation of fluids and essential minerals.
• Dialysis, to filter waste products from your blood. Some people with kidney failure caused by E. coli infection require dialysis.
• Blood transfusion, to treat anemia by giving you additional oxygen-rich red blood cells.

Medicines to avoid

Most people recover from E. coli infections in 5 to 10 days without the need for medicine. Antibiotics are not recommended. Tell your doctor if you think you may have E. coli infection and are taking antibiotics.

Nonprescription or prescription diarrhea medicines usually are not used to treat E. coli infection. Many antidiarrheal products slow the rate at which food and waste products move through the intestines. This may allow more time for the body to absorb the poisons produced by the bacteria, increasing the risk of complications such as severe blood and kidney problems.

Avoid these nonprescription products if you have or suspect you have an E. coli infection:

• Loperamide products. These include Imodium, Maalox, and other antidiarrheal products. Note: Only those products that list loperamide in their ingredients should be avoided.
• Products containing salicylates. These include Pepto-Bismol and similar bismuth-based antidiarrheal products, aspirin, and ibuprofen (such as Advil). Salicylates can increase bleeding from the intestines. Also, salicylates are associated with Reye syndrome, a rare but serious illness in children.

Prescription diarrhea medicines may be harmful when given to a person with E. coli infection. A doctor may prescribe one of these medicines if he or she does not know that E. coli caused the diarrhea. Be sure to discuss your symptoms with your doctor. Sharing information is important to get the proper diagnosis of your condition.

Avoid these prescription medicines if you have or think you may have an E. coli infection:

• Difenoxin with atropine (Motofen)
• Diphenoxylate with atropine (Lomotil)
• Loperamide (prescription-strength Imodium)

Home Treatment

Home treatment of infection with disease-causing E. coli bacteria consists of keeping yourself comfortable and preventing the spread of the bacteria. If you aren’t infected, take steps to prevent infection.

If you think that you or someone in your care may be infected with E. coli, contact a doctor immediately. Do not treat diarrhea symptoms with any nonprescription or prescription medicines.

Home treatment for diarrhea or bloody diarrhea caused by

E. coli infection

• Do not use nonprescription antidiarrheal products if you have bloody or non-bloody diarrhea that you suspect may be caused by E. coli infection. These products include Imodium and Maalox Anti-Diarrheal. Do not take other medicines that you have left over from a previous illness.
• Take frequent, small sips of water or a rehydration drink to replace lost fluids and help prevent dehydration. Because dehydration can be more dangerous in babies, call your doctor if you think your baby may be dehydrated. Your stomach cannot handle too much fluid at one time. Seek medical care if you develop signs of moderate dehydration, which include:
  • Dry appearance inside the mouth.
  • Eyes that don’t tear.
  • Low output of urine.
  • Lightheadedness.

Especially in children and adults age 65 and older, watch for symptoms of severe blood and kidney problems, such as fever, weakness, pale skin, or passing small amounts of urine. If any of these symptoms develop, see a doctor immediately.

Tips for protecting yourself against

E. coli infection from contaminated food and water

• Cook ground beef to a temperature of at least 160°F (71°C). Ground beef should be cooked until all pink color is gone, but don’t rely only on color. Check the temperature with a meat thermometer. Cut open restaurant and home-cooked hamburgers to ensure that they have been completely cooked. The juices should be clear or yellowish, with no trace of pink. Never eat raw or undercooked ground beef.
• When preparing food:
  • Wash your hands often with hot, soapy water, especially after handling raw meat.
  • Always wash cooking tools, cutting boards, dishes, counter tops, and utensils with hot, soapy water immediately after they have come into contact with raw meat. Do not put cooked meat back onto a plate that has held raw meat unless the plate has been thoroughly washed with soap and water and dried.
  • Use separate cutting boards for raw meat and for other food items.
  • Keep raw meat, poultry, and seafood separate from vegetables, fruits, breads, and other foods that have already been prepared for eating.
• Use only pasteurized milk, dairy, and juice products. Check product labels for the word “pasteurized.” Juice made from concentrate is the same as pasteurized.
• Use only treated (chlorinated) drinking water.
• Travelers to countries where the water supply may not be safe should be especially careful not to put ice in their drinks or drink tap water. All water consumed should be boiled or bottled. Eat meals when they are hot. Avoid raw fruits and vegetables, except those with skin that you peel yourself.

Tips for preventing person-to-person spread of

E. coli bacteria

• Wash your hands often, and always wash them after bowel movements or changing diapers. If your home has more than one bathroom, restrict the infected person to the use of one bathroom only.
• Dispose of soiled diapers and stools carefully. If the infection is suspected in a young child, use disposable diapers instead of cloth diapers until the illness has passed.
• Adults should make sure that children who have diarrhea wash their hands thoroughly after using the bathroom. Children infected with E. coli should avoid contact with other children, particularly during swimming.
• Wash handles on toilets and sinks with an antibacterial cleaner.
• People who have been diagnosed with E. coli infection should not handle food or work in a day care center or other institution until they have tested negative for the bacteria in two stool samples. If you have taken any antibiotic, the stool sample should be taken at least 48 hours after you took the last dose.
• Chlorinate water in swimming pools and hot tubs.

References

Other Works Consulted

• American Academy of Pediatrics (2015). Escherichia coli diarrhea (including hemolytic-uremic syndrome). In DW Kimberlin et al., eds., Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed., pp. 343–347. Elk Grove Village, IL: American Academy of Pediatrics.
• Procop GW, Cockerill F III (2001). Enteritis caused by Escherichia coli and Shigella and Salmonella species. In WR Wilson et al., eds., Current Diagnosis and Treatment in Infectious Diseases, pp. 548–556. New York: McGraw-Hill.

Credits

Current as of:
September 23, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD – Internal Medicine
Kathleen Romito MD – Family Medicine
Adam Husney MD – Family Medicine
Elizabeth T. Russo MD – Internal Medicine
W. David Colby IV MSc, MD, FRCPC – Infectious Disease

Current as of: September 23, 2020

Author:
Healthwise Staff

Medical Review:E. Gregory Thompson MD – Internal Medicine & Kathleen Romito MD – Family Medicine & Adam Husney MD – Family Medicine & Elizabeth T. Russo MD – Internal Medicine & W. David Colby IV MSc, MD, FRCPC – Infectious Disease

When E. Coli Causes a Urinary Tract Infection

Escherichia coli, commonly known as E. coli, is the cause of approximately 85% of urinary tract infections (UTIs). E. coli can develop in raw produce, unpasteurized fruit juice, raw and undercooked beef, and contaminated water. In most cases, individuals with healthy immune systems do not experience negative symptoms when exposed to E. coli. If an individual has a weakened immune system, he or she can become ill from E. coli exposure. One of the ways a victim can suffer from this type of food poisoning is a UTI.

UTI Symptoms

Symptoms of a UTI include:

• Cloudy urine;
• Blood in the urine, which can cause it to appear red or brown;
• An unusually foul smell to the urine;
• Back pain;
• An overwhelming, persistent urge to urinate;
• Painful urination; and
• Discharge from the urethra.

It can be easy to mistake UTI symptoms for symptoms of other conditions. This is especially common with older UTI patients and women who might mistake UTI symptoms for PMS and menstruation.

How E.Coli can Cause a UTI

E. coli bacteria develop and survive in the intestines. It exits the body through fecal matter, which is why produce fertilized with cow manure is strongly linked with E. coli. When an infected individual’s fecal matter comes into contact with his or her urethra, the individual can develop a UTI. UTIs are more common in women because the urethra opening is closer to the anus, so it is easier for bacteria to spread after using the toilet. A woman’s urethra is also shorter, which makes it easier for E. coli bacteria to reach the bladder and cause an infection.

Treating a UTI

UTIs must be treated with antibiotics. It is a common belief that cranberry juice and other products can treat UTIs, but the truth is that these products can only lessen an individual’s risk of developing one, and even then, data is mixed. They cannot treat an existing infection.

If you experience the symptoms discussed above, seek treatment from your primary care provider. Your doctor can determine whether you are suffering from a UTI or another type of infection and the cause of that infection. He or she can also prescribe antibiotics to fight the infection.

You can reduce your chance of contracting E. coli by always washing your hands thoroughly before and after handling animals and food. Wash all produce completely before you eat it and if you eat beef, be sure to cook it through completely to kill any lingering bacteria.

Work with an Experienced Libertyville Food Poisoning Attorney

A UTI can be extremely painful. When your UTI is the result of another party’s negligence, whether that party was a food retailer, a party host, or a food distributor, you have the right to file a personal injury claim to seek compensation for your damages related to the infection. To learn more about your rights and start working on your claim, contact our team of food poisoning lawyers at Newland & Newland, LLP today to schedule your initial consultation in our office. We serve clients in the Arlington Heights, Palatine, Rolling Meadows, Libertyville, Mundelein, Buffalo Grove, Schaumburg, Elk Grove, and Itasca areas.

(image courtesy of Annie Spratt)

90,000 E. coli is a bacterium commonly found in the lower intestines of warm-blooded organisms.

Overview

The bacterium Escherichia coli (E. coli), which produces shigatoxin, is often found in the intestines of humans and warm-blooded animals. Most E. coli strains are harmless. However, some strains, such as enterohaemorrhagic E. coli (STEC), can cause severe foodborne illness. This bacterium is transmitted to humans primarily through the consumption of contaminated foods, such as raw or undercooked minced meat products, raw milk, and contaminated raw vegetables and sprouts.

STEC produces toxins known as shiga toxins, so named because of their similarity to toxins produced by Shigella dysenteriae. The number of STEC bacteria can increase at temperatures between 7 ° C and 50 ° C (optimum temperature 37 ° C). Some STEC bacteria can grow in acidic foods with a pH of up to 4.4 and foods with a minimum water activity (aw) of 0.95.

Bacteria are killed by careful heat treatment of food – until all parts of the food reach a temperature of 70 ° C or higher.The most significant STEC serotype for public health is E. Coli O157: H7; however, sporadic cases and outbreaks are often caused by other serotypes.

Symptoms

Symptoms of diseases caused by STEC bacteria include abdominal cramps and diarrhea, which in some cases can progress to bloody diarrhea (hemorrhagic colitis). Fever and vomiting are also possible. The incubation period lasts from 3 to 8 days, with an average duration of 3-4 days.Most patients recover within 10 days, but in a small number of patients (especially young children and the elderly), infection can lead to the development of a life-threatening disease such as hemolytic uremic syndrome (HUS). HUS is characterized by acute renal failure, hemolytic anemia, and thrombocytopenia (low platelet count in the blood).

People suffering from bloody diarrhea or severe abdominal cramps should seek medical attention.Antibiotics are not part of the treatment for STEC disease and may increase the risk of developing HUS.

It is estimated that HUS can develop in 10% of patients with STEC infection, and the case fatality rate ranges from 3 to 5%. Globally, HUS is the most common cause of acute renal failure in young children. It can lead to neurological complications (such as convulsions, stroke, and coma) in 25% of patients and chronic kidney disease, usually mild, in about 50% of patients who survive.

Sources and transmission of infection

The information available on STEC refers mainly to serotype O157: H7, since it can be easily differentiated from other E. coli strains from a biochemical point of view. The reservoir of this pathogenic microorganism is mainly cattle. In addition, other ruminants (such as sheep, goats and deer) are considered significant reservoirs, and other infected mammals (such as pigs, horses, rabbits, dogs, cats) and birds (such as chickens and turkeys) are found.

E. coli O157: H7 is transmitted to humans primarily through the consumption of contaminated food such as raw or undercooked minced meat products and raw milk. Faecal contamination of water and other food, as well as cross-contamination during cooking (through beef and other meat products, contaminated work surfaces and kitchen utensils) can also lead to infection. Examples of foods that have caused E.coli O157: H7 include uncooked hamburgers, smoked salami, unpasteurized fresh apple juice, yogurt, and cheese made with raw milk.

A growing number of outbreaks are associated with the consumption of fruits and vegetables (including sprouts, spinach, lettuce, cabbage and lettuce), which can be contaminated by contact with faeces from domestic or wild animals at some stage of their raising or processing. STEC bacteria are also found in water bodies (such as ponds and rivers), wells and livestock drinkers.They can remain viable for several months in the manure and sediment at the bottom of the drinkers. Transmission has also been reported through both contaminated drinking water and recreational waters.

Close contact of people is one of the main routes of transmission of infection (oral-fecal route of infection). Asymptomatic carriers have been reported, that is, individuals who do not show clinical symptoms of the disease, but who are capable of infecting other people.The shedding period of STEC bacteria in adults is about one week or less, while in children this period may be longer. Among the significant risk factors for STEC infection are visits to farms and other places where livestock are kept, where direct contact with them is possible.

Prevention

To prevent infection, control measures must be observed at all stages of the food chain – from agricultural production on farms to processing, processing and preparation of food, both in commercial enterprises and at home.

Industrial

The number of cases can be reduced by implementing a variety of strategies to reduce the risk of minced meat (for example, screening animals before slaughter to prevent large numbers of pathogens from entering slaughterhouses). Good slaughter practices and good hygiene practices reduce faecal contamination of carcasses, but do not guarantee that food is free of STEC bacteria. To minimize microbiological contamination, it is essential to provide training in food hygiene among farm workers, slaughterhouse workers and food processors.The only effective way to kill STEC bacteria in food is through bactericidal treatments such as heating (such as heat treatment or pasteurization) or irradiation.

At home

Prevention measures for E. coli O157: H7 infection are similar to those recommended for the prevention of other foodborne diseases. The key practices for good food hygiene, as outlined in the WHO Five Principles for Improving Food Safety, can help prevent the transmission of pathogens that cause many foodborne diseases, as well as protect against foodborne illness caused by STECs.

The five essential principles for making food safer are:

These recommendations must be followed in all cases, especially the recommendation for “proper cooking food”, in which the temperature in the middle of the food reaches at least 70 ° C. Fruits and vegetables should be washed thoroughly, especially if eaten raw. If possible, vegetables and fruits should be peeled. Vulnerable populations (such as children and the elderly) should avoid eating raw or uncooked meat products, raw milk and products made with raw milk.

Regular hand washing is highly recommended, particularly before preparing food, eating and after using the toilet, especially for people caring for young children, the elderly and people with weakened immune systems, as the bacteria can be transmitted not only through food, water and direct contact with animals, but also from person to person.

A number of STEC infections result from contact with recreational water.Therefore, it is also important to protect such water bodies, as well as sources of drinking water, from animal excrement entering them.

Producers of fruits and vegetables

WHO’s Five Essential Principles for Growing Safer Fruits and Vegetables, for agricultural workers growing fresh fruits and vegetables for themselves, their families and for sale in local markets, provides basic practices for preventing microbial contamination of fresh produce during planting. growing, harvesting and storage.

The five most important principles for growing safer fruits and vegetables are:

• Maintaining good personal hygiene.
• Protection of fields from contamination by animal faeces.
• Use of treated faecal waste.
• Risk assessment and management of irrigation water use.
• Keeping harvest equipment and facilities clean and dry.

WHO activities

WHO conducts scientific assessments for food control for the presence of STEC.These assessments serve as the basis for international food standards, guidelines and recommendations developed by the Codex Alimentarius Commission.

With regard to prevention, WHO has developed a global strategy to reduce the burden of foodborne disease. WHO has developed an advisory message “Five Basic Rules for Safer Foods”. These five rules and their associated training manuals are materials for countries that are easy to use, replicate and adapt to different target audiences.

WHO contributes to strengthening food safety systems by promoting good manufacturing practices and educating retailers and consumers about the proper handling and prevention of food contamination.

During outbreaks of E. coli, such as the 2011 outbreaks in Europe, WHO supports coordination of information exchange and collaboration through the International Health Regulations and the International Food Safety Authorities Network (INFOSAN) in all over the world; WHO works closely with national health authorities and international partners to provide technical assistance and update information on outbreaks.

CURRENT STATE OF ANTIBIOTIC RESISTANCE AND COMPOSITION OF URINARY TRACT CAUSES IN PREGNANT WOMEN | Lokshin

Abstract

Introduction. The main component of the treatment of asymptomatic bacteriuria, acute cystitis and pyelonephritis in pregnant women is antibiotic therapy, which in most patients is prescribed empirically. For a successful choice of a drug, it is necessary to know both the structure of pathogens and the current profile of their antibiotic resistance.

Purpose of the study. Study of the species composition and antibiotic resistance of urinary tract infection (UTI) pathogens in pregnant women in the Moscow region.

Materials and methods. The study included 104 pregnant patients with uncomplicated UTIs who were observed and treated at the Lapino Clinical Hospital in the period from 2016 to 2017. The material for bacteriological studies was the average portion of urine.

Results. 90 patients were diagnosed with asymptomatic bacteriuria, 10 with acute cystitis and 4 with acute gestational pyelonephritis.The structure of pathogens of UTI is represented by: E. coli, Enterococcus faecalis, Klebsiella pneumoniae, Proteus spp., Staphylococcus spp., Streptococcus spp., Enterobacter cloacae. The most frequently detected pathogens were E. coli (67.3%) and fecal enterococcus (50%). Resistance of E. coli strains more than 20% was detected to ampicillin (36.4%), amoxicillin / clavulanate (23.2%), trimethoprim / sulfamethoxazole (27.4%), knalidixic acid (20.7%), cephalosporins 2 and 3 generations (25.7% and 24.3%, respectively).More than 20% of enterobacterial taxa were resistant to trimethoprim / sulfamethoxazole (24.4%), nalidixic acid (20.7%), 2nd generation cephalosporins (21.7%). Antibiotic resistance of E. coli and other enterobacteriaceae less than 10% was observed only in relation to carbapenems (0%) and fosfomycin (1.5% and 3.5%, respectively).

Conclusions. It is advisable to use the data obtained on the composition and sensitivity profile of uropathogens in UTI in pregnant women when choosing a starting empiric antibiotic therapy.

Disclosure: The study was not sponsored. The authors declare that they have no conflicts of interest.

Introduction

Urinary tract infections (UTIs) are one of the most common reasons for pregnant women to visit a urologist. The main component of the treatment of asymptomatic bacteriuria, acute cystitis and acute acute pyelonephritis in pregnant women is antibiotic therapy, which in most patients is prescribed empirically. It is obvious that for a successful choice of a drug, it is necessary to know both the structure of pathogens and the current profile of their antibiotic resistance.As a result of numerous previous studies, it has been established that community-acquired urinary tract infections in both pregnant and non-pregnant women, as a rule (in 70-90% of cases) are caused by E. coli and other members of the Enterobacteriacaeae family, and other pathogens are much less common [1 ] [2] [3] [4] [5]. At the same time, the composition of uropathogens in individual countries and even cities can not only have significant differences, but also change over time. In Russia, the largest and most authoritative study of the epidemiology of uropathogens (incl.including in pregnant women) is the study “DARMIS”, published in 2012 and showed the microbial landscape of community-acquired UTIs in the country as of 2010-2011. [6]. The study presented the characteristics of 152 strains of UTI pathogens in pregnant women collected from all over the country. According to our information, there have been no studies of UTIs in pregnant women of a similar volume and quality in the Moscow region in recent years.

It should be emphasized, however, that knowledge of the actual composition of uropathogens is not enough to select the optimal empirical antibiotic therapy.No less important is the modern profile of their antibiotic resistance, which also not only changes over time, but can differ significantly from region to region. All over the world, including Russia, there is a tendency towards a decrease in the sensitivity of UTI pathogens to the most commonly used antibacterial drugs. If the level of resistance to any antibiotic in the region is more than 1020%, this requires limiting its use as an empirical therapy [7].

The lack of up-to-date data on the composition and sensitivity of UTI pathogens in pregnant women in the Moscow region created the prerequisites for our study.

Material and methods

As part of a retrospective study of the composition and antibiotic resistance of UTI pathogens, we analyzed clinical data and the results of bacteriological studies in 104 pregnant women who were observed and treated at the Lapino Clinical Hospital in the period from 2016 to 2017.Only pregnant women with uncomplicated UTIs were included in the study. The exclusion criterion was the presence of such risk factors for resistant flora as stones in the urinary tract, severe concomitant diseases (for example, diabetes mellitus, renal failure), drainage / catheterization of the urinary tract, urological interventions in a gestational history, prolonged (3 or more days) hospitalization, and / or taking any antibacterial drugs within 3 months before the diagnosis of UTI.

The source of clinical data on patients (symptoms, anamnesis, results of physical and laboratory examinations, ultrasound data) was the electronic medical history of the Medialog medical information system.

The biological material for bacteriological research was the average portion of urine obtained after the toilet of the genitals. Bacteriological examination of clinical material was carried out in a local microbiological laboratory. In accordance with the clinical recommendations of the European Association of Urologists (EAU), a clinically significant titer of pathogens in asymptomatic bacteriuria was considered CFU 10 90 120 5 90 121 and more, in acute cystitis – 10 90 120 3 90 121 and more, in acute pyelonephritis – 10 90 120 4 90 121 and more [8 ].The sensitivity of pathogens to antibacterial drugs was determined by the diffusion-disk method in accordance with the EUCAST (European Committee on Anbmicrobial Suscepbbility Tesbng) criteria [9].

Statistical calculations were performed using MedCalc Stabsbcal Software version 17.0.4 (MedCalc Software bvba, Ostend, Belgium; https://www.medcalc.org; 2017).

Results

The study analyzed the results of positive bacteriological urine cultures obtained from 104 pregnant women with various urinary tract infections who had no known risk factors for resistant flora.In 90 patients, asymptomatic bacteriuria was diagnosed, in 10 – acute cystitis and in 4 – acute gestational pyelonephritis.

As a result of bacteriological research, 148 strains were identified, with the only pathogen detected in 60 (57.7%) patients, and two pathogens were detected in 44 (42.3%) patients. In the case of detection of two microorganisms, in the vast majority of cases (in 42 out of 44 patients) it was Enterococcus faecalis. E. coli was the most frequently detected pathogen – it was found in 70 (67.3%) patients.In general, members of the Enterobacteriaceae family were identified in 88.46% of patients. The second most detectable microorganism was fecal enterococcus – it was obtained in 52 (50%) patients. The structure of the identified pathogens is presented in Table 1.

Table 1. Structure of pathogens of community-acquired urinary tract infections isolated from pregnant women

Table 1. Pathogens of nosocomial urinary tract infections, isolated from pregnant women

It should be noted that the clinical significance of fecal enterococcus in UTI in general and in pregnant women, in particular, is highly controversial.In our cohort of patients, in the overwhelming majority of cases (in 42 out of 52 – in 80.8%), it was detected as the second microorganism, while the first pathogen was always a representative of Enterobacteriaceae. Only in 10 cultures fecal enterococcus was identified as the only causative agent: in 9 patients with asymptomatic bacteriuria and in 1 patient with symptoms of cystitis, but without leukocyturia. All identified enterococci had a similar resistance profile with 100% sensitivity to ampicillin, nitrofurantoin, carbopenems, and vancomycin.

The main interest, in our opinion, is the data on antibiotic susceptibility of E. coli and all identified members of the Enterobacteriaceae family (E. coli, Klebsiella pneumoniae, Proteus spp. And Enterobacter cloacae). Data on the sensitivity of Escherichia coli to the main groups of antibiotics are presented in Table 2.

Table 2. Escherichia coli sensitivity to the main groups of antibiotics

Table 2. The sensitivity of E. coli to the main groups of antibiotics

As can be seen from the table, pregnant women have a very high frequency of isolation of resistant E.coli to ampicillin (63.6%).

Also, the resistance of E. coli more than 20% was revealed to amoxicillin / clavulanate (23.2%), to trimethoprim / sulfamethoxazole (27.4%), to nalidixic acid (20.7%), as well as to cephalosporins of the 2nd and 3rd generation (respectively, 25.7% and 24.3%). E. coli resistance within 10-20% was detected in fluoroquinolones of the 2nd and 3rd generations (17.1%), in nitrofurantoin (15.3%), in gentamicin (18.75%) and tetracyclines (15.3%). Isolation of resistant E. coli less than 10% was noted only in relation to fosfomycin (1.5%) and carbapenems (0%).

Data on the sensitivity of the Enterobacteriaceae family to the main groups of antibiotics are presented in Table 3.

Table 3. Sensitivity of members of the Enterobacteriaceae family to the main groups of antibiotics

Table 3. Sensitivity representatives of the Enterobacteriaceae family to the main groups of antibiotics

E. coli

Microorganisms are always present in food.Pathogenic microorganisms can be killed by processing food. They can multiply rapidly due to improper transportation, storage, preparation, or feeding. An increase in the number of these microorganisms can lead not only to food spoilage, but also cause serious poisoning. A common representative of foodborne pathogenic bacteria is Escherichia coli. E. coli is part of the intestinal microflora of humans and animals.

Some types of Escherichia coli are pathogenic for humans, that is, they can cause disease.

Escherichia coli bacteria are a universal indicator of food quality. The presence of E. coli is an indicator of faecal contamination, especially water.

Unfortunately, we cannot tell from the appearance, smell or taste if food is contaminated with E. coli.

E. coli can be contaminated with many foods, including beef, herbs, ready-to-eat salads, fruits, raw milk and raw dough, slicing sausages, cheeses, especially in market conditions where the cutting machine is not always processed, mincers for minced meat …E. coli actively multiplies during rotting food.

The mechanism of transmission of the pathogen is focal-oral. Infection occurs through food, water, dirty hands.

This bacterium is capable of producing toxins (25 types) and, depending on the type of toxin produced by E. coli, it has a certain effect.

For example, enterotoxigenic E. coli have a high molecular weight thermolabile toxin that acts similarly to cholera, causing cholera-like diarrhea (gastroenteritis in young children, traveler’s diarrhea, etc.)).

Enteroinvasive Escherichia coli cause profuse diarrhea with an admixture of blood and a large number of leukocytes (similar to dysentery).

Enteropathogenic E. coli cause watery diarrhea and severe dehydration.

Enterohaemorrhagic Escherichia coli cause bloody diarrhea.

Symptoms

Symptoms of food poisoning of E. coli poisoning: abdominal pain, nausea, vomiting, diarrhea more than 20 times a day, possibly with blood.Body temperature usually rises slightly or remains normal.

E. coli is the most common pathogen causing meningitis in newborn babies. It has high rates of morbidity and mortality worldwide.

At risk

-Adults aged 65 and over

-Children under 5 years

-People with weakened immune systems, including pregnant women

-People who travel to certain countries

Prevention

To protect yourself from E. coli infections and other foodborne diseases, follow these basic safety rules:

-Wash your hands, utensils and kitchen surfaces with hot soapy water before and after cooking or eating.

– Use separate cutting boards for raw and cooked food

– Thoroughly wash fruits and vegetables, use a vegetable brush.

– Keep raw foods, especially meat and poultry, separate from ready-to-eat foods.

– Chill or freeze perishable food as quickly as possible.

– Avoid unpasteurized juices, dairy products.

– Do not eat raw dough.

– Drink bottled water.

-Thoroughly fry the meat.

Everything about Escherichia coli | Domestos

Causes of E. coli transmission, causes and channels of its spread, as well as methods of prevention.

E. coli is a bacteria that can harm your health. Learning how to kill and prevent E. coli can help you reduce your risk of infection and keep it from spreading.

We will help you deal with questions such as “E. coli: causes”, “how is E. coli transmitted?” and how Domestos can help kill harmful bacteria living in your toilet and prevent the spread of the disease.Let’s take a closer look at what this bacterium is.

INTESTINAL RECIPE: SYMPTOMS

E. coli is a rod-shaped bacterium that lives in the human intestine and has many varieties. Most of them are harmless microorganisms, but there are some that lead to serious health problems. E. coli is caused by poor hygiene and cleanliness, so the use of chlorine-containing detergents such as Domestos is necessary.

Before answering the questions “where does Escherichia coli come from?” and “how is Escherichia coli transmitted?” mention should be made of symptoms associated with infection such as vomiting, stomach cramps and fever.

INTESTINAL WICK: REASONS

One of the first steps to prevent E. coli in your home should be to answer the question “how is E. coli transmitted?” There are several main reasons for this:

• Contaminated food:

  Infected bacteria can be found in meat of cattle, including beef and lamb, as E. coli bacteria can be found in the intestines of animals.In addition, farm products can also be contaminated: greens, fruits and vegetables.

• Infected Water:

  It is very easy to catch E. coli by drinking water from an infected source.

All the reasons described above are the answer to the question “where does Escherichia coli come from?” Now let’s move on to the most important thing – the prevention of E. coli in your home.

IS THE INTESTINAL STICK TRANSFERRED?

The presence of harmless species of E. coli is the norm for the human intestinal microflora.These bacteria are good for your health by preventing other disease-causing bacteria from growing in your gut. However, if the digestive tract is disrupted, the harmless rate of Escherichia coli may increase and then a doctor’s consultation is necessary.

Unfortunately, E. coli is contagious and thus even more dangerous. E. coli is transmitted from person to person by airborne droplets and sexually. In addition to direct contact with an infected person, the infection can be transmitted through the consumption of poor-quality food or contaminated water.

INTESTINAL WICK: PREVENTION WITH PERSONAL HYGIENE

To stop the spread of E. coli, it is imperative to wash your hands:

• After handling animals

• After any contact with an infected person

• After any contact with an infected person

• After any contact with an infected person

• After changing diapers, dirty clothes or bedclothes

• After using the toilet

• After cleaning

INTESTINAL STICK: PREVENTION AT HOME

Now let’s move on to household cleaning – an important part of preventing intestinal colds.Follow these simple tips to protect your home:

• Clean your bathroom and toilet thoroughly – use chlorine-based cleaners when cleaning sinks, plumbing fixtures and all hard surfaces. Particular attention should be paid to the toilet, as it is one of the main sources of the spread of E. coli. Using Domestos will help kill all harmful bacteria in your toilet and bathroom. Such a cleaning agent will save you time and also take care of your health.However, before using any new product, be sure to test it and read the instructions carefully.

• Wipe down all pens in your home to prevent the spread of bacteria.

• Wipe down the washing machine after washing dirty clothes and bed linen.

When it comes to disinfecting your home, chlorine-based cleaners are becoming the mainstay of hygiene. Numerous studies have repeatedly shown the effectiveness of Domestos gel containing chlorine in killing harmful bacteria and in the fight against intestinal infections.