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What antibiotic treats ecoli: Escherichia coli – Infectious Disease and Antimicrobial Agents

by alexxlab

Antibiotics, Cephalosporins, 3rd Generation, Penicillins, Amino, Penicillins, Extended-Spectrum, Fluoroquinolones, Tetracyclines, Sulfonamides, Monobactams, Carbapenems

  1. Bennett JE, Dolin R, Blaser MJ. Enterobacteriaceae. Mandell, Douglas, and Bennett’s Principles and Practices of Infectious Diseases. 9th. Philadelphia, PA: Elsevier; 2020. 2673.

  2. Bennett JE, Dolin R, Blaser MJ. Enterobacteriaceae. Mandell, Douglas, and Bennett’s Principles and Practices of Infectious Diseases. 9th. Philadelphia, PA: Elsevier; 2020. 2679.

  3. Kermorvant-Duchemin, E; Laborie, S; Rabilloud, M; Lapillonne, A; Claris, O. Outcome and prognostic factors in neonates with septic shock. Pediatric Critical Care Medicine. March 2008. 9:186-191. [QxMD MEDLINE Link]. [Full Text].

  4. com”>Khadka, P, Khadka P, Thapaliya, J, Bikram Karkee, et al. Fatal strongyloidiasis after corticosteroid therapy for presumed chronic obstructive pulmonary disease. JMM Case Reports. Sep 2018. 5:[QxMD MEDLINE Link]. [Full Text].

  5. Medina, M; Castillo-Pino, E. An introduction to the epidemiology and burden of urinary tract infections. Therapeutic Advances in Urology. 02May2019. [QxMD MEDLINE Link]. [Full Text].

  6. Frank C, Werber D, Cramer JP, Askar M, Faber M, an der Heiden M, et al. Epidemic profile of Shiga-toxin-producing Escherichia coli O104:h5 outbreak in Germany. N Engl J Med. 2011 Nov 10. 365(19):1771-80. [QxMD MEDLINE Link].

  7. Buchholz U, Bernard H, Werber D, Böhmer MM, Remschmidt C, Wilking H, et al. German outbreak of Escherichia coli O104:h5 associated with sprouts. N Engl J Med. 2011 Nov 10. 365(19):1763-70. [QxMD MEDLINE Link].

  8. Camins BC, Marschall J, De Vader SR, Maker DE, Hoffman MW, Fraser VJ. The clinical impact of fluoroquinolone resistance in patients with E coli bacteremia. J Hosp Med. 2011 Jul. 6(6):344-9. [QxMD MEDLINE Link]. [Full Text].

  9. Walmsley RS, David DB, Allan RN, Kirkby GR. Bilateral endogenous Escherichia coli endophthalmitis: a devastating complication in an insulin-dependent diabetic. Postgrad Med J. 1996 Jun. 72(848):361-3. [QxMD MEDLINE Link].

  10. [Guideline] Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine. October 2019. 200:e45-e67. [Full Text].

  11. [Guideline] Nicolle LE, Gupta K, Bradley SF, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 21 March 2019. 68:e83-e110. [Full Text].

  12. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010 Jan 15. 50 (2):133-64. [QxMD MEDLINE Link].

  13. McGannon CM, Fuller CA, Weiss AA. Different classes of antibiotics differentially influence shiga toxin production. Antimicrob Agents Chemother. 2010 Sep. 54(9):3790-8. [QxMD MEDLINE Link].

  14. Pitout JD, Laupland KB. Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis. 2008 Mar. 8(3):159-66. [QxMD MEDLINE Link].

  15. Melzer M, Petersen I. Mortality following bacteraemic infection caused by extended spectrum beta-lactamase (ESBL) producing E. coli compared to non-ESBL producing E. coli. J Infect. 2007 Sep. 55(3):254-9. [QxMD MEDLINE Link].

  16. Doi Y, Park YS, Rivera JI, Adams-Haduch JM, Hingwe A, Sordillo EM, et al. Community-associated extended-spectrum ß-lactamase-producing Escherichia coli infection in the United States. Clin Infect Dis. 2013 Mar. 56(5):641-8. [QxMD MEDLINE Link]. [Full Text].

  17. Batard E, Ollivier F, Boutoille D, Hardouin JB, Montassier E, Caillon J, et al. Relationship between hospital antibiotic use and quinolone resistance in Escherichia coli. Int J Infect Dis. 2012 Nov 22. [QxMD MEDLINE Link].

  18. Karlowsky JA, Denisuik AJ, Lagacé-Wiens PR, Adam HJ, Baxter MR, Hoban DJ, et al. In Vitro Activity of Fosfomycin against Escherichia coli Isolated from Patients with Urinary Tract Infections in Canada; CANWARD Surveillance Study. Antimicrob Agents Chemother. 2013 Dec 9. [QxMD MEDLINE Link].

  19. Agustin ET, Gill V, Domenico P. CSF gram stain in meningitis. Intern Med. 1994. 15:14-24.

  20. Barnett BJ, Stephens DS. Urinary tract infection: an overview. Am J Med Sci. 1997 Oct. 314(4):245-9. [QxMD MEDLINE Link].

  21. Boam WD, Miser WF. Acute focal bacterial pyelonephritis. Am Fam Physician. 1995 Sep 1. 52(3):919-24. [QxMD MEDLINE Link].

  22. Bohnen JM. Antibiotic therapy for abdominal infection. World J Surg. 1998 Feb. 22(2):152-7. [QxMD MEDLINE Link].

  23. Bonoan JT, Mehra S, Cunha BA. Emphysematous pyelonephritis. Heart Lung. 1997 Nov-Dec. 26(6):501-3. [QxMD MEDLINE Link].

  24. Carpenter HA. Bacterial and parasitic cholangitis. Mayo Clin Proc. 1998 May. 73(5):473-8. [QxMD MEDLINE Link].

  25. Childs SJ. Current concepts in the treatment of urinary tract infections and prostatitis. Am J Med. 1991 Dec 30. 91(6A):120S-123S. [QxMD MEDLINE Link].

  26. Cunha BA. Abdominal pain in patients with diabetis mellitus. Infect Dis Prac. 1997. 21:14-5.

  27. webmd.com”>Cunha BA. Acute acalculous cholecystitis. Infect Dis Prac. 1997. 21:70-1.

  28. Cunha BA. Acute and chronic bacterial prostatitis. Infect Dis Prac. 1994. 18:78-9.

  29. Cunha BA. Antibiotic concentration dependent susceptibility of urinary tract isolates. Antib Clinician. 1999. 3:57-8.

  30. Cunha BA. Quinolones: Clinical aspects. Antib Clinician. 1998. 2:129-35.

  31. Cunha BA. The fluoroquinolones for urinary tract infections: a review. Adv Ther. 1994 Nov-Dec. 11(6):277-96. [QxMD MEDLINE Link].

  32. Cunha BA. Therapeutic approach in treating UTIs. Antib Clinician. 1998. 2(S2):35-40.

  33. Cunha BA. Urine gram stain in urosepsis. Intern Med. 1997. 18:75-8.

  34. Cunha BA. Urosepsis. J Crit Ill. 1997. 12:616-25.

  35. Donnenberg MS, Kaper JB. Enteropathogenic Escherichia coli. Infect Immun. 1992 Oct. 60(10):3953-61. [QxMD MEDLINE Link].

  36. DuPont HL. Travellers’ diarrhoea: contemporary approaches to therapy and prevention. Drugs. 2006. 66(3):303-14. [QxMD MEDLINE Link].

  37. Eisenstein BI, Jones GW. The spectrum of infections and pathogenic mechanisms of Escherichia coli. Adv Intern Med. 1988. 33:231-52. [QxMD MEDLINE Link].

  38. Glandt M, Adachi JA, Mathewson JJ, Jiang ZD, DiCesare D, Ashley D. Enteroaggregative Escherichia coli as a cause of traveler’s diarrhea: clinical response to ciprofloxacin. Clin Infect Dis. 1999 Aug. 29(2):335-8. [QxMD MEDLINE Link].

  39. Gold R. Bacterial meningitis–1982. Am J Med. 1983 Jul 28. 75(1B):98-101. [QxMD MEDLINE Link].

  40. Hansing CE, Allen VD, Cherry JD. Escherichia coli endocarditis. A review of the literature and a case study. Arch Intern Med. 1967 Oct. 120(4):472-7. [QxMD MEDLINE Link].

  41. Harrington SM, Dudley EG, Nataro JP. Pathogenesis of enteroaggregative Escherichia coli infection. FEMS Microbiol Lett. 2006 Jan. 254(1):12-8. [QxMD MEDLINE Link].

  42. Harvey D, Holt DE, Bedford H. Bacterial meningitis in the newborn: a prospective study of mortality and morbidity. Semin Perinatol. 1999 Jun. 23(3):218-25. [QxMD MEDLINE Link].

  43. Johnson JR. Virulence factors in Escherichia coli urinary tract infection. Clin Microbiol Rev. 1991 Jan. 4(1):80-128. [QxMD MEDLINE Link].

  44. Jonas M, Cunha BA. Bacteremic Escherichia coli pneumonia. Arch Intern Med. 1982 Nov. 142(12):2157-9. [QxMD MEDLINE Link].

  45. Klein NC, Cunha BA. Third-generation cephalosporins. Med Clin North Am. 1995 Jul. 79(4):705-19. [QxMD MEDLINE Link].

  46. Koutkia P, Mylonakis E, Flanigan T. Enterohemorrhagic Escherichia coli O157:H7–an emerging pathogen. Am Fam Physician. 1997 Sep 1. 56(3):853-6, 859-61. [QxMD MEDLINE Link].

  47. Lepelletier D, Caroff N, Reynaud A, Richet H. Escherichia coli: epidemiology and analysis of risk factors for infections caused by resistant strains. Clin Infect Dis. 1999 Sep. 29(3):548-52. [QxMD MEDLINE Link].

  48. webmd.com”>Lerner AM. The gram-negative bacillary pneumonias. Dis Mon. 1980 Nov. 27(2):1-56. [QxMD MEDLINE Link].

  49. McDonald MI. Pyogenic liver abscess: diagnosis, bacteriology and treatment. Eur J Clin Microbiol. 1984 Dec. 3(6):506-9. [QxMD MEDLINE Link].

  50. Mead PS, Griffin PM. Escherichia coli O157:H7. Lancet. 1998 Oct 10. 352(9135):1207-12. [QxMD MEDLINE Link].

  51. Moon HW. Pathogenesis of enteric diseases caused by Escherichia coli. Adv Vet Sci Comp Med. 1974. 18(0):179-211. [QxMD MEDLINE Link].

  52. Neu HC. Infections due to gram-negative bacteria: an overview. Rev Infect Dis. 1985 Nov-Dec. 7 Suppl 4:S778-82. [QxMD MEDLINE Link].

  53. Nordmann P. Trends in beta-lactam resistance among Enterobacteriaceae. Clin Infect Dis. 1998 Aug. 27 Suppl 1:S100-6. [QxMD MEDLINE Link].

  54. Ortega AM, Cunha BA. Acute prostatitis. Contemp Urol. 1997. 18:73-80.

  55. Palmer DL. Microbiology of pneumonia in the patient at risk. Am J Med. 1984 May 15. 76(5A):53-60. [QxMD MEDLINE Link].

  56. Phillips AD, Frankel G. Mechanisms of gut damage by Escherichia coli. Baillieres Clin Gastroenterol. 1997 Sep. 11(3):465-83. [QxMD MEDLINE Link].

  57. Roberts JA. Pyelonephritis, cortical abscess, and perinephric abscess. Urol Clin North Am. 1986 Nov. 13(4):637-45. [QxMD MEDLINE Link].

  58. Savatta D, Cunha BA. Acute pyelonephritis and its mimics: Xanthogranulomaotus pyelonephritis and malacoplakia. Infect Dis Prac. 1996. 20:86-8.

  59. Schimpff SC. Gram-negative bacteremia. Support Care Cancer. 1993 Jan. 1(1):5-18. [QxMD MEDLINE Link].

  60. Schindzielorz A, Edberg SC, Bia FJ. Strongyloides stercoralis hyperinfection and central nervous system involvement in a patient with relapsing polychondritis. South Med J. 1991 Aug. 84(8):1055-7. [QxMD MEDLINE Link].

  61. Shea KW, Cunha BA. Escherichia coli sternal osteomyelitis after open heart surgery. Heart Lung. 1995 Mar-Apr. 24(2):177-8. [QxMD MEDLINE Link].

  62. Tabacof J, Feher O, Katz A, et al. Strongyloides hyperinfection in two patients with lymphoma, purulent meningitis, and sepsis. Cancer. 1991 Oct 15. 68(8):1821-3. [QxMD MEDLINE Link].

  63. Tan JS, File TM. Urinary tract infections in obstetrics and gynecology. J Reprod Med. 1990 Mar. 35(3 Suppl):339-42. [QxMD MEDLINE Link].

  64. Tenner SM, Yadven MW, Kimmel PL. Acute pyelonephritis. Preventing complications through prompt diagnosis and proper therapy. Postgrad Med. 1992 Feb 1. 91(2):261-8. [QxMD MEDLINE Link].

  65. Tice AD. Short-course therapy of acute cystitis: a brief review of therapeutic strategies. J Antimicrob Chemother. 1999 Mar. 43 Suppl A:85-93. [QxMD MEDLINE Link].

  66. Wanke CA. Escherichia coli. J Diarrhoeal Dis Res. 1988 Mar. 6(1):1-5. [QxMD MEDLINE Link].

  67. Weinberger M, Cytron S, Servadio C, et al. Prostatic abscess in the antibiotic era. Rev Infect Dis. 1988 Mar-Apr. 10(2):239-49. [QxMD MEDLINE Link].

  68. webmd.com”>Westphal JF, Brogard JM. Biliary tract infections: a guide to drug treatment. Drugs. 1999 Jan. 57(1):81-91. [QxMD MEDLINE Link].

  69. Whipp SC, Rasmussen MA, Cray WC Jr. Animals as a source of Escherichia coli pathogenic for human beings. J Am Vet Med Assoc. 1994 Apr 15. 204(8):1168-75. [QxMD MEDLINE Link].

Combinations of Up To 5 Antibiotics May Work Against Resistant E Coli

The conventional approach to fighting resistant E coli infections typically involves the use of no more than 2 antibiotics; however, combining as many as 5 may be the trick to fighting these infections.

Drug-resistant Escherichia coli (E coli) bacteria are a growing public health threat, but investigators at the University of California, Los Angeles, say that combinations of up to 4 or 5 antibiotics may be effective at killing these harmful pathogens.

While most E coli are safe and part of healthy intestinal microflora, pathogenic forms of the bacteria cause intestinal illness. Exposure from contaminated food or water can lead to symptoms such as abdominal cramping, diarrhea, and vomiting, which can lead to life-threatening complications.

A 2018 E coli outbreak in 36 states linked to contaminated romaine lettuce was the largest E coli outbreak since 2006, leading to 210 reported cases, 96 hospitalizations, and 5 deaths. While most intestinal E. coli infections pass within a week, cases of pneumonia, meningitis, or urinary tract infections from the pathogen are typically treated with an antibiotic such as a third-generation cephalosporin. Increasingly, however, E coli are becoming resistant to antibiotics by producing extended-spectrum beta-lactamase, an enzyme rendering certain antibiotics ineffective and leading to multi-drug resistance.

Antibiotic-resistant E coli is a growing global problem, and in the United States, public health officials worry that the emergence of the mcr-1 gene in a number of pathogenic bacteria could make more superbugs resistant to even last-resort drugs such as colistin. While scientists have, in the past, discouraged combining more than 2 antibiotics to fight a resistant pathogen, a new study by UCLA investigators suggests that using as many as 5 antibiotics in tandem may be an effective strategy against resistant infections.

In the study, published on September 3, 2018 in the journal npj Systems Biology and Applications, investigators used 8 antibiotic drugs to create a total of 18,278 combinations of 2 to 5 drugs and study their interactive effects on E coli. Testing how the combinations affected bacterial growth responses, the research team found that of the combinations of 4 drugs, 1,676 performed better than they expected. Of the 5-drug combinations, 6,443 were more effective than expected. Many combinations also performed below the team’s expectations, including 2,331 4-drug combinations and 5,199 5-drug combinations.

“There is a tradition of using just 1 drug, maybe 2,” said one of the study’s senior authors Pamela Yeh, PhD, in a recent statement. The authors note that some combinations were effective because the medications target E coli in different ways, such as attacking cell walls or the bacteria’s DNA. “We’re offering an alternative that looks very promising. We shouldn’t limit ourselves to just single drugs or 2-drug combinations in our medical toolbox. We expect several of these combinations, or more will work much better than existing antibiotics.”

While the investigators say they’ve found antibiotic combinations that are effective in a laboratory setting, much more testing is required before these combinations can be considered ready for testing in humans. “With the specter of antibiotic resistance threatening to turn back health care to the pre-antibiotic era, the ability to more judiciously use combinations of existing antibiotics that singly are losing potency is welcome,” Michael Kurilla, MD, PhD, director of the Division of Clinical Innovation at the National Institutes of Health/National Center for Advancing Translational Sciences said. “This work will accelerate the testing in humans of promising antibiotic combinations for bacterial infections that we are ill-equipped to deal with today.”

Escherichia coli . ABC of antibiotic therapy. Vidal medicines guide

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The materials are intended exclusively for physicians and specialists with higher medical education. Articles are informational and educational in nature. Self-medication and self-diagnosis are extremely dangerous for health. The author of the articles does not give medical advice: a clinical pharmacologist is a doctor only and exclusively for doctors.

Author: Trubacheva E. S.,
doctor – clinical pharmacologist

With this article we begin our consideration of representatives of the microbiological world, with whom we most often meet in daily clinical practice, and the topic of today’s conversation will be Escherichia coli, it is also Escherichia coli li ).

The relevance of the discussion of this microorganism lies in the fact that E. coli is a champion in creating problems for both patients and medical staff in hospitals and outpatient services. Only Klebsiella is worse than her, but we’ll talk about it later. At the same time E. coli does not fly through the air and does not have legs for independent movement and infection with it is almost always a “dirty hand disease”. With the pathology caused by this pathogen, the patient can come to any doctor, and the medical staff can bring E. coli on their hands to any patient with only one difference – it will not be a wild and pretty animal killed by ordinary amoxicillin, but an individual armed to the teeth, able to kill herself very effectively. That is, this is one of those enemies that you definitely need to know in person.

Microbiological aspects

E. coli is a typical member of the family Enterobacteriacea e is a gram-negative bacterium, optional nym anaerobe as part of the normal human intestinal microflora. But it immediately becomes a pathogen, having got out of its normal habitat, although some strains are also pathogenic for the gastrointestinal tract. That is, E. coli refers to intestinal commensals, intestinal pathogens and extra-intestinal pathogens, each of which we will briefly analyze.

The more common strains E. coli are:

  1. Strain serotype O157:H7 (STEC O157 ) or the so-called enterohemorrhagic strain E.coli , which is the cause of 90% of cases of hemorrhagic colitis and 10% of cases of hemolytic uremic syndrome. It occurs quite often, and if you work in hospitals for planned care, then this is one of the mandatory analyzes for making a decision on hospitalization, so one way or another it is heard. The problem of infection with this pathogen is associated with the use of poorly thermally processed food and the transmission of the strain by contact from person to person, in other words, through the hands.
  2. The second extremely dangerous highly pathogenic strain of Escherichia coli – O104:h5, which caused an epidemic in Germany in 2011 with a high mortality rate among patients with food toxic infections due to the development of hemolytic uremic syndrome. If you remember, it was a very loud story with border closures for Spanish cucumbers, then in general for all fruit and vegetable products from Europe to Russia, while they were looking for at least a source, not to mention the culprit of those events. Lettuce leaves, which were irrigated with water with signs of fecal contamination, were finally blamed, and then it was about germinated seeds, which were also watered with fecal-infected water. So went out on a specific strain E. coli – O104:h5, which, after being sanitized with an antibiotic, splashes out endotoxin, which causes hemolysis and acute renal failure. As a result, mass mortality of patients treated with antibiotics.

The same strain was then found in an outbreak of PTI in Finland, but by that time, patients with diarrhea were no longer treated with bactericidal antibiotics until microbiological results were available and the situation was nipped in the bud.

And the third high-profile (for our country) case is a mass disease of St. Petersburg schoolchildren in Georgia, where this strain was also detected (the press release of Rospotrebnadzor on this case is here).

  1. In addition to the above, there are enterotoxic (cause “traveler’s diarrhea”), enteroinvasive (cause bloody diarrhea) and enteropathogenic (watery diarrhea in newborns) strains.

When is E. coli an extraintestinal pathogen ? Almost always when found outside of its normal habitat.

  1. Diseases of the urinary tract . Here E. coli is the absolute leader and plays a leading role in development:
  • Acute cystitis
  • Pyelonephritis
  • Renal abscesses and
  • Prostatitis

This fact is explained by the close anatomical location of the two systems and flaws in personal hygiene, which makes it possible to immediately prescribe drugs that are active against Escherichia coli at the stage of empirical therapy for the above diseases.

  1. Diseases of the gastrointestinal tract :
  • Traveler’s diarrhea
  • Intra-abdominal abscesses and peritonitis, most often of a secondary nature (perforation of the intestine as a result of a primary disease, or with defects in surgical intervention)
  1. Infections of the central nervous system in very debilitated patients, resulting in the development of meningitis. It occurs mainly in the elderly and newborns. In addition, in the case of nosocomial infection, meningitis can develop as a result of poor treatment of the hands of medical personnel before surgery or dressings.
  2. Bloodstream infections , namely sepsis, as a continuation of the development of diseases of the urinary tract, gastrointestinal tract and biliary tract due to metastasis of the focus of infection. It is extremely difficult to treat, especially if nosocomial strains are involved, the lethality is extremely high.
  3. Infections of the skin and soft tissues as a result of wound infections after interventions on the abdominal organs.
  4. Nosocomial pneumonia , caused by resistant strains of E. coli, is entirely associated with defects in patient care and the factor of cleanliness, or rather its absence, of the hands of medical personnel or caring relatives. The fact of nosocomial infection is proved elementarily, which will be clearly demonstrated in the next section.
  5. Postpartum (and not only) endometritis . We are forced to mention this pathology as well, since infection with Escherichia coli occurs more and more often, and there is no great alertness. As a result, it is possible to miss the antibiotic therapy very badly and, as a result, come to the extirpation of the organ due to the ineffectiveness of antibiotic therapy. A later than usual arrival and a more aggressive course than usual may suggest an idea. An additional examination of the prianal region can also lead to the likelihood of developing just such an infection.

(part two) Practical issues of diagnosis and treatment.

When can we suspect that we have a patient with an E. coli infection?

  • Patients with diarrhea who returned from vacation and were still able to attend (traveler’s diarrhea or enterotoxigenic E. coli strains).
  • Patients with all diseases of the urinary system, including pregnant women, but strictly symptomatic (no need to treat asymptomatic bacteriuria, otherwise you will grow resistant strains and create a problem for yourself, the woman, and the maternity hospital in the future).
  • In hospitals – nosocomial pneumonia, postoperative meningitis, peritonitis, sepsis, etc., which are secondary.

Only microbiological examination can confirm or completely exclude E. coli from pathogens. Of course, in modern conditions, microbiology is already becoming almost exclusive, but we came to learn, and we need to learn from the right examples, so a number of antibiograms performed by automated testing systems will be considered below. Suddenly you are lucky, and your medical institution already has everything or will soon, and you already know how to work with it all?

If you read this cycle in order, then in the basic section on microbiology, a series of antibiograms of a certain microorganism was laid out in the context of an increase in antibiotic resistance, and this was our today’s heroine – Escherichia coli.

  1. Let’s start with the wild and extremely cute strain E. coli , which lives in the intestines and provides vitamin K synthesis. antibiotics for about a year. And this is the sensitivity we have in mind when we prescribe empiric antibiotic therapy

How do we treat?

  • As you can see, the animal is sensitive to absolutely everything, and this is exactly the case when you can freely use the tabular materials of reference books or clinical recommendations, since the mechanisms of resistance are completely absent.
  1. If you have a patient who has been treated with penicillin antibiotics for the last six months, then the antibiogram may look like this.

If such E. coli turns out to be an extra-intestinal pathogen, and you have a pregnant woman and UTI (the most common case), then we need to overcome resistance to penicillins, that is, suppress the activity of penicillinases. Accordingly, drugs with beta-lactamase inhibitors, most often amoxicillin / clavulanate, will demonstrate high efficiency, as the safest and most effective. The only thing is that the patient must be warned that antibiotic-associated diarrhea may develop as a result of stimulation of intestinal receptors.

  1. Separately, I would like to draw attention to the following strain E. coli as a typical owner of extended spectrum beta-lactamase. And these ESBLs are most often produced as a result of the indefatigable use of third-generation cephalosporins and its very specific representative – ceftriaxone.

In what situations can we see (or think about) such an animal:0059

  • The patient was transferred from another hospital (although the next picture can be found there)
  • The patient did not receive anything, and was not in the hospital at all, but the pathogen came from the hands of medical personnel, causing nosocomial infection
  • And the simplest case – the culture was taken at the time of ceftriaxone therapy

    • What to do?

    • Remember that the patient in front of you is a carrier of a pathogen that can be transferred and create a serious danger to the life of a weaker person. Therefore, both the staff and the patient himself must strictly observe sanitary rules to prevent transfer.
    • How to treat? Since not a single beta-lactamase inhibitor works here anymore, ESBL destroy them perfectly, the choice will be small, and it is better that this choice is made by a specially trained specialist – a clinical pharmacologist, since in this situation not only data on susceptibility and resistance, but also the MIC of the pathogen, for example. Not to mention the factor of pharmacodynamics and the focus of localization of infection.
    • If wedge. there is no pharma or he is not specially trained – then we treat in accordance with the clinical recommendations for the relevant nosology from the section “reserve drugs”. It would not be superfluous to discuss the situation with the bacteriologist of the clinical laboratory doing the crops for you.
    1. One of the worst choices you can see

    Such a patient will not come to you with his feet, he will not be seen by the outpatient service, these are absolutely inpatients, and if they are brought, then only from another medical institution. Most often, these are patients in intensive care or intensive care units, and such a pathogen is 100% nosocomial in nature.

    When can we detect it:

    • secondary peritonitis,
    • nosocomial pneumonia,
    • pyelonephritis,
    • postoperative meningitis,
    • sepsis, etc.

    And it will always be an iatrogenic lesion as a result of improper hand hygiene of personnel or handling of instruments. You can object “but what about severe peritonitis?”. I will answer that for severe peritonitis without care defects, the strain in the third figure is most characteristic, since in order to grow such a beast, severe peritonitis will not have enough health, it will have time to die from complications, and E. coli itself cannot walk with legs, we We only carry them with improperly washed pens, and it is elementary to prove this, since exactly the same strains will be sown during routine inspections of the epidemiological service.

    What to do?

    • For the eradication of such a pathogen, not only a separate trained specialist and a pharmacy with a full set of reserve drugs are needed, but also the hard work of the epidemiological service, since such a patient should be isolated in a separate ward, but rather an isolation room (do not think that it is nonsense – with proper organization, such things are quite real) with the implementation of quarantine measures, since the main problem of the appearance of this kind of pathogens is that they very quickly scatter throughout the building (or hospital, if the buildings are not isolated) and seed everyone and everything, harming others patients weakened by a serious illness and populating the intestines of all medical personnel.
    • And one more extremely vile property of such pathogens – they are able to carry out horizontal transfer of resistance mechanisms with other flora of the family Enterobacteriacea e , and even if you get rid of E. coli, her friend Klebsiella can become an unpleasant surprise, causing even more harm and essentially finishing off the patient. It is impossible to get rid of these pathogens completely, for this it is necessary to get rid of medical personnel as the main carriers, but it is possible to control – the measures are detailed in the current SanPiN 2.1.3.2630-10. So if such a pathogen is detected, we will talk not only about the treatment of the patient in whom it is found, but also about taking measures to prevent infection of all other patients (and this, I remind you, almost always ICU or ICU) who are nearby.
    1. In conclusion, it is necessary to mention the pan-resistant E. coli armed with a full range of resistance mechanisms. There will be total R in the antibiogram, and the MICs of pathogens will break through all possible ceilings. Fortunately for the author, she has not yet encountered such a beast, which is due to the presence of a working surveillance system, so there will be no picture, although it is easy to imagine. Such patients, if E. coli turns out to be a pathogen, and not a colonizer (you never know from whose hands, for example, fell into a wound), unfortunately, they almost do not survive, since they are initially extremely severe somatically, and E. coli usually draws a line to their existence on mortal earth.

    What to do?

    • Prevent the development of such, I’m not afraid of the word, beasts in your hospitals, and if it appears, drive the epidemiological service to save hands and surfaces from this kind of infection, which is possible only if there is a sufficient amount of consumables, gloves and disinfectants.

    And now let’s summarize our difficult conversation:

    • Escherichia coli is a very serious pathogen and should not be underestimated. Its types also need to be clearly oriented.
    • First of all, we think about it in the treatment of urinary tract infections, especially in pregnant women.
    • If we have a patient with signs of an intestinal infection, then the approach to antibiotic therapy should be purely individual, and if the condition allows, then before receiving microbiology – no antibiotics at all. If it does not allow, it should be bacteriostatics.
    • We never treat only the analysis, and even the microbiological conclusion, we always treat the patient with the whole complex of his symptoms and syndromes. But microbiology helps to solve both differential diagnostic problems, which makes it possible to separate an unconditional pathogen from a peacefully living commensal.
    • Microbiological diagnosis is key both to confirm the pathogen itself and to select the appropriate antibiotic
    • In case of detection of resistant and pan-resistant pathogens, in addition to treating the patient himself, the epidemiological service of the medical institution should be fully involved

    Summarizing the above, and no matter how insulting it may sound, but almost always infections caused by E. coli are “diseases of dirty hands” and an indicator of microbiological trouble. And one of the serious problems of medical and preventive services, since, with all their desire, they will not be able to completely remove the source of infection, since it is literally in all of us, and only compliance with sanitary rules and sanitary education. work can significantly contribute to curbing the development of the above diseases.

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    • College student with altered mental status

    • Antibiotic therapy for epidural abscesses

    • Clostridium difficile

    Escherichia coli and cystitis

    Escherichia coli and cystitis

    coli Escherichia coli was isolated in 1885 by the German scientist Theodor Escherich, after whom the genus of bacteria was named.

    Escherichia live in the intestines of humans, animals, birds, reptiles, and fish.

    RESISTANCE (RESISTANCE) E.Coli

    For Escherichia coli , the optimum growth temperature is 35-37°C. These microorganisms are able to form colonies, including those protected by the so-called “biofilms”.

    In the environment E.Coli are relatively stable. At a temperature of 60°C, they die within 15 minutes, at 100°C – instantly. In soil and water, they are able to remain viable for months. They “survive” in milk for more than 30 days, in infant formula for more than 3 months, on objects and toys for up to 3-5 months. Direct sunlight causes bacteria to die after a few minutes.

    E.Coli are sensitive to most disinfectants (chlorine preparations, formaldehyde, sodium hydroxide, etc.) and antibiotics (aminoglycosides, tetracyclines, rifampicin, etc.). However, the bacterium is able to rapidly acquire resistance to antimicrobial agents.

    Escherichia coli SPECIES

    – Non-pathogenic

    Most strains of E. coli are harmless and are part of the normal intestinal flora of humans and animals. Moreover, E. coli benefits the body, for example, preventing the development of pathogenic microorganisms in the intestines.

    – Diarrheal

    According to WHO, the first place among diarrheal diseases in newborns and young children is occupied by escherichiosis.

    Allocate the so-called traveler’s diarrhea. This disease, caused by Escherichia, is most often found in tourists in countries with a hot climate. The spread of infection is facilitated by pollution with sewage, violation of sanitary and hygienic conditions, infection of food products (dairy, meat and vegetables) with Escherichia.

    – Pathogenic

    Can cause extraintestinal disease. In some cases, Escherichia coli invades other organs. For example, in the genitourinary system, respiratory organs, in the biliary tract. Such bacteria can cause inflammatory processes, especially against the background of immunodeficiency.

    An example of a pathogenic species is uropathogenic Escherichia coli.

    Infection with the uropathogenic bacterium Escherichia coli occurs more often in women. This is facilitated by the peculiarity of the urinary system. Bacteria enter the bladder from the urethra, multiply in the urine, and cause inflammation (cystitis) .

    Possible mechanism of infection with uropathogenic Escherichia coli:

    Bacteria E.Coli are motile due to flagella and have pili (fimbria) with which they attach to the walls of internal organs.

    Approximately 150 million people are affected annually by urinary tract infections caused by uropathogenic Escherichia coli. Despite antibiotic therapy, 30–50% of patients relapse. This is due to the increase in the prevalence of E.Coli resistant to the latest generation of antibiotics. Antibiotic resistance calls for new approaches to the treatment and prevention of bacterial infections.

    One such approach is the use of natural substances D-mannose and cranberry proanthocyanadins. According to studies, D-mannose binds the fimbria of bacteria and prevents it from attaching to the wall of organs: the intestines, the bladder … The “bound” bacteria are washed out of the body without causing harm. This reduces the colonization of pathogenic Escherichia coli ., and the frequency of exacerbations of cystitis decreases. Cranberry proanthocyanidins have a similar effect.

    It is useful to take lactobacilli, especially the stamp Lactobacillus casei et rhamnosus, which is an antagonist of E.