eMedicine Specialties > Infectious Diseases > Bacterial Infections

Escherichia Coli Infections: Follow-up

Author: Tarun Madappa, MD, MPH, Critical Care Fellow, Section of Critical Care Medicine, St Vincent Catholic Medical Center, New York Medical College, New York.
Coauthor(s): Chi Hiong U Go, MD, Assistant Professor, Department of Internal Medicine, Texas Tech University Health Science Center at Odessa
Contributor Information and Disclosures

Updated: Feb 19, 2009

Follow-up

Further Inpatient Care

  • Supportive and symptomatic care
  • Adequate hydration and oxygenation
  • Periodic neurological test for meningitis

Further Outpatient Care

  • Supportive care and rehabilitation should be provided to persons with meningitis who develop neurologic sequelae.

Inpatient & Outpatient Medications

  • Most severe E coli infections warrant hospitalization. These include meningitis, pneumonia, cholecystitis/cholangitis, intra-abdominal abscess, and some cases of complicated UTI and pyelonephritis.
  • In patients with pyelonephritis, a switch to oral medications should be made as soon as the patient is able to tolerate oral intake.
  • The duration of therapy depends on the type of infection.
  • In case of enterohemorrhagic E coli (EHEC) diarrhea, antibiotics are contraindicated and treatment is supportive and symptomatic in nature.

Complications

  • HUS may complicate EHEC infection.
  • E coli meningitis in neonates usually results in neurological sequelae.

Prognosis

  • The prognosis depends on the specific diagnosis; therefore, no generalizations can be made.

Patient Education

  • Patients should be instructed on personal hygiene, such as washing hands and improving food preparation techniques.
  • When traveling to endemic areas, drink bottled water.
  • Prophylactic antibiotics may be administered for as long as 3 weeks for travelers in developing countries in whom the risk and benefits have been discussed.
  • Advise patients to cook meat properly to prevent hemorrhagic colitis and HUS.

Miscellaneous

Medicolegal Pitfalls

  • Meningitis must be excluded in neonates with E coli septicemia because of the need for a longer course of antibiotics and the developmental sequelae if it is not treated early.
  • Patients who are receiving high-dose corticosteroids may develop S stercoralis hyperinfection and E coli meningitis. Consider routine screening tests and empiric treatment with thiabendazole in high-risk patients with S stercoralis infection.

Special Concerns

Since the late 1990s, multidrug-resistant Enterobacteriaceae (mostly E coli) that produce extended-spectrum beta-lactamases (ESBLs), such as the CTX-M enzymes, have emerged within the community setting as an important cause of UTIs. These bacteria are resistant to the groups of antibiotics that are commonly used to treat these types of infections (penicillins, cephalosporins) and to antibiotics normally reserved for more severe infections (eg, fluoroquinolones, gentamicin).

The spread of CTX-M–positive bacteria considerably changes how the treatment of community-acquired infections is approached and limits the oral antibiotics that may be administered. This finding has major implications for treating individuals who do not clinically respond to first-line antibiotics.2

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Eleftherios Mylonakis, MD, to the development and writing of this article.



More on Escherichia Coli Infections

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Differential Diagnoses & Workup: Escherichia Coli Infections
Treatment & Medication: Escherichia Coli Infections
Follow-up: Escherichia Coli Infections
Multimedia: Escherichia Coli Infections
References
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Further Reading

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Keywords

E coli, Escherichia coli, traveler's diarrhea, traveler diarrhea, E coli cholecystitis, E coli bacteremia, E coli cholangitis, E coli urinary tract infection, E coli UTI, E coli neonatal meningitis, E coli pneumonia, E coli acute bacterial meningitis, E coli nosocomial pneumonia, E coli hospital-acquired pneumonia, E coli nosocomial infection, E coli hospital-acquired infection, E coli bronchopneumonia, enterotoxigenic E coli, ETEC, enteropathogenic E coli, EPEC, enteroinvasive E coli, EIEC, E coli dysentery

enterohemorrhagic E coli, EHEC, E coli hemorrhagic colitis, hemolytic-uremic syndrome, HUS, enteroaggregative E coli, EAggEC, enteroadherent E coli, EAEC, uncomplicated E coli urethritis, uncomplicated E coli cystitis, symptomatic E coli cystitis, E coli pyelonephritis, acute E coli prostatitis, E coli prostatic abscess, E coli urosepsis, E coli septic arthritis, E coli endophthalmitis, E coli suppurative thyroiditis, E coli sinusitis, E coli osteomyelitis, E coli endocarditis, E coli skin infection, E coli diabetic skin infection, E coli soft-tissue infection, E coli diarrheal disease

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Contributor Information and Disclosures

Author

Tarun Madappa, MD, MPH, Critical Care Fellow, Section of Critical Care Medicine, St Vincent Catholic Medical Center, New York Medical College, New York.
Tarun Madappa, MD, MPH is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Chi Hiong U Go, MD, Assistant Professor, Department of Internal Medicine, Texas Tech University Health Science Center at Odessa
Chi Hiong U Go, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine
Disclosure: Nothing to disclose.

Medical Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Charles V Sanders, MD, Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center
Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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