eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Escherichia Coli Infections: Follow-up

Author: Archana Chatterjee, MD, PhD, Professor of Pediatrics, Medical Microbiology and Immunology, and Pharmacy, Division of Pediatric Infectious Diseases, Chief of Division of Pediatric Infectious Diseases, Creighton University School of Medicine; Hospital Epidemiologist and Medical Director of Infection Control, Children's Hospital
Coauthor(s): Catherine O'Keefe, DNP, APRN, Assistant Professor of Nursing, Pediatric Nurse Practitioner, Pediatric Infectious Diseases, Creighton University School of Nursing; Sara L Cuthill, MD, Fellow, Developmental and Behavioral Pediatrics, Departmental and Behavioral Pediatrics, Interstate Medical Office East; Meera Varman, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University School of Medicine
Contributor Information and Disclosures

Updated: Jan 8, 2009

Follow-up

Further Inpatient Care

  • Admit for fluid resuscitation and intravenous antibiotic administration any child who is significantly dehydrated, is persistently vomiting, or who has evidence of pyelonephritis.
  • Children with suspected or confirmed sepsis, meningitis, or hemolytic-uremic syndrome (HUS) require skilled inpatient management. HUS may progress to renal failure, which requires meticulous fluid electrolyte management and may require dialysis.

Further Outpatient Care

  • Monitor patients with Escherichia coli infection for postinfectious functional GI disorders such as irritable bowel syndrome.29

Transfer

  • Arrange transfer to a tertiary care facility if HUS is suspected. These patients may require dialysis and should be managed by a team that includes a pediatric intensivist, nephrologist, and infectious disease specialist.

Deterrence/Prevention

  • Traveler's diarrhea
    • Drink only carbonated beverages and boiled or bottled water (preferably carbonated). Consider bringing supply of bottled water or premixed infant formula.
    • Travelers should avoid ice, raw salads, and any fruits they do not peel themselves. Consume foods while they are steaming hot.
    • Prophylactic antibiotic treatment is not recommended for infants and children. Parents should carry packets of oral rehydration salts when traveling outside the United States.
    • Promising data have been reported in a patch vaccine containing heat-labile toxin from E coli.30,31
  • Thoroughly cooking ground beef is the most effective measure to prevent hemorrhagic colitis caused by E coli 0157:H7.
  • Although an National Institutes of Health (NIH) investigational vaccine for E coli O157:H7 has been found to be immunogenic in young children, sporadic outbreaks could limit its use on a broad scale.32  Priority has been placed on vaccination strategies to reduce the carriage of these organisms in the principal reservoir of this pathogen (ie, cattle).17

Patient Education

  • Advise parents of children diagnosed with hemorrhagic colitis to observe their child closely for signs of HUS (eg, oliguria or anuria, pallor, irritability).
  • Make parents of children diagnosed with urinary tract infection (UTI) aware of the possibility that UTI may be the cause of future episodes of fever, particularly fever without apparent source. Parents should be reminded to inform treating physicians of the child's history of UTI and to discuss indications for obtaining a urine culture.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider and investigate Escherichia coli 0157:H7 in the differential diagnosis of bloody diarrhea (Most laboratories do not assay for pathogenic E coli without specific instruction.)
  • Failure to recognize and diagnose hemolytic-uremic syndrome (HUS) and to obtain appropriate subspecialist consultations
  • Failure to follow up diagnosis of urinary tract infection (UTI) with appropriate imaging studies because an undiagnosed anatomic abnormality or vesicoureteral reflux can lead to renal scarring and eventually progress to renal insufficiency or failure

Special Concerns

  • Always consider a UTI in infants and young children who present with fever without an apparent source.
 


More on Escherichia Coli Infections

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

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Keywords

Escherichia coli infections, E coli infections, Escherichia coli, E coli, colibacillus, diarrhea, diarrheal illness, hemolytic-uremic syndrome, HUS, urinary tract infection, UTI, neonatal sepsis, meningitis, enterotoxigenic E coli, ETEC, enterohemorrhagic E coli, EHEC, enteropathogenic E coli, EPEC, enteroinvasive E coli, EIEC, enteroaggregative E coli, EAEC, hemolytic anemia, thrombocytopenia, renal insufficiency, diarrhea, oliguria, anuria, traveler's diarrhea, bacteremia, sepsis, respiratory distress, prematurity, low birth weight, hemorrhagic colitis, abdominal cramping, dysentery

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Contributor Information and Disclosures

Author

Archana Chatterjee, MD, PhD, Professor of Pediatrics, Medical Microbiology and Immunology, and Pharmacy, Division of Pediatric Infectious Diseases, Chief of Division of Pediatric Infectious Diseases, Creighton University School of Medicine; Hospital Epidemiologist and Medical Director of Infection Control, Children's Hospital
Archana Chatterjee, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, International Society for Infectious Diseases, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: GlaxosmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi-Pasteur Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; GlaxoSmithKline Grant/research funds Other; MedImmune  Other; Merck Grant/research funds Other; Novartis Grant/research funds Other; Sanofi-Pasteur Grant/research funds Other

Coauthor(s)

Catherine O'Keefe, DNP, APRN, Assistant Professor of Nursing, Pediatric Nurse Practitioner, Pediatric Infectious Diseases, Creighton University School of Nursing
Catherine O'Keefe, DNP, APRN is a member of the following medical societies: American Academy of Nurse Practitioners, National Association of Pediatric Nurse Practitioners, and Nebraska Nurse Practitioners
Disclosure: Nothing to disclose.

Sara L Cuthill, MD, Fellow, Developmental and Behavioral Pediatrics, Departmental and Behavioral Pediatrics, Interstate Medical Office East
Sara L Cuthill, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Meera Varman, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University School of Medicine
Meera Varman, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: phamaceutical companies Honoraria Speaking and teaching; phamaceutical companies Grant/research funds clinical trials

Medical Editor

Ashir Kumar, MBBS, MD, FAAP, Professor, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University; Consulting Staff, Department of Pediatrics, EW Sparrow Hospital
Ashir Kumar, MBBS, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota School of Medicine
Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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