Escherichia coli (E coli) Infections Treatment & Management

Updated: May 11, 2023
  • Author: Ryan P Collier, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Treatment

Medical Care

Medical care of E coli infection is based on the clinical syndrome and severity of the infection.

In addition to antibiotics, provide supportive care, such as hydration, adequate oxygenation, and blood pressure support, if indicated.

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Surgical Care

Surgical drainage/decompression may be indicated in patients with cholecystitis or cholangitis. 

Surgical drainage or debridement may be indicated for those patients with intra-abdominal abscess with ultimate surgical choice depending on size and location of the abscess. For surgical drainage, interventional radiology may assist with aspiration and drain placement. Generally antibiotics need to be continued to treat an intraabdominal infection for at least 4-7 days post-surgical source control. [12]

In patients with urinary tract obstruction, such as prostatic hypertrophy, TURP may be indicated to relieve the continued bladder outlet obstruction and urinary retention. In some cases, ureteral stents may need to be placed for decompression of the renal pelvis for obstructing renal stones. Antibiotics are needed in addition to the stents; however, place these stents as soon as possible with urological services assisting with stone removal. Institute adequate surgical drainage for prostatic abscesses using transurethral unroofing or a perineal incision.

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Diet

Oral food and liquids should be cautiously withheld in suspected cases of aspiration pneumonia in individuals with altered mental status, stroke, or prior intubation who have not yet been evaluated by a speech-language pathologist.

Food, hydration, and electrolyte containing solutions should be given to prevent malnutrition during an E coli diarrheal episode.

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Activity

Activity can be continued as tolerated by the patient.

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Consultations

Consultation with an infectious disease provider is recommended to treat infections that require long-term IV antibiotics and monitoring. Some infections that require multi-week antimicrobial therapy are pyogenic liver abscesses, multiple intraabdominal abscesses that are not source controlled/ surgically drained, empyema, and perinephric abscesses.

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Long-Term Monitoring

Generally, no long-term monitoring for E coli related infections is required once the initial infection is identified and treated. Weekly safety lab monitoring may be needed if the patient is on long term IV antibiotic therapy to treat the infection.

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