Escherichia coli

Paul Auwaerter, M.D.
Escherichia coli is a topic covered in the Johns Hopkins ABX Guide.

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MICROBIOLOGY

  • Aerobic, gram-negative (GN) rod, E. coli is a member of Enterobacteriaceae: human strains may be: (1) commensal bowel flora, (2) intestinal pathogenic (enteric/diarrheogenic), (3) extra-intestinal pathogenic.
    • Predominant GN in composition of normal human colonic flora.
    • Motile, flagellated, non-spore forming.
  • E. coli easy to grow from sterile specimens.
    • Stool cx: only if severe diarrhea (may need reference lab to ID) or suspect O157:H7 (cx all bloody diarrhea) use sorbitol-MacConkey agar or perform Shiga toxin EIA.
    • ~ 90% strains ferment lactose (i.e., lactose-fermenter, D-glucose fermentation produces mixed acids that trigger an indicator such as methyl red)
      • Some diarrheogenic E. coli strains, including many of the EIEC strains, typically lactose negative.
      • Indole testing in all E. coli ~ 99% (+).
      • Catalase positive, oxidase negative.
  • Major resistance concerns[14]:
    • Plasmid-mediated AmpC β-lactamases (e.g., CMY)
    • Extended-spectrum β-lactamases (e.g., CTX-M)
      • Now worldwide concern in community-acquired UTIs and also bloodstream infections
      • In some Asian countries rates of ESBL E. coli have been reported as high as 55-79%.
      • Rates are lower in North America but rising.
    • Carbapenemases (e.g., New Delhi metallo-β-lactamase, Klebsiella pneumonaie carbapenemase and OXA-48)

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MICROBIOLOGY

  • Aerobic, gram-negative (GN) rod, E. coli is a member of Enterobacteriaceae: human strains may be: (1) commensal bowel flora, (2) intestinal pathogenic (enteric/diarrheogenic), (3) extra-intestinal pathogenic.
    • Predominant GN in composition of normal human colonic flora.
    • Motile, flagellated, non-spore forming.
  • E. coli easy to grow from sterile specimens.
    • Stool cx: only if severe diarrhea (may need reference lab to ID) or suspect O157:H7 (cx all bloody diarrhea) use sorbitol-MacConkey agar or perform Shiga toxin EIA.
    • ~ 90% strains ferment lactose (i.e., lactose-fermenter, D-glucose fermentation produces mixed acids that trigger an indicator such as methyl red)
      • Some diarrheogenic E. coli strains, including many of the EIEC strains, typically lactose negative.
      • Indole testing in all E. coli ~ 99% (+).
      • Catalase positive, oxidase negative.
  • Major resistance concerns[14]:
    • Plasmid-mediated AmpC β-lactamases (e.g., CMY)
    • Extended-spectrum β-lactamases (e.g., CTX-M)
      • Now worldwide concern in community-acquired UTIs and also bloodstream infections
      • In some Asian countries rates of ESBL E. coli have been reported as high as 55-79%.
      • Rates are lower in North America but rising.
    • Carbapenemases (e.g., New Delhi metallo-β-lactamase, Klebsiella pneumonaie carbapenemase and OXA-48)

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