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Escherichia coli

Escherichia coli is a topic covered in the Johns Hopkins ABX Guide.

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  • 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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Last updated: February 8, 2018


Auwaerter, Paul. "Escherichia Coli." Johns Hopkins ABX Guide, The Johns Hopkins University, 2018. Johns Hopkins Guide, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540214/all/Escherichia_coli.
Auwaerter P. Escherichia coli. Johns Hopkins ABX Guide. The Johns Hopkins University; 2018. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540214/all/Escherichia_coli. Accessed August 19, 2019.
Auwaerter, P. (2018). Escherichia coli. In Johns Hopkins ABX Guide. Available from https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540214/all/Escherichia_coli
Auwaerter P. Escherichia Coli [Internet]. In: Johns Hopkins ABX Guide. The Johns Hopkins University; 2018. [cited 2019 August 19]. Available from: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540214/all/Escherichia_coli.
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TY - ELEC T1 - Escherichia coli ID - 540214 A1 - Auwaerter,Paul,M.D. Y1 - 2018/02/08/ BT - Johns Hopkins ABX Guide UR - https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540214/all/Escherichia_coli PB - The Johns Hopkins University DB - Johns Hopkins Guide DP - Unbound Medicine ER -