E Coli Infections in Hospitals

Escherichia coli is a rod shaped bacteria which commonly dwells in the intestinal tract of warm blooded animals, which takes only 20 minutes to reproduce. The vast majority of E.coli strains are harmless and actually offer measurable benefit to the host, producing Vitamin K2 and inhibiting colonization by pathogenic bacteria. Normal gut flora contains E.coli. However, a slim set of E.coli strains does not offer this symbiotic relationship to their host. Some may cause serious food poisoning, with E.coli outbreaks accounting for a number of food recalls. This gut bacteria is expelled into the environment when fecal matter is voided and will thrive on it for several days, with slowed growth on the fourth day.

It has been rigorously studied for over six decades as it inexpensive and easy to procure and culture in a lab setting. It is currently the most widely studied prokaryotic organism.

E.coli is the most common cause of hospital-acquired urinary tract infections. Research indicates that nosocomial UTI-causing E.coli strains differ from community-acquired strains in their virulence traits. Like other bacterial strains, E.coli has displayed an increasing resistance to antibiotics which can be troublesome to healthcare providers and menacing in general.

In addition to UTIs, certain virulent strains can cause gastroenteritis, urinary tract infections, neonatal meningitis, hemorrhagic colitis, pneumonia (rare), cholecystitis, bacteremia, cholangitis, and Crohn's disease. Certain strains of E.coli can produce potentially lethal toxins, which can cause life threatening complications.

Causes of E.coli Infections in Hospitals

Consumption of contaminated food is an easy and common way people acquire an E.coli infection. This is possible in both community and hospital settings. The bacteria can be found in ground beef should any intestinal E.coli get on the meat during processing. Unpasteurized milk is another means of transmission, as the bacteria can exist on the cow's udder and contaminate dairy products. Fresh produce is another culprit for E.coli infections, with a notable E.coli outbreak in 2006 due to fresh spinach.

Oral-fecal transmission is a major cause of E.coli infections. For this reason, unwashed hands in a hospital setting can lead to a greater incidence of nosocomial E.coli infection, especially in immunocompromised or elderly patients. Many E.coli infections can occur after healthcare is rendered. Vascular catheters can provide an adequate portal of entry for bloodstream infection by E.coli, if proper sanitary methods are not followed.

Symptoms of E.coli Infections

Like any bacteria that cause a wide variety of infections, symptoms will differ based on the type of infection involved, also varying in severity.

In the case of intestinal infection with E.coli, symptoms usually begin within 5 days of exposure.

  • abdominal cramping
  • sudden, severe watery diarrhea that may change to bloody stools
  • fatigue
  • fever
  • gas
  • loss of appetite/nausea
  • vomiting (uncommon)
  • bloody urine
  • decreased urine output
  • pale skin
  • bruising
  • dehydration

Symptoms of an E.coli induced UTI include:

  • Burning sensation while urinating
  • Intense and frequent urge to urinate, despite having no urine to void
  • Cloudy, bloody or foul-smelling urine
  • Chills/fever
  • In women, pelvic pain; in men, rectal pain
  • Pain in lower back, abdomen, hips, or flank

Risk Factors for E.Coli Infections

E.coli is not unique in the risk factors that make people more susceptible to contracting an infection. Age plays a critical role, as children with underdeveloped immune systems are less likely to be able to stave off infection. The elderly are also at an increased risk as their immune systems are no longer functioning in their prime. Those with weakened immune systems who may be taking immunocompromising drugs or who have AIDS are a greater risk of becoming ill after consuming or being infected by E.coli.

Because certain foods are more likely to become contaminated with E.coli, consuming them constitutes a risk factor for E.coli infection. Apple juice, unpasteurized milk, undercooked meat and soft cheeses are more likely to become contaminated. Although scientists are not entirely sure as to why people are more likely to contract an E.coli infection between the months of June and September.

Those who take drugs that aim to reduce stomach acid levels may also be at an increased risk for developing E.coli infections, as these acids offer a degree of protection against E.coli.

The use of vascular catheters is another risk factor because it allows a point of entry for the bacteria.

Treatment for E.coli Infection

Treating E.coli mostly centers around managing its associated complications, such as dehydration. Antibiotics are not recommended in the treatment of E.coli as this could promote drug resistance in a given strain if the patient does not administer the drug properly. Antidiarrheal medications are likewise not recommended as a course of treatment because they slow the movement of diarrhea through the system, giving the bacteria a greater window of time to flourish and allowing the body to absorb more of the toxins it releases.

Patients with E.coli infection should avoid salicylate-containing substances, which can cause bleeding in the intestines, such as:

  • Pepto-Bismol
  • aspirin
  • ibuprofen

Antidiarrheal medications should be avoided, these include:

  • Difenoxin with atropine (Motofen)
  • Diphenoxylate with atropine (Lomotil)
  • Loperamide (prescription-strength Imodium)

Treatment options include careful attention to hydration and regulation of fluids and minerals. Dialysis may be used in cases of E.coli induced kidney failure.

Prevention of E.coli in Hospitals

There is no vaccine available to curb the incidence of community or nosocomial E.coli infections. Avoidance of risky foods and diligence with regard to cross contamination may help prevent infection. One may reduce the risk or effectively prevent E.coli infection by only serving patients in hospitals pasteurized milk and juice, washing all produce thoroughly and cooking all meat at least 180 degrees. Raw foods should be kept separate from another in hospital kitchens; utensils should be disposable and sterile. Perhaps the most important facet of prevention is the fastidious hand washing of health care staff after using the restroom and at intervals throughout the day.

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