Information for Clinicians | E. coli infection

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</div> <div class="cdc-mobile-menu-footer"> <a href="/ecoli/site.html"> <span> View All </span> <span><em>E. coli </em>infection</span> </a> </div> </div> </div> <div class="cdc-header-mobile__faux-title" aria-hidden="true"> </div> </div> </header> <main class="container cdc-main" role="main" aria-label="Main Content Area"> <section class="cdc-page-title-bar cdc-page-offset noindex"> <time class="cdc-page-title-bar__item cdc-page-title-bar__item--date" datetime="2024-05-14 00:00:00"> May 14, 2024 </time> </section> <div class="cdc-page-feature cdc-page-feature--ssi"></div> <div class="cdc-page-title cdc-page-offset syndicate"> <h1>Information for Clinicians</h1> </div> <div id="content" class="cdc-page-content cdc-page-offset syndicate container"> <div class="cdc-dfe-body "> <div class="cdc-dfe-body__top "> <div class="dfe-section dfe-section--page-summary summary-blurb summary-list" data-section="cdc_generic_summary"> <div class="dfe-section__header"> <h2>Key points</h2> </div> <div class="dfe-section__content"> <ul class="nested-list"> <li class="level-1">Most intestinal <em>E. coli</em> infections can be managed symptomatically.<ul> </ul> </li> <li class="level-1">Patients with profuse diarrhea or vomiting should be rehydrated.<ul> </ul> </li> <li class="level-1">Early use of intravenous fluids may decrease the risk of renal failure in children with STEC infection.<ul> </ul> </li> </ul> </div> <div class="dfe-section__image" id="page-summary-image"> <figure class="dfe-image dfe-image__large"><div class="image-container calculated-ratio-16-9 aspect-ratio-16-9"><img src="/ecoli/media/images/2024/05/DFE-Ecoli-Clinician-Doctors-walk-and-talk.jpg" alt="Two clinicians discussing something on their tablet."></div></figure> </div> <div id="nav-buttons"> </div> </div> </div> <div class="cdc-dfe-body__center "> <div class="dfe-section" data-section="cdc_generic_section_1"> <a class="onThisPageAnchor" id="cdc_generic_section_1-diagnosis" name="Diagnosis" title="Diagnosis"></a><h2>Diagnosis</h2> <p><em>E. coli</em> infection is diagnosed when the bacteria are identified from the sample of a patient with an acute diarrheal illness.</p> <h3>Testing for STEC</h3> <p>Stool samples should be routinely cultured for <em>E. coli</em> O157 and simultaneously assayed for non-O157 STEC with a test that detects Shiga toxins (or the genes that encode them). </p> <p>All presumptive <em>E. coli</em> O157 isolates and Shiga toxin-positive specimens should be sent to a public health laboratory for further characterization. </p> <p><strong>Rapid, accurate diagnosis of STEC infection is important</strong> because early clinical management decisions can affect patient outcomes and early detection can help prevent secondary spread.<br></p> <h3>Testing for other <em>E. coli</em></h3> <p>Most U.S. clinical laboratories do not use tests that can detect diarrheagenic <em>E. coli</em> other than STEC. Public health laboratories typically test for non-STEC<em> E. coli</em> only during an outbreak of diarrheal illness with an unknown origin.</p> <div class="dfe-block dfe-block--keep_reading"><b>Keep Reading:</b> <a href="/ecoli/php/laboratories/index.html">Laboratory Testing for <em>E. coli</em></a></div> </div> <div class="dfe-section" data-section="cdc_generic_section_2"> <a class="onThisPageAnchor" id="cdc_generic_section_2-treatment" name="Treatment" title="Treatment"></a><h2>Treatment</h2> <h3>Hydration</h3> <p>Most <em>E. coli</em> infections can be managed symptomatically. Patients with profuse diarrhea or vomiting should be rehydrated. </p> <p>Evidence from studies of children with STEC O157 infection indicates that early use of intravenous fluids (within the first 4 days of diarrhea onset) may decrease the risk of renal failure.<br></p> <h3>Antibiotics</h3> <p>Antibiotics used to treat infection with diarrheagenic <em>E. coli </em>other than STEC include fluoroquinolones (such as ciprofloxacin), macrolides (such as azithromycin), and rifaximin. </p> <p>Clinicians treating a patient whose clinical syndrome suggests STEC infection (<a href="https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/escherichia-coli-diarrheagenic">see a clinical syndrome table</a>) should be aware that administering antimicrobial agents may increase the risk of <a href="https://www.cdc.gov/ecoli/signs-symptoms/hus.html">hemolytic uremic syndrome</a>.</p> <p>Resistance to antimicrobials is increasing worldwide. The decision to use an antibiotic should be carefully weighed against the severity of illness, the possibility that the pathogen is resistant, and the risk of adverse reactions, such as rash, antibiotic-associated colitis, and vaginal yeast infection.</p> <h3>Antimotility agents</h3> <p>Antimotility agents should be avoided for patients with bloody diarrhea; treatment should be reassessed if symptoms have not improved in 48 hours. Antimotility agents also should not be given to patients with STEC infection because these agents may increase the risk of complications, including toxic megacolon, HUS, and neurologic complications. </p> <p>No known data show that kaolin-pectin compounds (e.g., Kaopectate<sup>®</sup>) or lactobacillus slow diarrhea or relieve abdominal cramping. </p> <div class="dfe-block dfe-callout dfe-callout--standard"><div class="dfe-callout__icon" role="presentation"></div> <h3>Resource&lrm;</h3> <div class="dfe-callout__body"><div class="callout-desc"><a href="https://academic.oup.com/cid/article/65/12/e45/4557073" class="tp-link-policy" data-domain-ext="com">Clinical practice guidelines for the diagnosis and management of infectious diarrhea<span class="visually-hidden sr-only" aria-label=" external icon" role="img"></span><span class="cdc-icon-external cdc-link-icon" aria-hidden="true" alt="external icon"></span></a></div> </div></div> </div> <div class="dfe-section" data-section="cdc_generic_section_3"> <a class="onThisPageAnchor" id="cdc_generic_section_3-hemolytic-uremic-syndrome-hus" name="Hemolytic%20uremic%20syndrome%20(HUS)" title="Hemolytic uremic syndrome (HUS)"></a><h2>Hemolytic uremic syndrome (HUS)</h2> <p><a href="/ecoli/signs-symptoms/hus.html">HUS</a>, which can be a complication of STEC infection, is a type of thrombotic microangiopathy, characterized by anemia, kidney injury, and a low platelet count (thrombocytopenia). </p> <p>HUS can lead to permanent health problems and even death. </p> <p>The features of HUS, especially in adults, can be similar to thrombotic thrombocytopenic purpura (TTP), in which blood clots form in small blood vessels throughout the body. TTP can lead to strokes, brain damage, and death. </p> <h3>HUS diagnosis</h3> <p>HUS is diagnosed using standard blood chemistry and blood count tests. </p> <h3>HUS treatment</h3> <p>HUS is treated with supportive care, including the management of fluids and electrolytes. In some cases, treatment may involve: </p> <ul class="nested-list"> <li class="level-1">Dialysis<ul> </ul> </li> <li class="level-1">Transfusions of red blood cells, platelets, or both<ul> </ul> </li> </ul> <p>With good supportive care, most people with HUS recover completely. Outcomes are typically better for children than adults. </p> </div> </div> <div class="cdc-dfe-body__right page-right-rail"> <aside class="page-right-rail__static noindex" role="complementary"> <div class="on-this-page " data-sid=""> <h2 class="on-this-page__heading"> On This Page </h2> <div class="card-body"> <ul> <li><a href="#cdc_generic_section_1-diagnosis">Diagnosis</a></li> <li><a href="#cdc_generic_section_2-treatment">Treatment</a></li> <li><a href="#cdc_generic_section_3-hemolytic-uremic-syndrome-hus">Hemolytic uremic syndrome (HUS)</a></li> </ul> </div> </div> </aside> <aside class="page-right-rail__dynamic noindex" role="complementary"> <div data-related-nav></div> </aside> </div> </div> <div data-journey-next></div> <section class="container page-mobile-bar"> <time class="page-mobile-bar__item page-mobile-bar__item--date" datetime="2024-05-14 00:00:00"> May 14, 2024 </time> </section> <div class="page-content-sources noindex"> <div class="page-content-sources__header"> <a data-action="summary" class="collapsed" href="#content-sources" role="button" data-bs-toggle="collapse" aria-expanded="false" aria-controls="content-sources" data-cs-toggle="">Sources</a> <a data-action="print" href="#print" class="d-none d-md-block" aria-label="print this page" onclick="window.print()">Print</a> <a data-action="share" href="#share" data-bs-toggle="dropdown" aria-label="share this page" aria-expanded="false">Share</a> <div class="dropdown-menu page-share-bar" data-popper-placement="bottom-start"> <a href="#" class="page-share-facebook"><span class="cdc-icon-facebook"></span></a> <a href="#" class="page-share-linkedin"><span class="cdc-icon-linkedin"></span></a> <a href="#" class="page-share-twitter"><span class="cdc-icon-twitter"></span></a> <a href="#" class="page-share-syndication"><span class="cdc-icon-rss"></span></a> </div> </div> <div class="page-share-container"> <div class="page-share-popup" id="page-share-popup" role="dialog"> <a target="_blank" title="Share to Facebook" rel="noreferrer noopener" class="page-share-facebook metrics-share-facebook" href="https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.cdc.gov"> <span class="sr-only">Facebook</span> <span class="cdc-icon-facebook-inverse"></span> </a> <a target="_blank" title="Share to LinkedIn" rel="noreferrer noopener" class="page-share-linkedin metrics-share-linkedin" href="https://www.linkedin.com/shareArticle?url=https%3A%2F%2Fwww.cdc.gov&title=Living%20with%20High%20Blood%20Pressure"> <span class="sr-only">LinkedIn</span> <span class="cdc-icon-linkedin-inverse"></span> </a> <a target="_blank" title="Share to Twitter" rel="noreferrer noopener" class="page-share-twitter metrics-share-twitter" href="https://twitter.com/share?url=https%3A%2F%2Fwww.cdc.gov&text=Living%20with%20High%20Blood%20Pressure"> <span class="sr-only">Twitter</span> <span class="cdc-icon-twitter-inverse"></span> </a> <a target="_blank" title="Embed this Page" rel="noreferrer noopener" class="page-share-syndication metrics-share-syndicate" href="https://tools.cdc.gov/medialibrary/index.aspx#/sharecontent/https://https://www.cdc.gov/ecoli/hcp/guidance/index.html"> <span class="sr-only">Syndicate</span> <span class="fi cdc-icon-syndication-round"></span> </a> </div> </div> <div id="content-sources" class="page-content-sources__body accordion-collapse collapse"> <div class="callout callout-content-source" role="status"> <div class="callout-heading">Content Source:</div> <a class="cdc-block-link" href="/ncezid/index.html">National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)</a> </div> </div> </div> <section class="container related-pages related-pages__mobile"> <div data-related-nav-mobile></div> </section> </div> </main> <section class="site-footer container noindex"> <div class="row cdc-footer__inner"> <div class="col-lg-3 site-footer__heading"> <h2> <a href="/ecoli/about/index.html"> <span class="cdc-footer__super-title" aria-label="<em>E. coli</em> Infection (<em>Escherichia coli</em>)"> <a href="/ecoli/about/index.html"> <em>E. coli </em>infection </a> <i class="cdc-icon cdc-fa-light cdc-fa-angle-right"></i> </span> </a> </h2> <p>Six types of <em>E. coli </em>can cause diarrheal illness in people. 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