What is it?
Escherichia coli (E.coli) is a facultative anaerobic, gram-negative bacterium, which is found normally in the human intestine. It appears to be covered in small hairs, which enable it to move around the gut.
Symptoms
E.coli is a common bacterium causing urinary tract infections, especially in patients who are catheterised. Symptoms include burning on micturition, frequency and a feeling of bladder fullness.
Other sites of infection caused by E.coli can include; wounds, cannula sites, tracheostomy tubes and blood stream infections.
How is it spread?
It is spread by direct contact especially when toilet hygiene is required. It often colonises where the normal defense mechanisms are breached for example when a urinary catheter is insitu. It can colonize the lower end of the urethra and vagina.
Management
To treat the infection with appropriate antibiotics. To maintain meticulous hand hygiene, wearing of the correct personal protective equipment when dealing with body fluids and urinary catheter care.
Extended Spectrum Beta- Lactamase (ESBL)Escherichia coli
Beta – lactamase is an enzyme which is produced by bacteria, this enzyme breaks down certain types of antibiotics.
Resistant strains are becoming more common. The resistance can make the organisms difficult to treat. Hence causing concern both nationally and locally (Bisson et al (2002) these are known as Extended Spectrum Beta Lactamase (ESBL) E. coli.
Escherichia coli 0157
What is it?
Commonly found in the gut of cattle and some sheep. One particular strain, E-coli 0157, can cause severe gastric symptoms and can be fatal for young children, elderly and the immuno suppressed. It has caused outbreaks and in 5% of cases may progress to haemolytic uraemic syndrome (acute renal failure).
Symptoms
In a gastric infection the incubation period can be from one to five days and the onset of diarrhoea and vomiting is abrupt, often accompanied by a slightly raised temperature. This can be followed by bouts of watery faeces, which may lead to dehydration and can be accompanied by abdominal pain. Occasionally the patient may develop haemorrhagic colitis, which produces severe abdominal pain and bloody diarrhoea.
How is it spread?
Spread is by contact and the faecal/oral route. The ingestion of only a few E-coli organisms can be potentially fatal. It is sometimes known as traveller’s diarrhoea following the ingestion of contaminated food aboard. It is also associated with the barbeque season with contaminated or uncooked beef products such as beef burgers. It has also been found in unpasteurised milk. There have also been reports of transmission by indirect contact from both food, by poor storage of uncooked meat products, and by animals e.g. children playing in fields previously occupied by cattle. It can be waterborne.
It can be transmitted from person to person, especially within family groups and institutions such as schools care homes and hospitals. It may be carried in the excreta for up to three weeks.
Management
Specimens
A stool specimen sent to the laboratory for culture and sensitivity will be tested for a number of different causes of gastrointestinal infection, including; E-coli, Salmonella, Shigella and Campylobacter.
Isolation
Standard isolation is required; patients should be nursed in a single room with their own toilet facilities or a commode, which needs to be cleaned between each use. Clinical staff must wear gloves and aprons when dealing with body fluids and when disposing of excreta. Careful hand washing is essential and frequent cleaning of toilet seats, sinks and door and toilet flush handles should be maintained using appropriate disinfectants. Soiled linen must be disposed of in red linen bags with dissolvable liners.
Treatment
Most cases will be self-limiting, requiring no treatment. Management and maintenance of both fluid and electrolyte balance will be required in some cases.
Prevention
Effective hand hygiene by clinical staff between patients is essential. Patients who are symptomatic with E-coli should be reminded to include effective hand washing before and after using toilet facilities and after changing baby’s nappies. They should not be preparing food.
Cleaning
Isolation rooms must be cleaned thoroughly following the discharge of the patient using appropriate disinfectants.
References
Ayliffe G, Fraise A, Geddes A, Mitchell K (2000) Control of Hospital Infection -A Practical handbook 4th Edition, Arnold London
Bannister B, Begg N, Gillespie S (2000) Infectious Disease 2nd Edition
Blackwell Science Oxford
Chin J. Editor (2000) Control Of Communicable Diseases manual 17th Edition
American Public Health Association Washington
Gladwin M, Trattler B, (2002) Clinical Microbiology Made Ridiculously Simple
MedMaster Miami
