Table 1. Serogroup Clustering of Different Types of E. coli Infections.
Type of E. coli Infection
Some Predominant Serogroups
Enteric
Enterotoxigenic
O Groups: 1,6,7,8,9,11,12,15,20,25,
27,60,63,75,78,80,85,88,89,99,101,109,114,115,128,139,148,149,153,159,1166,167
Enterohemorrhagic
O Groups: 157,26,103,111,113,+ around 50 others
Enteroinvasive
O Groups: 11,28,29,112,115,121,124,
136,143,144,147,152,164,173
Enteropathogenic
O Groups: 18,26,44,55,86,111,114,
119,125,126,127,128,142,157,158
Enteroaggregative
O Groups: 3,15,44,51,77,78,86,91,92,
111,113,126,141,146
Diffusely
Adherent
O Groups: 75,11,15,126
Urinary Tract Infection
O:K:H Groups: O1:K1:H7, O4:K12:H5, O4:K12:H1, O6:K13:H1 and others
Bacteremia
O:K:H Groups: O4:K12:H5, O2:K2:H1, O2:K1:H4, O1:K1:H-, O75:K5:H5 and others
Central Nervous System
O:K:H Groups: O18ac:K1:H7, O7:K1:H1, O2:K1:H6, O16:K1:H6, O83:K1:H4 and others (with K1)
Table 2. In Vitro Susceptibility of Escherichia coli to Antimicrobials*
Antibiotic
n
Range (µg/mL)
MIC50
(µg/mL)
MIC90 (µg/mL)
Reference
Amikacin
108
0.78 - 12.5
1.56
3.13
(86)
Amikacin
373
≤0.5 - 16
2
4
(149)
Amoxicillin
10
<2 - >128
>128
>128
Amoxicillin and clavulanic acid
100
≤2 - >64
16
32
(129)
Amoxicillin and clavulanic acid
44
-
2/1
4/2
(90)
Amoxicillin and clavulanic acid
10
<2-16
4
16
(122)
Ampicillin
512
2 - >128
8
16
(125)
Aztreonam
20
≤0.032 - 0.5
0.062
0.125
Aztreonam
373
≤1 - >64
≤1
≤1
(149)
Aztreonam
108
≤0.008 - 4
0.03
0.12
(77)
Cefaclor
44
-
1
2
(90)
Cefaclor
10
1 - 16
4
16
Cefaclor
98
1 - 256
2
16
Cefadroxil
44
-
4
4
Cefepime
108
≤0.008 - 2
0.01
0.12
(77)
Cefepime
373
≤0.5 - >64
≤0.5
≤0.5
Cefepime
105
0.008 - 1
0.03
0.06
Cefepime
98
<0.06 - 0.5
<0.06
0.12
Cefepime
43
0.025 - 6.25
0.05
0.20
Cefixime
44
-
0.12
0.5
Cefotaxime
108
≤0.008 - 8
0.06
0.12
Cefotaxime
98
<0.06 - 64
<0.06
0.12
Cefotaxime
15
0.015 - 0.25
0.06
0.12
Cefotaxime
528
0.03 - 8.0
0.006
0.25
Cefotaxime
512
≤0.01 - 4
0.06
0.13
Cefotaxime
373
≤0.5 - >64
≤0.5
≤0.5
Cefpirome
43
0.025 - 6.25
0.10
0.20
(143)
Cefprozil
10
1-16
2
8
Ceftazidime
43
0.10 - 100
0.20
0.78
(143)
Ceftazidime
20
0.062 - 0.25
0.125
0.25
Ceftazidime
27
0.05 - 0.39
0.1
0.2
Ceftazidime
108
0.03 - 4
0.12
0.5
Ceftazidime
108
0.025 - 0.78
0.10
0.20
(86)
Ceftazidime
98
<0.06 - 64
0.12
0.25
(75)
Ceftazidime
40
0.05 - 0.78
0.2
0.39
(100)
Ceftazidime
15
0.03 - 1
0.25
0.5
Ceftazidime
528
0.03 - 16
0.006
0.25
(27)
Ceftazidime
373
≤0.5 - >64
≤0.5
≤0.5
(149)
Cefpirome
108
≤0.008 - 2
0.03
1
(77)
Cefpirome
40
0.025 - 0.78
0.05
0.2
(100)
Ceftriaxone
27
0.025 - 0.1
0.05
0.05
Ceftriaxone
98
<0.006 -64
<0.006
0.12
(75)
Ceftriaxone
32
0.008 - 0.25
0.03
0.06
(65)
Ceftriaxone
373
≤0.5 - >64
≤0.5
≤0.5
(149)
Cefuroxime
44
-
1
2
(90)
Cefuroxime
10
1-16
4
8
Cefuroxime
100
≤2 - 64
4
16
(129)
Cefuroxime
98
0.25 - 256
4
16
(75)
Cephalexin
98
2 - 256
8
16
(75)
Cephalexin
100
≤2 - ≥64
4
64
Cephalexin
10
4 - 8
4
8
(122)
Cephalexin
44
-
4
4
Cephalothin
512
1 - >128
8
16
(125)
Cephalothin
100
4 - >64
32
>64
(129)
Ciprofloxacin
20
≤0.008
≤0.008
≤0.008
(4)
Ciprofloxacin
108
≤0.006 - 1.56
0.012
0.025
(86)
Ciprofloxacin
98
<0.06 - 32
<0.06
0.12
(75)
Ciprofloxacin
528
0.008 - 0.5
0.015
0.03
(27)
Ciprofloxacin
373
≤0.12 - >16
≤0.12
≤0.12
(149)
Ciprofloxacin
100
≤0.006 - 0.78
0.013
0.025
(23)
Ciprofloxacin
40
0.012 - 0.2
0.025
0.025
(59)
Ciprofloxacin
32
0.002 - 0.03
0.008
0.003
Clarithromycin
10
8 - >64
16
32
(122)
Doxycycline
10
<0.5 - >32
1
2
(122)
Enoxacin
20
≤0.008 - 0.063
0.016
0.032
(4)
Erythromycin
10
All >32
>32
>32
(122)
Fleroxacin
108
0.05 - 25
0.10
0.20
(86)
Fosfomycin
100
1 - 32
2
2
(38)
Gatifloxacin
84
0.016 – 0.25
0.03
0.03
(91)
Gatifloxacin
39
0.0125 – 0.78
0.05
0.05
(153)
Gemifloxacin
70
0.008 – 0.125
0.016
0.016
(91)
Gentamicin
20
0.25 - 4
0.5
1.0
(4)
Gentamicin
108
0.20 - >100
0.78
0.78
(86)
Gentamicin
512
0.25 - 4
1
1
(125)
Gentamicin
373
≤1 - >64
≤1
≤1
(149)
Imipenem
20
0.125 - 0.5
0.25
0.25
(4)
Imipenem
108
0.05 - 0.78
0.10
0.20
(86)
Imipenem
108
0.01 - 0.25
0.12
0.25
(77)
Imipenem
32
0.06 - 0.25
0.12
0.25
(65)
Imipenem
15
0.03 - 0.5
0.25
0.5
(45)
Imipenem
528
0.06 - 2.0
0.06
0.25
(27)
Imipenem
373
≤0.12 - >16
≤0.12
≤0.12
(149)
Levofloxacin
39
0.0125 – 0.78
0.025
0.2
(153)
Lomefloxacin
40
0.1 - 1.56
0.2
0.2
(59)
Lomefloxacin
29
≤0.03 - 0.12
0.12
0.12
(23)
Mecillinam
512
0.13 - >128
0.5
1
(125)
Meropenem
32
0.02 - 0.06
0.03
0.06
(65)
Minocycline
108
0.78 - >100
3.13
50
(86)
Moxifloxacin
84
0.016 – 0.25
0.03
0.03
(91)
Nalidixic acid
512
1 - >128
2
4
(125)
Nitrofurantoin
512
2 - 128
16
16
(125)
Norfloxacin
20
≤0.008 - 0.032
≤0.008
0.016
(4)
Norfloxacin
100
0.013 - 3.13
0.05
0.10
(23)
Norfloxacin
108
0.012 - 6.25
0.05
0.10
(86)
Norfloxacin
512
≤0.01 - 1
0.06
0.06
(125)
Ofloxacin
40
0.05 - 0.78
0.1
0.1
(59)
Ofloxacin
20
≤0.008 -0.032
≤0.008
0.016
(4)
Ofloxacin
29
≤0.03 - 0.12
0.06
0.06
(23)
Ofloxacin
108
0.025 - 12.5
0.05
0.10
(86)
Piperacillin/tazobactam
373
≤2 - >256
≤2
4
(149)
Piperacilin/tazobactam
528
0.25 - 128.0
1.0
2.0
(27)
Piperacillin
373
≤2 - ≤256
≤2
>256
(149)
Piperacillin
15
0.25 - >128
32
>128
(45)
Piperacillin
20
0.5 - >256
1.0
256
(4)
Sparfloxacin
40
0.1 - 1.56
0.39
0.78
(59)
Sparfloxacin
29
≤0.03
0.03
0.03
(23)
Sulfamethoxazole
512
5 - 512
32
512
(125)
Temafloxacin
100
0.025 - 6.25
0.10
0.20
(92)
Tosufloxacin
108
≤0.006 - 3.13
0.025
0.05
(86)
Ticarcillin/clavulanic acid
528
0.25 - >256
2.0
32
(27)
Ticarcillin/clavulanic acid
373
≤2 - >256
≤2
64
(149)
Tobramycin
20
0.5 - 16
0.5
1.0
(4)
Trimethoprim
512
≤0.06 - >64
0.25
0.5
(125)
TMP-SMX
512
0.25 - >128
1
2
(125)
TMP-SMX
20
≤0.063/1.19 -0.5/9.5
0.125/2.38
0.25/4.75
(4)
Zidovudine
9
0.031 - 1
0.125
-
(131)
ddI 9 31 - >62.5 62.5 - (131) *All studies reported reflect clinical isolates except reference (129) in which trimethoprim-resistant isolates from stools of children
attending day care centers were selected for study.
Table 3. Antimicrobial Resistance Among Enteropathogenic E. coli Strains.
Antibiotic
USA outbreaks
n = 28a
Nairobi, Kenya
n=78b
Ibadan, Nigeria
n=100c
Singapore
n=83d
Nigeria
N=240e
Oxytetracycline
-
100
-
Tetracycline
39
-
88
67
45
Ampicillin
39
100
58
41
62
Chloramphenicol
11
94
70
27
65
TMP-SMX
0
73
35
30
42
Sulfamethoxazole
-
-
81
-
Gentamicin
-
9
85
0
60
Streptomycin
64
-
-
67
44
Cefazolin
-
5
-
-
Cephalothin
32
-
47
-
Cefamandole
-
3
-
-
Cefotaxime
-
0
-
-
Ceftriaxone
-
-
-
0
Amikacin
-
3
-
-
Nalidixic acid
0
0
4
-
90
a EPEC serotype strains, resistance determined by single disc diffusion (85).
b EPEC identified by EAF probe, resistance determined by neosensitab system (128).
c EPEC identified serologically; resistance determined by disc diffusion (69).
d EPEC identified serologically; resistance determined by disc diffusion(74).
e EPEC identification method not described; resistance determined by disc diffusion (101).
Table 4: Antibiotic Resistance In Community-Acquired Urinary Tract Infections Due To E. coli
Site
Year
n
Amp
SXT
Nitro
FQ
Ref
Netherlands
1991
938
39
12%
7
0
(151)
UK
1992
1493
19
6
1
France
1995
47
30
13
-
0
(112)
Israel
1995
611
48
31
-
4
(165)
Belguim
1995-6
128
27
17
1
1
Trinidad
1995
385
17
11
1
(104)
Bangladesh
1996-7
179
60
-
18
(58)
France
1996-7
865
41
22
-
2
Canada
1998
1681
41
19
.1
1
(172)
United States
1998
63186
37%
18
1
1
(49)
Table 5a. Treatment Options for E. coli Urinary Tract Infections
Syndrome
1st line therapy
2nd line therapy
Comments
Acute uncomplicated cystitis in women*
TMP-SMX DS for 3 days
Or Trimethoprim for 3 days
Ofloxacin for 3 days
Or Other quinolone for 3 days
Or Nitrofurantoin for 7 days
Or Fosfomycin (single dose)
Quinolones are second line due to expense and emergence of resistance; use if TMP-SMX resistance >20%.
Acute cystitis in women with diabetes, symptoms for >7d, recent UTI, use of diaphragm, age>65 years+
As above, but consider 7 day regimen
Acute cystitis in pregnant women+
3rd generation oral cephalosporin
or nitrofurantoin for 7 days
Amoxicillin
Or TMP-SMX
Increasing rates or resistance to amoxicillin
TMP-SMX FDA class C
Acute uncomplicated pyelonephritis in women - mild/moderate*
Oral quinolone
Or TMP-SMX if susceptible
14 days standard, 7 days probably sufficient in mild/mod
Acute uncomplicated pyelonephritis in women - severe*
IV quinolone
Or AG +/- ampicillin
Or 3rd generation cephalosporin +/- aminoglycoside
Change to oral regimen according to susceptibilities once afebrile
Acute pyelonephritis in pregnancy+
Ceftriaxone 14 days followed by oral cephalosporin
Aztreonam
Or TMP-SMX
TMP-SMX FDA class C
* Guidelines sponsored by the Infectious Diseases Society of America and American Urological Association (163)
+ Stamm WE, New Engl J Med 1993 (134)
Table 5b. Oral and Parenteral Regimens for E. coli Urinary Tract Infections
Drug
Typical
Adult dose
Interval
Oral Regimens
TMP-SMX
160/800mg
q 12 hours
Trimethoprim
100 mg
q 12 hours
Fluroquinolones
Ciprofloxacin
250 mg
q 12 hours
Norfloxacin
400 mg
q 12 hours
Ofloxacin
200 mg
q 12 hours
Lomefloxacin
400 mg
q day
Enoxacin
400 mg
q 12 hours
Levofloxacin
250 mg
q 12 hours
Macrocrystalline nitrofurantoin
100 mg
qid
Amoxicillin
250 mg
q 8 hours
Cefpodoxime
100 mg
q 12 hours
Parenteral Regimens
TMP-SMX
160mg/800mg
q 12 hours
Ciprofloxacin
200 - 400 mg
q 12 hours
Ofloxacin
200 - 400 mg
q 12 hours
Ceftriaxone
1 - 2 grams
daily
Ampicillin
1 gram
q 6 hours
Aztreonam
1 gram
q 8 - 12 hours