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