What to do if E. coli and salmonella are present in stool?

Management of E. coli and Salmonella in Stool

For patients with E. coli and Salmonella detected in stool samples, treatment should focus on supportive care with fluid and electrolyte replacement while avoiding antimicrobial therapy unless specific risk factors for invasive disease are present. 1

Initial Assessment

• Evaluate for signs of severe illness: fever, bloody or mucoid stools, severe abdominal cramping/tenderness, or signs of sepsis 1
• Assess for dehydration and electrolyte abnormalities, which are common complications of infectious diarrhea 1
• Determine if the patient belongs to a high-risk group: immunocompromised, elderly, very young children, pregnant women 1
• Check for bloody diarrhea, which occurs in 25-51% of Salmonella cases and varies in E. coli infections (5-34% for toxigenic strains) 1

Management Approach

1. Supportive Care (Primary Treatment)

• Provide adequate oral or intravenous rehydration based on severity of dehydration 1
• Monitor and correct electrolyte abnormalities (potassium, sodium, calcium, magnesium) 1
• Avoid antimotility agents (e.g., loperamide) in:
  • Children <18 years of age with acute diarrhea 1
  • Any patient with suspected or confirmed inflammatory diarrhea 1
  • Patients with suspected or confirmed STEC (Shiga toxin-producing E. coli) infection 1

2. Antimicrobial Therapy Considerations

• Generally avoid antibiotics for uncomplicated E. coli and Salmonella infections as they may:

  • Prolong bacterial shedding of Salmonella 1
  • Potentially increase risk of hemolytic uremic syndrome (HUS) in STEC infections 1
  • Lead to development of antimicrobial resistance 1

• Consider antimicrobial therapy only in specific situations:

  • Patients with signs of invasive disease or sepsis 1
  • Immunocompromised individuals 1
  • Infants <6 months of age with Salmonella 1
  • Elderly patients with significant comorbidities 1

3. Infection Control Measures

• Implement strict hand hygiene with soap and water after using toilet, changing diapers, before food preparation, and after handling soiled items 1
• Use appropriate infection control measures including gloves and gowns when caring for patients with diarrhea 1
• For asymptomatic individuals with Salmonella in stool:
  • Those in low-risk settings (not healthcare workers, childcare workers, or food handlers) generally don't need treatment 1
  • Those in high-risk settings should be treated according to local public health guidance 1

4. Follow-up and Public Health Considerations

• Notify local public health authorities as both E. coli and Salmonella infections are reportable diseases 1
• Advise patients to avoid swimming, water-related activities, and sexual contact while symptomatic 1
• Food handlers, healthcare workers, and childcare workers may require negative stool cultures before returning to work (follow local regulations) 1
• Educate patients about proper food safety practices to prevent cross-contamination 1

Special Considerations

• For STEC infections, monitor for development of HUS (hemolytic uremic syndrome), particularly in children 1
• For immunocompromised patients, consider broader diagnostic testing and more aggressive management 1
• In patients with persistent symptoms (>14 days), consider additional testing to rule out other causes 1

Common Pitfalls to Avoid

• Prescribing antibiotics routinely for uncomplicated cases, which can prolong shedding and increase resistance 1
• Using antimotility agents in patients with bloody diarrhea or suspected STEC, which may increase risk of complications 1
• Failing to implement appropriate infection control measures, leading to secondary transmission 1
• Not considering the possibility of STEC in patients with bloody diarrhea, which requires specific management 1