From the Guidelines
E. coli can cause pneumonia in immunocompromised hosts and certain immunocompetent patients, particularly those with underlying conditions such as diabetes mellitus, head trauma, or those hospitalized in ICUs 1.
Patient Populations at Risk
- Immunocompromised hosts
- Elderly patients, especially those in long-term care facilities
- Patients with underlying conditions such as:
- Diabetes mellitus
- Head trauma
- Those hospitalized in ICUs
- Patients with exposure to antibiotics, which can promote colonization of the pharynx by gram-negative bacilli, including E. coli 1
Clinical Context
In the context of hospital-acquired, ventilator-associated, and healthcare-associated pneumonia, E. coli is a common pathogen, along with other aerobic gram-negative bacilli such as P. aeruginosa and Klebsiella pneumoniae 1. The frequency of specific multidrug-resistant (MDR) pathogens, including E. coli, may vary by hospital, patient population, and exposure to antibiotics 1.
Key Considerations
When designing an empiric therapy regimen, it is essential to consider the local epidemiology and risk factors for MDR pathogens, including E. coli, in both ventilated and non-ventilated patients 1.
From the Research
Patient Characteristics
- Patients with Escherichia coli (E. coli) pneumonia are often older and more severely ill, with a higher likelihood of being female and from a nursing home 2.
- They may have underlying diseases, such as cerebrovascular disease, diabetes mellitus, or chronic obstructive pulmonary disease 3.
- E. coli pneumonia can occur in patients with or without abdominal or urinary symptoms, as the infection may originate from an occult gastrointestinal (GI) source 4.
Risk Factors
- Bacteremia is a common feature of E. coli pneumonia, and patients with this condition are more likely to have a principal diagnosis of sepsis 5.
- Previous administration of antibacterial agents does not appear to be a significant risk factor for E. coli pneumonia 3.
- Aspiration of E. coli from the oropharynx is a possible source of infection, particularly in patients with compromised respiratory function 6.
Clinical Features
- E. coli pneumonia can present with severe symptoms, including hypotension and respiratory failure 6.
- Patients with E. coli pneumonia may have a higher mortality rate compared to those with pneumococcal pneumonia, but similar to those with other gram-negative pneumonias 5.
- The rate of fluoroquinolone resistance is high in E. coli pneumonia, which can impact treatment options 5.