Last updated: February 21, 2017

E coli in urine

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e coli in urine infographic

e coli in urine infographic


E coli in urine: Introduction

E coli in urine

Image courtesy of: National Kidney & Urologic Diseases Information Clearinghouse (NKUDIC)

E coli in urine is a common finding in patients with urinary tract infection. sometimes, E coli in urine is incidentally discovered when routine urine tests are done. At other times, patients with symptoms of urinary tract infection get their diagnosis confirmed when the lab discovers the exact strain of E coli in urine. Among patients admitted to the hospital with other medical problems, a significant number usually have E coli in urine. The presence of E coli in urine in those patients sometimes complicate the treatment of the primary disease. The symptoms associated with E coli infection in urine depends upon the age and health status of the patient and also depends upon the severity of infection. The infographic on top shows you what may happen when you get E coli in urine.

E coli in urine: severity of infection

When E coli first enter the urinary tract, they go to the lower urinary tract which is the portion below the urinary bladder. In normal healthy people with good immune system, E coli may be just flushed out in the urine before they get the chance to invade and infect. However, when there is significant burden of E coli in urine or when the normal flow of urine is blocked or slowed down, E coli may proliferate and cause infection. At this state, the body tries to fight the infection by sending white blood cells into the urine. These white blood cells(WBC) can be detected in the urine with simple tests. The presence of WBC in the urine is proof that E coli in urine has caused infection. If there were just a few E coli in the urine without any WBC, they may not have had the chance to initiate the infection yet. Therefore, seeing E coli in urine does not always mean that you have urinary tract infection. Seeing E coli in urine along with WBCs definitely mean that you have urinary tract infection.

In most otherwise healthy people, E coli in urine may only cause lower urinary tract infection. In some people, especially those with other medical problems or ones with very high numbers of E coli in urine, the infection can climb upwards. It can go all the way up to the kidneys and cause kidney infection. When E coli in urine causes kidney infection, the symptoms may be different from that of lower urinary tract infection. Lower urinary tract infection with E coli usually causes symptoms that are limited to the urinary bladder and urethra. Those people may have pain, burning or other symptoms that are present when urinating. When E coli in urine invade the kidneys, they usually produce systemic symptoms or symptoms that can affect the whole body. Example of these type of symptoms include body aches, high fevers, loss of appetite, nausea, vomiting etc. As in any disease, the actual symptom in any individual patient depends on that particulars patient’s age, gender, general health, pain tolerance and other unique characteristics. The infected kidney can also be painful and the pain may be felt in the flank area of the side of the infected kidney.

In more extreme cases, E coli in urine can invade the blood vessels inside the kidneys and enter the blood circulation. From there they can circulate to the whole body causing widespread activation of immune system. The number of WBC in the blood can rise abruptly to try to fight the infection. The presence of large number of E coli in blood and the resulting increase with WBC as well as other infection fighting elements in the blood can trigger severe illness. This kind of overwhelming systemic struggle of the body while fighting widespread infection is called sepsis. Sepsis can make someone very sick and lethargic. Without proper treatment, sepsis can cause result in exhaustion of the body’s defenses and it can crash. When it happens, the blood pressure can go down and patients can go into septic shock.

I will describe some real patient cases who had E coli in urine. These are real patients I admitted to the hospital. You will learn how different patients with E coli in urine present and how they are treated.

E coli in urine: A 68 year old female admitted to the hospital with stroke

Mrs. G is a 68 year old female who was admitted to the hospital after she developed a weakness on the right side. She was diagnosed with ischemic stroke. She had some problems with speaking and swallowing. She was unable to get out of the bed by herself and was unable to control her urine. They inserted a catheter to help her drain the urine. Despite everything that was going on with her, Mrs G was relatively pleasant. He was still smiling even when her face was asymmetric and her voice as difficult to understand. She was working with her physical therapist and was moving as much as she could.

After two days in the hospital, Mrs. G had a low grade fever. She did not have complaints and she was able to speak in a better voice. We could understand most of what she was saying. We were worried that she might have developed on infection. But we did not know what kind of infection it was. We ordered a chest x-ray looking for possible pneumonia. We ordered a urine test looking for urine infection. Her chest x-ray came back normal but the urine had some white blood cells in it. E coli in urine takes a few days to show up. Until then you have to look for other things to decide if the urine is infected. Seeing more than 10 white blood cells in the urine is as good as seeing E coli in urine to diagnose urinary tract infection. But when you have not detected E coli in urine, the infection can be from any microorganisms. E coli is one of the most common bacteria that can cause urinary tract infection.

The full name of E coli is Escherichia Coli and it normally lives in the human colon. While most strains of E coli are harmless, some cause infection. When the harmful E coli finds a way to get out of the colon and climb up the urinary tract and cause kidney infection. The names of two other common bacteria that can cause urine infection are: Proteus mirabilis and Klebsiella pneumoniae. Overall, about 70% of patients with urinary tract infection have E coli in urine.

We started Mrs. G on an antibiotics that would kill E coli in urine and would also be effective against other common infections. She responded to the treatment. Her fevers went down and she was able to transfer to the bathroom to urinate on her own. We took the urine catheter out as that was probably what helped E coli to climb up into her urinary tract. Finally the urine culture came back and sure enough we found E coli in urine.

I hope the story of Mrs. G helped you understand more about E coli in urine and how it gets there in a patient admitted to the hospital with stroke. Please check back soon as I will be uploading more stories about different other types of scenarios and how you get E coli in urine in those cases.