E coli in urine: Introduction

E coli in urine is a common finding in patients with urinary tract infection(UTI). Sometimes, E coli infection 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 culture.

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 complicates the treatment of the primary disease. Among urinary tract infection causes, E coli is the most common offending bacteria.

E coli infection infection symptoms depend 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.

Is E Coli contagious?

The short answer is:

No, E Coli is not considered contagious because it is present everywhere.

Here is the long answer:

If you have a drug resistant form of UTI, there is a chance of spreading that particular strain of E coli among other patients. Antibiotic resistant E coli urinary tract infection can be a serious health hazard and it does spread by contamination. Therefore, normal E Coli UTI is not considered contagious but antibiotic resistant E coli urinary tract infection may be considered contagious.

How do you get E coli infection? Where does E coli come from?

E coli are normally found inside your intestines. They are also present in your fecal material. They may reach your urinary tract by contamination. 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 E coli urine 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 most likely suggests that you have urinary tract infection.

Symptoms of E coli in bladder: E coli lower UTI

In most 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. E coli can go all the way up to the kidneys and cause kidney infection. When E coli cause kidney infection, the symptoms may be different from that of lower urinary tract infection.

E coli lower urinary tract infection symptoms are limited to the urinary bladder and urethra. Those people with E coli UTI may have symptoms of bladder infection such as pain, burning or discomfort when urinating.

Kidney infection

When E coli invade the kidneys, they usually produce systemic symptoms (E coli UTI symptoms that can affect the whole body). Example of these type of symptoms include body aches, high fevers, loss of appetite, nausea, vomiting etc. The infected kidney can also be painful and the pain may be felt in the flank area of the side of the infected kidney. As in any disease, the actual symptom in any individual patient depends on that particular patient’s age, gender, general health, pain tolerance and other unique characteristics.

E coli blood infection sepsis

In more extreme cases, E coli in urine can invade the blood vessels inside the kidneys and enter the blood circulation. Unlike E coli in urine, finding E coli in blood culture is a matter of serious concern. Once in blood, they can circulate to the whole body causing widespread activation of immune system. The number of WBC in the blood can rise abruptly as they try to fight the infection. The presence of large number of E coli in blood and the resulting increase in 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, E coli blood infection 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.

How to get rid of a UTI caused by E coli?

E coli treatment depends on the severity of the infection. You can get rid of E coli bladder infection by simply taking the prescribed antibiotic pills at home. Most urinary tract infection antibiotics target common E coli strain. If you have a severe kidney infection caused by E. coli, you may need hospitalization and iv antibiotics. If you have overwhelming sepsis caused by E coli in blood and urine, you may need to be treated in ICU with strong antibiotics for E coli sepsis.

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

This is an example of a real patient that I treated in the hospital. I hope it will help you better understand E coli infection symptoms.

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. She was still smiling even when her face was asymmetric and her voice was 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 any 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 an 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 very high number of white blood cells in it. E coli in urine culture 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 abnormal. Mrs. G had more than 200 WBCs per high power field of the microscope. In fact, they reported it as “too many WBCs to count”. In addition to WBC, they also saw many bacteria in the urine. Although it takes a few days to confirm the identity of the bacteria in the urine culture, it was most likely E. coli.

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 find a way to get out of the colon , they climb up the urinary tract and cause kidney infection. The names of two other types of bacteria in urine that can cause UTI 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 E coli 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 climb up her urinary tract. Finally the urine culture came back and sure enough we found E coli in urine culture.

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.