Overview
Escherichia coli, also known as Escherichia coli, is a common gram-negative bacillus in the intestinal tract and is widely distributed in nature. It is generally non-pathogenic, but can cause extraintestinal infections under certain conditions. Escherichia coli pneumonia is a pneumonia caused by E. coli, which often occurs in hospitalized patients with systemic failure or immunocompromised, and is one of the more common types of hospital-acquired pneumonia. Patients mainly present with chills, fever, cough, purulent sputum, often accompanied by nausea, vomiting, abdominal pain, diarrhea and other discomforts, and in severe cases, there are consciousness disorders and peripheral circulatory disorders, and the morbidity and mortality rate is high.
Etiology
There are three ways of E. coli infection: hematogenous dissemination, endogenous inhalation and exogenous inhalation. Endogenous inhalation, i.e., inhalation of oropharyngeal secretions containing pathogenic bacteria, is an important pathogenesis leading to pneumonia; hematogenous dissemination, i.e., extrapulmonary foci of infection carry pathogenic bacteria to the lungs along with the bloodstream, is more commonly seen in nosocomial pneumonia caused by E. coli; and exogenous inhalation includes direct inhalation of contaminated ambient air, as well as infections caused by the use of nebulizers, humidifying devices, and mechanical ventilation by artificial respirators.
Symptoms
The patient suddenly develops chills, high fever, cough, yellow pus sputum, jaundice, impaired consciousness, and a severely ill appearance, and may have shortness of breath and cyanosis. A few patients start violently and rapidly develop neuropsychiatric symptoms, such as blurred consciousness, agitation, drowsiness, delirium, and coma. A few patients may show signs of peripheral circulatory failure such as decreased blood pressure, cold extremities, excessive sweating, and cyanosis of lips and fingertips. Physical examination may show clinical manifestations of pulmonary solid changes such as wet rales and turbid sounds on percussion.
Examination
1. Laboratory examination
(1) Leukocytosis, the total number of leukocytes can be more than 20.0×109/L. The total number of leukocytes can be more than 20.0×109/L.
(2) Gram-negative bacilli can be seen in sputum smear.
(3) Bacterial culture can confirm the diagnosis of E. coli infection, including respiratory specimen culture, blood culture, pleural fluid culture.
2. Chest x-ray examination
The x-ray shows small patchy infiltration shadows in the lower lungs unilaterally or bilaterally, with blurred edges, which can sometimes be fused. Multiple abscesses are easily formed after tissue necrosis, and if it spreads to the pleura, it can cause pleural exudate or pus chest.
Diagnosis
Based on the clinical manifestations of pulmonary solid lesions such as wet rales and turbid sounds on percussion on physical examination, combined with laboratory and chest X-ray findings, the diagnosis can be made clearly.
Treatment
1. General treatment
Intravenous fluids, oxygen therapy.
2. Symptomatic and supportive treatment
Attention to nutritional support, adequate drainage of sputum.
3.Drug treatment
Sensitive antibiotics should be selected according to the results of drug sensitivity, and sensitive and effective antibiotics mainly include broad-spectrum penicillin, third-generation cephalosporins, aminoglycosides and fluoroquinolones, such as ciprofloxacin and ofloxacin. Serious infections can be combined with the application of sensitive antibiotics. The course of antibiotic treatment is 10-14d.
4. Treatment of primary diseases
Actively treat the primary disease, such as gastrointestinal tract infection, pyelonephritis, etc.
Prognosis
The prognosis is poor for patients who are old and frail and have extensive lung lesions combined with severe infections.
Prevention
Enhance physical fitness and maintain oral hygiene. Active treatment of primary diseases, rational application of antibiotics and other drugs, prevention of hospital-acquired infections and other comprehensive preventive measures are particularly important.
Nursing care
1. Fever care
High fever should be bed rest, reduce oxygen consumption, available physical cooling, or follow the doctor’s instructions to apply drugs to lower the temperature, intravenous replenishment of water and salt lost due to fever, monitoring, recording temperature changes.
2. Cough and sputum care
Encourage the patient to take deep breaths, assist in turning over and chest percussion, guide effective coughing, and promote sputum expectoration. If the sputum is thick and sticky, encourage the patient to drink more water, or give nebulized inhalation.