Dr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\\n\\n
Seeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\\n\\n
Over these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\\n\\n
We are excited about the present, and we look forward to sharing many more successes in the future.
\\n\\n
Thank you all for being part of the journey. 5,000 times thank you!
\\n\\n
Now with 5,000 titles available Open Access, which one will you read next?
Preparation of Space Experiments edited by international leading expert Dr. Vladimir Pletser, Director of Space Training Operations at Blue Abyss is the 5,000th Open Access book published by IntechOpen and our milestone publication!
\n\n
"This book presents some of the current trends in space microgravity research. The eleven chapters introduce various facets of space research in physical sciences, human physiology and technology developed using the microgravity environment not only to improve our fundamental understanding in these domains but also to adapt this new knowledge for application on earth." says the editor. Listen what else Dr. Pletser has to say...
\n\n\n\n
Dr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\n\n
Seeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\n\n
Over these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\n\n
We are excited about the present, and we look forward to sharing many more successes in the future.
\n\n
Thank you all for being part of the journey. 5,000 times thank you!
\n\n
Now with 5,000 titles available Open Access, which one will you read next?
\n'}],latestNews:[{slug:"stanford-university-identifies-top-2-scientists-over-1-000-are-intechopen-authors-and-editors-20210122",title:"Stanford University Identifies Top 2% Scientists, Over 1,000 are IntechOpen Authors and Editors"},{slug:"intechopen-authors-included-in-the-highly-cited-researchers-list-for-2020-20210121",title:"IntechOpen Authors Included in the Highly Cited Researchers List for 2020"},{slug:"intechopen-maintains-position-as-the-world-s-largest-oa-book-publisher-20201218",title:"IntechOpen Maintains Position as the World’s Largest OA Book Publisher"},{slug:"all-intechopen-books-available-on-perlego-20201215",title:"All IntechOpen Books Available on Perlego"},{slug:"oiv-awards-recognizes-intechopen-s-editors-20201127",title:"OIV Awards Recognizes IntechOpen's Editors"},{slug:"intechopen-joins-crossref-s-initiative-for-open-abstracts-i4oa-to-boost-the-discovery-of-research-20201005",title:"IntechOpen joins Crossref's Initiative for Open Abstracts (I4OA) to Boost the Discovery of Research"},{slug:"intechopen-hits-milestone-5-000-open-access-books-published-20200908",title:"IntechOpen hits milestone: 5,000 Open Access books published!"},{slug:"intechopen-books-hosted-on-the-mathworks-book-program-20200819",title:"IntechOpen Books Hosted on the MathWorks Book Program"}]},book:{item:{type:"book",id:"565",leadTitle:null,fullTitle:"Breast Reconstruction - Current Techniques",title:"Breast Reconstruction",subtitle:"Current Techniques",reviewType:"peer-reviewed",abstract:"Breast reconstruction is a fascinating and complex field which combines reconstructive and aesthetic principles in the search for the best results possible. 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1. Introduction
Numerical modeling of free surface flow across real-life applications is gaining momentum. These model domains are characterized by thousands of computational cells, and the physical characteristics have varying complexities. Over the last three decades, with the growth of computational and visualization resources, multiple numerical models have been developed for solving the free surface flow equations across one, two, and three dimensions. While some of these models are available for free in the public domain, others are licensed by their respective vendors. Based on the assumptions used in these models, the complexity of flow equations can range from Bernoulli’s energy equation to three-dimensional unsteady Navier-Stokes equations. The models continue to evolve as the physics of flow is better understood, and the need for accurately predicting the flow variables across large spatial and temporal domains as their values is an important factor in the hydraulic design of structures and other related applications. Computational fluid dynamics (CFD) models that focus on solving the complete Navier-Stokes equations, rather than the energy equation or shallow water equations which are used in the hydraulic models, are also gaining popularity among the hydraulic modeling community.
The goal of this chapter is to evaluate the DHM results with a few industry-wide established software and experimental data to underscore the advantages and limitations in the models. To this end, we have chosen one critical application each from one-dimensional and two-dimensional flows.
2. One-dimensional application
2.1 Flows with hydraulic jump
Modeling flows with hydraulic jump where the flow transits from super critical to subcritical has been used by different researchers [1, 2, 3, 4] to test the reliability of their numerical formulations. Hydraulic jump is often created inflows to dissipate the flow energy, which can otherwise among others, erode the channels. They occur in gravity flows and are characterized by a large variation in flow depth and velocity before (Froude number > 1) and after (Froude number < 1) the jump. While capturing the internal flow details like bubble breakup, turbulence characteristics, tracking the water surface, aeration, fluid mixing, and turbulence is not possible using the shallow water equations, these equations can, however, predict the location and the flow depths before and after of the jump at steady state, which are important variables in the design calculations.
2.2 Experimental setup and model variables
A dataset from a series of experiments [5] that were conducted in the hydraulics laboratory at California State University, Fullerton, to simulate the location of steady-state hydraulic jump, was used for validating the models. The rectangular open channel flume was 15.2 m long, 0.46 m wide and 0.6 m in height. The channel sides are of glass, while the bottom interface with water is a metal sheet with a Manning roughness coefficient of 0.01. The bottom slope of the channel can be changed by tilting the flume, and in this investigation, it was set to 0.012. The flow discharge is 0.036 m3/s.
Boundary conditions need to be consistent with the physics of flow and appropriately complement the flow Equations [6]. The number of boundary conditions at the two ends of the flow domain is governed by the local Froude number. From a mathematical perspective, a boundary condition is a constraint imposed at the boundary node to arrive at a unique solution to a well-posed equation set. Specifying more or less than the required number may make the problem “ill-posed” and can lead to incorrect solutions. While one-dimensional supercritical flow requires superimposing two boundary conditions at the upstream end, a subcritical flow requires superimposing one boundary condition at the downstream end. In this simulation, at the upstream end, a flow depth of 0.04 m and flow discharge was specified. At the downstream end, a constant flow depth of 0.24 m was used. For this flow and boundary depth combination, the Froude numbers at the upstream and downstream end of the channel are 3.37 and 0.66, respectively.
2.3 Examined numerical models
The results of the DHM, RAS, WSPG, and TUFLOW models were compared with the experimental data. The other three models are briefly described below.
HEC-River Analysis System (RAS): HEC-RAS (steady state) model is based on the solution of the one-dimensional energy equation between two sections with energy losses given by Manning’s equation. The momentum equation can be used in situations where the water surface profile is rapidly varied as in hydraulic jump, hydraulics of bridges, and evaluating profiles at river confluences (stream junctions). RAS model also has modules to solve unsteady flows, sediment transport, and water quality analysis. In this work, the steady-state model was used. The model was developed by the US Army Corps of Engineers and can be downloaded for free [7].
Water Surface Pressure Gradient (WSPG): WSPG is one of the first models in computational hydraulics that was developed by the Los Angeles County Department of Public Works. The model solves the Bernoulli energy equation between any two cross sections, using the standard step method. The program computes uniform and nonuniform steady flow water surface profiles. As part of the solution, it can automatically identify a hydraulic jump in the channel reach. The model is currently distributed for a fee by civil design [8].
Two-dimensional unsteady flow (TUFLOW): The two-dimensional depth-averaged shallow water equations are solved in TUFLOW using a structured grid system with an alternating direction implicit scheme. The algorithm can capture flow transitions from supercritical to subcritical. TUFLOW incorporates the 1-D component (ESTRY software) or quasi-2D modeling system based on the full one-dimensional free surface flow Equations [9]. The model was developed by BMT WBM and can be downloaded for a fee.
2.4 Results
Figure 1 is a plot of the steady-state depth profile from the four models together with the experimental data. But for DHM, all other models satisfactorily predict the location and the flow depth before and after the jump. The reason as to why DHM could not capture the jump is because of the number of boundary conditions that the DHM permits from the end user. At the upstream end, DHM allows for only the flow discharge to be specified (and not two boundary conditions). The model had 18 grid elements in the computational domain. The upstream element is #1, and the end downstream element is #18. Element #14 corresponds to the end of the channel (length = 15.2 m). At element #1, the input discharge is 0.036 m3/s. At element #18, critical depth condition is specified, and the grid elevation was progressively raised such the depth at element #14 equals 0.24 m.
Figure 1.
Steady-state results for one-dimensional rapidly varying flow.
Because of this boundary condition limitation in the DHM, the jump is smoothened out in the solution. Although the downstream depth is consistent with other models, at the upstream end, the DHM predicted depth is higher than actual depth. DHM computed the flow transitioning from supercritical to subcritical without going through a hydraulic jump as required by theory and observed in the flume model. It can be concluded that DHM cannot be used in applications which require the prediction of the location of hydraulic jump.
3. Two-dimensional applications
3.1 Overland flow on a sloping domain
Overland flow is a dynamic response of the watershed to excess rainfall. Overland flow typically occurs as sheet flow on the land surface, and when the flow joins a channel, it is known as streamflow. The spatial and temporal distribution of two-dimensional overland flow variables is driven by the topographical characteristics of the domain and the boundary conditions. The nonhomogeneous surface characteristics and varying width of the natural watercourse path in the direction of flow make it an ideal case for comparing the results of different models.
Modeling overland flow has drawn the attention of many researchers. Since excess rainfall can cause flooding and mudslides which has the potential to cause loss of human life and disrupt the local economy, reliably predicting the flow variables for different precipitation scenarios can assist decision-makers and emergency personnel. Researchers have modeled these flows by solving the two-dimensional fully dynamic shall water Equations [10, 11] or their diffusion [12, 13] or kinematic approximations [14, 15].
3.1.1 Examined numerical models
The results of the DHM, extended DHM (EDHM), RAS, WSPG, and the CFD (OpenFOAM) models were compared. The back engine for EDHM is identical to DHM, with the primary difference between the two models being the larger array size of the variables in EDHM. When DHM was originally developed, the maximum array dimension was limited to 250, largely because of the available computational resources in 1980s. In EDHM, the dimension of all the arrays was increased to 9999. Since background information relating to RAS and WSPG has been given earlier, characteristic features of the CFD model, OpenFOAM, are summarized below.
OpenFOAM (Open-source Field Operation and Manipulation) is a freely available open-source software [16] that is gaining popularity across CFD applications. Its versatile C++ toolbox for the Linux operating system enables developing customized, efficient numerical solvers, and pre-/post-processing utilities for all kinds of CFD flows [17]. This code uses a tensorial approach following the widely known finite volume method (FVM), first used by McDonald [18]. Both structured and unstructured meshes can be used in the computational domain. The time integration can be done through backward Euler, steady-state solver, and Crank-Nicholson. The available gradient, divergence, Laplacian, and interpolation schemes are second-order central difference, fourth-order central difference, first-order upwind, and first-/second-order upwind. The turbulence models that can be used in OpenFOAM are LES, k-ɛ, and k-ɯ. The available solvers, options in specifying the boundary conditions, mesh generation tools, flow visualization software, and extensive documentation are making OpenFOAM popular among the CFD modeling community [2, 13, 19].
3.1.2 Study area and model variables
The study area is shown in Figure 2. Overland flow generated by a storm down a steep slope hits the flat main street after which a significant portion of the flow continues flowing North. The flow is supercritical from the inlet boundary location to the downstream of the main street. At the street downstream, there is a wall which reduces the flow velocity, thus forcing the flow to be critical. In this analysis, lateral flow on the main street was neglected.
Figure 2.
Map of the study area. The inflow and outflow boundary locations are identified by and .
In the models, the Manning roughness coefficient was set to 0.015 for the street portion and 0.03 for the earth. A uniform grid size of 15 ft was used, which resulted in a total of grids in the domain. The grids were oriented with the natural watercourse (NWC) path. The NWC ranged between 27 and 35 ft in the vicinity of the upstream end (southwest corner), and its width ranged between 45 and 60 ft in the vicinity where the water hits the main street. Having a 15 ft grid enabled us to cover the entire NWC path (Figure 3). The elevation at the center of the grid in the DHM was obtained from the topography map of the area. For the RAS and WSPG models, the required cross-sectional data was obtained from the top map. The rest of the input variables were consistent with the DHM data.
Figure 3.
DHM computational domain. The domain is aligned with the natural watercourse path and had 248 cells, which are 15 ft squares.
The intensity of rainfall and the bottom slope enhances the power of gravity-driven overland flow to make it supercritical (Froude number > 1). The available power in the water near the street can potentially push any moving or stationary automobiles. At the upstream end center cell, the flow hydrograph (Figure 4) was used as the boundary condition. The peak discharge at t = 0.5 hours is 755 cfs. At the downstream end, a critical depth boundary was specified. To keep the effect of downstream boundary minimal on the solution, the domain was extended by about 250 ft north of the main street.
Figure 4.
Input hydrograph at the upstream end.
Our focus was on predicting the flow depth at multiple probe locations on the main street. To conserve space, these results are plotted at two of the thirteen probe locations. These probe locations are 9 and 13 (Figure 5).
Figure 5.
Location of the probes along the center of the main street. The flow depth results were compared at probe locations 9 and 13.
3.1.3 Results
The DHM computational results include a variety of hydraulics relationships that are useful in further detailed analysis, such as flow velocity, flow depth, Froude number, and so forth. Of course, the code can be readily included in the DHM or as a post-processor routine, which enhances the DHM outcome. Of particular interest are the computational results from the DHM in comparison with the computational results produced by the CFD application. To display these computational results, hypothetical “probes” are inserted into the computational mesh where computational results are assembled and collated into a form suitable for visualization. The results from the visualization assessment are depicted below.
Figures 6 and 7 are plots comparing the flow depth, at probe location 9 and 13 on the main street. The data from DHM, EDHM, WSPG, RAS, and CFD (OpenFOAM) are plotted, for a specific CFD simulation time period. It is noted that the computational results are of high similarity, yet the computational effort ranges vastly. The DHM takes approximately 1 hour of CPU for the indicated simulation. In comparison, because of the varying small grid sizes in the domain, the CFD model required 2 weeks of CPU time using a parallel processor.
Figure 6.
Comparison of flow depth at probe 9 location.
Figure 7.
Comparison of flow depth at probe 13 location.
3.2 Open channel flow with a constriction
Numerically predicting the characteristics of flow through a channel with symmetric abrupt constriction (Figure 8) in the form of reduced channel width has drawn the attention of many researchers and has been part of any standard text book in hydraulics. The idea of developing DHM for this application was inspired after reading a recent paper [20] who tested a series of 2D models for multiple applications, one of which is flow through a constriction. Our focus was to estimate the DHM head loss at steady state and compare it with the published data.
Figure 8.
Definition sketch of the test problem along with the location of the two points (P1 and P2).
3.2.1 Examined numerical models
The results of the extended DHM (EDHM), Mike 21, TUFLOW, and HEC-RAS 2D models were compared, with the bench mark data from the equations provided by the Federal Highways Administration (FHA). Mike 21 and HEC-RAS 2D are briefly outlined here. Mike 21 solves the two-dimensional free surface flows where stratification can be neglected. It was originally developed for flow simulation in coastal areas, estuaries, and seas. The various modules of the system simulate hydrodynamics, advection-dispersion, short waves, sediment transport, water quality, eutrophication, and heavy metals [21].
HEC-RAS 2D (5.0.1) solves the two-dimensional Saint-Venant Equations [7] for shallow water flows using the full momentum computational method. The equations can model turbulence and Coriolis effects. For flow in sudden contraction, which is accompanied by high velocity, using the full momentum method in RAS 2D is recommended. The model uses an implicit finite volume solver.
3.2.2 Model variables
Figure 8 is the definition sketch of the test problem. The rectangular channel is 3100 ft long and 320 ft wide. The constriction is 60 × 60 ft. The channel length before constriction is 310 ft, and its length after constriction is 2730 ft. The computational domain in EDHM had 10 ft square cells, and the total number of cells was 9920. The longitudinal slope is 1%, the transverse slope is zero, and the model was run for a total of 1 hour. The upstream inflow is 1000 cfs. Since there are 30 cells at the upstream end, a uniform steady inflow of 33.3 cfs was specified at each of the cells. At the downstream end, a free overall boundary was specified. Constricting the flow area results in loss of energy. This loss of energy is reflected in a rise in energy gradient line and energy upstream of the constriction. Of interest is to estimate the head loss that occurs between points 1 and 2 (shown in Figure 8). The head loss (HL) equals WSE2 − WSE1, where WSE is the water surface elevation [20].
3.2.3 Results
Table 1 shows the comparison of the head loss value obtained from the models along with the published data of other models. It is noted that in this effort, the computational models are compared with respect to head loss (as given in [20]) through the constriction, and this is the primary form of assessment. The DHM WSE change value is within the range of other model predictions, although all the model predictions are above the FHA value.
WSE change (ft)
HEC-RAS 2D
1.27
TUFLOW
0.99
Mike 21
1.28
EDHM
1.16
FHA equation
0.8
Table 1.
Comparison of change in water surface elevation at constriction between EDHM and published data*.
Except for EDHM all other data were obtained from the literature [20].
4. Conclusions
Results from multiple computer models are compared with those of DHM for one- and two-dimensional flows. The considered one-dimensional flow was a mixed flow with a hydraulic jump. All the model results (DHM, WSPG, RAS, TUFLOW) were compared with the benchmark experimental data. Because of the way the boundary conditions are specified in the DHM, the model cannot simulate the hydraulic jump. For the two-dimensional overland flow, the model results (DHM, EDHM, TUFLOW, MIKE 21, WSPG, RAS, RAS2D, and the CFD model, OpenFOAM) were compared between themselves. The agreement of the predicted flow variables reinforces the reliability of the current model.
\n',keywords:"HEC-RAS, WSPG, TUFLOW, OpenFOAM, Froude number, hydraulic jump, overland flow",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/72844.pdf",chapterXML:"https://mts.intechopen.com/source/xml/72844.xml",downloadPdfUrl:"/chapter/pdf-download/72844",previewPdfUrl:"/chapter/pdf-preview/72844",totalDownloads:126,totalViews:0,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,dateSubmitted:null,dateReviewed:"June 17th 2020",datePrePublished:null,datePublished:"September 9th 2020",dateFinished:null,readingETA:"0",abstract:"In this chapter, the performance of DHM for one- and two-dimensional flows is compared with the results of HEC-RAS, HEC-RAS 2D, WSPG, TUFLOW, Mike 21, and OpenFOAM models. The latter four models are currently widely used in industry, and benchmarking their data with DHM can shed more light on the reliability of DHM. As the results indicate, for applications which do not violate the assumptions made in DHM, the results are in agreement.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/72844",risUrl:"/chapter/ris/72844",book:{slug:"a-diffusion-hydrodynamic-model"},signatures:"Theodore V. Hromadka II and Prasada Rao",authors:[{id:"181008",title:"Dr.",name:"Theodore V.",middleName:"V.",surname:"Hromadka II",fullName:"Theodore V. Hromadka II",slug:"theodore-v.-hromadka-ii",email:"tedhromadka@yahoo.com",position:null,institution:{name:"United States Military Academy",institutionURL:null,country:{name:"United States of America"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. One-dimensional application",level:"1"},{id:"sec_2_2",title:"2.1 Flows with hydraulic jump",level:"2"},{id:"sec_3_2",title:"2.2 Experimental setup and model variables",level:"2"},{id:"sec_4_2",title:"2.3 Examined numerical models",level:"2"},{id:"sec_5_2",title:"2.4 Results",level:"2"},{id:"sec_7",title:"3. Two-dimensional applications",level:"1"},{id:"sec_7_2",title:"3.1 Overland flow on a sloping domain",level:"2"},{id:"sec_7_3",title:"3.1.1 Examined numerical models",level:"3"},{id:"sec_8_3",title:"3.1.2 Study area and model variables",level:"3"},{id:"sec_9_3",title:"3.1.3 Results",level:"3"},{id:"sec_11_2",title:"3.2 Open channel flow with a constriction",level:"2"},{id:"sec_11_3",title:"3.2.1 Examined numerical models",level:"3"},{id:"sec_12_3",title:"3.2.2 Model variables",level:"3"},{id:"sec_13_3",title:"Table 1.",level:"3"},{id:"sec_16",title:"4. Conclusions",level:"1"}],chapterReferences:[{id:"B1",body:'Viti N, Valero D, Gualtieri C. Numerical simulation of hydraulic jumps. Part 2: Recent results and future outlook. Water. 2018;11:28. DOI: 10.3390/w11010028'},{id:"B2",body:'Bayón Barrachina A, López Jiménez PA. Numerical analysis of hydraulic jumps using OpenFOAM. Journal of Hydroinformatics. 2015;17(4):662-678. DOI: 10.2166/hydro.2015.041'},{id:"B3",body:'Mortazavi M, Le Chenadec V, Moin P, Mani A. Direct numerical simulation of a turbulent hydraulic jump: Turbulence statistics and air entrainment. Journal of Fluid Mechanics. 2016;797:60-94'},{id:"B4",body:'Gharangik AM, Chaudhry MH. Numerical simulation of hydraulic jump. Journal of Hydraulic Engineering ASCE. 1991;117:1195'},{id:"B5",body:'Rao P, Hromadka TV II. Numerical modeling of rapidly varying flows using HEC-RAS and WSPG models. Technical Note. Springerplus. 2016;5:662. DOI: 10.1186/s40064-016-2199-0'},{id:"B6",body:'Hirsh C. Numerical Computation of Internal and External Flows. New York (NY): John Wiley & Sons; 1990'},{id:"B7",body:'U.S. Army Corps of Engineers (USACE). HEC-RAS River Analysis System. User’s Manual. Davis, CA: Hydrologic Engineering Center; 2019. Version 5.0.7. Available from: http://www.hec.usace.army.mil/software/hec-ras/'},{id:"B8",body:'Water Surface Pressure Gradient for Windows. Joseph E. Bonadiman & Associates, Inc.; Available from: https://civildesign.com/products/wspgw-water-surface-pressure-gradient-for-windows'},{id:"B9",body:'BMT-WBM, Australia. User’s Manual for TUFLOW. Spring Hill: WBM Oceanics Australia; 2019'},{id:"B10",body:'Costabile P, Costanzo C, Macchione F, Mercogliano P. Two-dimensional model for overland flow simulations: A case study. European Water. 2012;38:13-23'},{id:"B11",body:'Ponce VM. Modeling surface runoff with kinematic, diffusion, and dynamic waves. In: Singh VP, Kumar B, editors. Proceedings of the International Conference on Hydrology and Water Resources. New Delhi, India, December 1993. Dordrecht: Water Science and Technology Library, Springer; 1996. p. 16'},{id:"B12",body:'Kazezyılmaz-Alhan CM. An improved solution for diffusion waves to overland flow. Applied Mathematical Modelling. 2012;36:465-1472'},{id:"B13",body:'Santillana M. Analysis and numerical simulation of the diffusive wave approximation of the shallow water equations [PhD thesis]. Austin: University of Texas; 2008'},{id:"B14",body:'Liu Q , Chen L, Li J, Singh V. Two-dimensional kinematic wave model of overland-flow. Journal of Hydrology. 2004;291(10):28-41'},{id:"B15",body:'Tsai T, Yang J. Kinematic wave modelling of overland flow using characteristic method with cubic-spline interpolation. Advances in Water Resources. 2005;28(7):661-670'},{id:"B16",body:'The Free Software Foundation Inc. OpenFOAM: The Open Source CFD Toolbox User Guide. London, United Kingdom: The Free Software Foundation Inc; 2019. Available from: https://openfoam.org/'},{id:"B17",body:'Weller H, Tabor G, Jasak H, Fureby C. A tensorial approach to computational continuum mechanics using object-oriented techniques. Computers in Physics. 1998;12:620-631'},{id:"B18",body:'McDonald PW. The computation of transonic flow through two-dimensional gas turbine cascades. American Society of Mechanical Engineers. Paper No: 71-GT-89, V001T01A089; 1971. p. 7. DOI: 10.1115/71-GT-89'},{id:"B19",body:'Bayon A, Valero D, García-Bartual R, Jos F, Valles-Mor FJ, Lopez-Jim P. Performance assessment of OpenFOAM and FLOW-3D in the numerical modeling of a low Reynolds number hydraulic jump. Environmental Modelling & Software. 2016;80:322-335'},{id:"B20",body:'Paudel M, Roman SB, Pritchard J. A Comparative Study of HEC-RAS 2D, TUFLOW, & Mike 21. In: ASFPM 2016 Annual National Conference, Grand Rapids, MI. 2016'},{id:"B21",body:'DHI, MIKE 11 & MIKE 21 Flow Model. Scientific Documentations. 2019. Available from: https://www.mikepoweredbydhi.com'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Theodore V. Hromadka II",address:"ted@phdphdphd.com",affiliation:'
Department of Mathematical Sciences, United States Military Academy, USA
Department of Civil and Environmental Engineering, California State University, USA
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1. Introduction
Escherichia coli strains compose, physiologically part of the microflora of the gastrointestinal tract [1, 2, 3, 4]. Belonging to the Enterobacteriaceae family, fermentative, non-sporulated and facultative anaerobic commensals, they are mainly from the large intestine [5, 6].
Despite being commensal microorganisms, they are the Gram-negatives which are most often a cause of human infections, having pathogenic strains that cause a wide variety of intestinal or extra-intestinal infections, such as urinary tract, intra-abdominal and soft tissue, sepsis, neonatal meningitis, gastrointestinal infection, and pneumonia, often leading to bacteremia [3, 7]. Although Gram-positive microorganisms have been increasing as a cause of sepsis due to the instrumentation of medical care—understood as the use of invasive devices or tools for the treatment or diagnosis of patients, and to infections associated with health care—E. coli continues to be an important and perhaps the most frequent cause of threatening infections in our environment [8, 9].
They are classified as Gram-negative bacteria and divided into 3 main groups: commensal lines, intestinal pathogenic lines (enteric or diarrhea) and extra-intestinal pathogenic lines [10].
Furthermore, Gram-negative bacteria produce large molecules consisting of a lipid and a polysaccharide, known as lipopolysaccharides (LPS), lipoglycans and endotoxin, which increases their pathogenicity in relation to Gram-positive bacteria [11].
2. Epidemiology
E. coli is one of the most commonly isolated bacteria in the bloodstream (responsible for approximately 20% of all clinically significant isolates) and is the Gram-negative organism most frequently isolated in adult patients with bacteremia [12]. In the United States of America, E. coli sepsis was associated with approximately 40,000 deaths in 2001, a number that corresponds to 17% of all cases of sepsis [13].
Studies have shown an increasing incidence of E. coli early-onset sepsis in all age groups, overruling group B Streptoccocus for the last 10 years. Beyond that, E. coli resistant strains also increased equally in all age groups, with high resistance rates to first line antibiotics available (ampicillin and gentamicin).
Very low birth weight newborns remained the group with higher incidence (10.4 cases per 1000 live births) and mortality (35.3%). Systematic use of PCR increased E. coli early-onset sepsis diagnosis, mainly in the term newborn group. There was also an increase in resistant E. coli strains causing early-onset sepsis, with especially high resistance to ampicillin and gentamicin (92.8 and 28.6%, respectively) [14].
3. Risk factors
Several hospital-based studies have suggested that a number of comorbid illnesses, including diabetes, malignancy, chronic lung disease, cirrhosis and heart disease, may increase the risk of E. coli bacteremia. Previous researches have also identified age (very young and very elder), hospital acquisition, comorbid illnesses, presence of shock, non-urinary focus, and antimicrobial resistance in conjunction with inadequate treatment as being associated with higher rates of death [15, 16, 17].
Dialysis, solid organ transplantation and neoplastic disease were important risk factors for acquiring E. coli bacteraemia. Ciprofloxacin resistance and non-urinary focus were independently associated with an increased risk of death [18]. For males, urinary catheterization and incontinence were associated as risk factors to Escherichia coli bloodstream, and for females, cancer, renal failure, heart disease and urinary incontinence were risk factors reported [19]. Several risk factors which have significantly mortality due to E. coli bacteremia are age, severe sepsis or shock, non-urinary origin, Charlson index, inadequate empirical treatment (Table 1).
Mortality risk factor
P
OR (95% CI)
Age
0.03
1.04 (1–1.08)
Severe sepsis or shock
<0.0001
14.64 (6.14–30.86)
Non-urinary origin
0.013
2.78 (1.24–6.2)
Charlson index
0.006
1.31 (1.08–1.59)
Inadequate empirical treatment
0.006
2.98 (1.25–7.11)
Table 1.
Results of multivariate analyses examining risk factors for mortality associated with bacteraemia due to E. coli [15].
4. Pathogenesis
The human gastrointestinal tract is normally inhabited by Escherichia coli, which is why they are the bacterial species most commonly found in the isolation of fecal culture [20, 21]. By the time the strains acquire additional genetic material, they can become pathogenic and circulate widely throughout the body. Pathological clones are divided into two major groups: intestinal (among the most virulent enteric pathogens) and extraintestinal (less present, but not less dangerous) [22, 23].
4.1 Intestinal
4.1.1 EPEC
Typical enteropathogenic Escherichia coli (tEPEC) contains a virulence plasmid (pEAF) that encodes the bundle-forming pilus (BFP), the primary factor for colonization [24, 25]. In addition, EPEC carries the crossomic island of locus for enterocyte effacement, which features the eae gene, which is the encoder of a colonization factor in the outer membrane protein called intimin [26, 27]. Only the E. coli strain that has pEAF and the eae gene can be considered tEPEC, one that has only the eae gene and is called atypical EPEC (aETEC) [28].
The small intestine is the most likely place for EPEC infection to occur. For the onset of diseases, tEPEC obeys the following steps:
Initial localized adhesion of organisms to enterocyte via BFP.
Induction of signal transduction in the enterocyte by secretion of protein toxins.
Development of intimin-mediated intimate adhesion to the enterocyte.
Around 20 protein toxins are injected directly into the target epithelial cell, made, together with the intimin, by the chromosomal island LEE and expressed by both tEPEC and aEPEC [29]. The complex nanomachine called type III secretion injector is the one that injects protein toxins. It is assumed that some modifications happen to the epithelial stem cells, which is physiologically absorbent, and through a pathological process, it becomes a secretory dynamo [30].
What is believed is that type III ejection toxins are responsible for binding to protein elements of the cell’s signal transduction apparatus. This event is accompanied by the mobilization of calcium from the intracellular compartment, activation of protein kinase C, kinase light chain myosin and induction of protein phosphorylation by tyrosine. The rearrangement of cytoskeletal proteins is induced by effectors, which results in the classic lesion "attaching and erasing," changes in the secretion of water and electrolytes and increased permeability of the tight intestinal junctions [31].
4.1.2 ETEC
Enterotoxigenic Escherichia coli (ETEC) consists of ingestion of bacteria, intestinal colonization and production of virulence factors. Colonizing fimbriae (CFs) must be expressed by ETEC to allow the consolidation of the bacteria in the intestine [32].
After colonization, ETEC produces two classes of secretory toxins encoded by plasmids: heat-labile toxin (LT) and heat-stable toxin (ST). To be classified as ETEC, E. coli must contain one or both classes of toxins [33, 34].
LT toxin is related to Vibrio cholera toxins in terms of structure, function and mechanism. It works by stimulating adenylate cyclase and increasing adenosine intracellular cyclic monophosphate (AMP), a fact that stimulates chloride secretion from intestinal crypt cells and inhibits the absorption of sodium chloride at the ends of the villi. After that, the water secretion is free in the intestinal lumen, clinically developing watery diarrhea [35].
STa toxin, the only ST variant that causes disease in humans, activates cyclic GMP of enterocytes, leading to increased chloride secretion and decreased sodium chloride absorption. As a final result, the secretion of free water in the intestinal lumen clinically appears as watery diarrhea [36].
4.1.3 EHEC
Among the pathotypes that cause the most severe conditions, the strains classified as enterohemorrhagic (EHEC) stand out, which are the most common to cause disease in developed countries [29].
They are bacteria responsible for food infections and represent a risk to the health of the population, so they must be monitored frequently. Thus, good hygiene practices, as well as the use of quality tools, are extremely important to help reduce the risk of cross-contamination and human infection.
EHEC has the ability to attach itself to the host and to produce shiga-toxins, which gives the strain pathogenicity. The toxins produced by EHEC cause damage to the mucosa of the large intestine, where they are absorbed by reaching the bloodstream, which makes it possible to affect other organs, such as the kidneys [37]. An average of 5–10% of patients confirmed with EHEC infection develop potentially fatal complications, such as hemolytic uremic syndrome (HUS), which leads to sudden renal failure and hemolytic anemia [38].
Outbreaks are related to the ingestion of contaminated food and water, causing watery diarrhea and hemorrhagic colitis to those infected. The disease has a sudden onset with severe abdominal cramps and watery diarrhea that progresses to bloody, on average after 24 hours, lasting between 1 to 8 days.
The treatment consists of supportive therapy for fluid replacement, since the use of antibiotics is not indicated, as there is no proven efficacy. In fact, it could increase the risk of developing HUS, since the death of the bacteria would increase the release of toxins, predisposing to the syndrome [39].
4.1.4 EIEC
Enteroinvasive E. coli (EIEC) is very close to Shigella and develops a colitis similar to shigellosis. The intestinal cell is invaded by the EIEC which multiplies intracellularly and reaches the adjacent intestinal cells [40].
To differentiate Shigella from EIEC it is necessary to analyze the strains, those from EIEC ferment glucose and xylose, this differentiates them. Nucleic acid tests, including multiplexed panels, are used to detect organisms [41].
4.1.5 DAEC
Diffusely adherent E. coli is associated with diarrhea, which is characterized as watery and can become persistent in children between 1 and 5 years of age, occurring more frequently in developing and developed countries. In addition, this bacterium is also related to urinary tract infections and complications during the pregnancy period.
The pattern of diffuse adhesion in HEp-2 or HeLa cells is a characteristic that differentiates this pathotype from the others, although DAEC strains are quite heterogeneous. This adhesion is mediated by fimbrial and afimbrial adhesins, which can cause damage to microvilli due to the disorganization of the cytoskeleton. However, some strains produce an adhesin involved in diffuse adhesion (AIDA-I), instead of encoding the diffuse adhesion pattern, which is why they are called atypical DAEC [42].
In addition, DAEC can also provide a pro-inflammatory effect [43].
4.2 Extraintestinal
The type of E. coli responsible for the invasion, colonization and induction of diseases in body sites outside the gastrointestinal tract is the extraintestinal pathogenic Escherichia coli (ExPEC). It is noteworthy that diseases caused by ExPEC range from urinary tract infections, neonatal meningitis, sepsis, pneumonia, surgical site infections to infections in other extraintestinal sites, representing a burden in terms of medical costs and lost productivity [44].
Thereto, the ExPEC strains were isolated from food products, in particular raw meat and poultry, indicating that these organisms potentially represent a new class of foodborne pathogens [45].
4.2.1 Urosepsis
Almost 25% of sepsis cases originate from the urogenital tract. [46, 47, 48]. Considering this percentage, the most common pathogen that causes urinary tract infection (and, consequently, urosepsis) is Escherichia coli (50%) [49]. It is known that this condition is better managed with an interprofessional team of health professionals—a nephrologist, infectious disease expert, urologist, intensivist, a nurse and a pharmacist [50, 51]. The outcomes after urosepsis depend on the cause and severity of the infection, and if the patient has a complicating factor in the urinary tract that is identified and warrants treatment, it should be performed as soon as possible. As an example, the literature reveals Foley catheter placement to relieve urinary retention or stent placement to bypass an obstructing ureteral calculus causing urosepsis. Moreover, the prognosis also depends on the type of bacteria, antimicrobial resistance, and patient comorbidity.
In addition to early antibiotics, there are some important parts of the management of sepsis. Initial fluid resuscitation with crystalloid is still recommended at a minimum of 30 mL/kg. Consider early administration of vasopressor support to maintain a mean arterial pressure greater than 65 mm Hg. The first choice for vasopressor support in sepsis is norepinephrine (with epinephrine and vasopressin 2 and 3). Tight glucose control is also recommended, with corticosteroids and blood products being more controversial in the literature [52].
5. Antimicrobial resistance
Although Escherichia coli is one of the most-studied microorganisms worldwide, its characteristics are constantly changing. Elseways, one important global problem is the increase of antimicrobial resistance shown by bacteria, being considered as “threatens the achievements of modern medicine” [53, 54].
E. coli resistant strains increased equally in all age groups, with high resistance rates to our first line antibiotics (ampicillin and gentamicin), with relevant highlight in neonatal E. coli isolates from invasive infection [55]. Table 2 shows the temporal trends for antibiotic resistance to E. coli.
Agent or phenotype [n (%)]
1997 n = 58
1998 n = 49
1999 n = 52
2000 n = 83
2001 n = 86
2002 n = 70
2003 n = 87
2004 n = 122
2005 (January–June) n = 56
Total n = 663
P
Ampicillin
27 (46.6)
24 (49)
24 (46.2)
50 (60.2)
54 (62.8)
46 (65.7)
55 (63.2)
70 (57.9)
35 (62.5)
385 (58.2)
0.02
Trimethoprim/sulfamethoxazole
14 (24.1)
11 (22.4)
13 (25.0)
28 (33.7)
21 (24.4)
28 (40)
32 (36.8)
41 (33.6)
20 (35.7)
208 (31.4)
0.02
Ciprofloxacin
9 (15.5)
7 (14.3)
10 (19.2)
7 (8.4)
14 (16.3)
16 (22.9)
22 (25.3)
27 (22.1)
13 (23.2)
125 (18.9)
0.02
Amoxicillin/clavulanate
9 (15.5)
4 (8.2)
9 (17.3)
16 (19.3)
8 (9.3)
7 (10)
11 (12.6)
15 (12.3)
20 (35.7)
99 (14.9)
0.1
Gentamicin
4 (6.9)
6 (12.2)
5 (9.6)
5 (6.0)
8 (9.3)
6 (8.6)
7 (8.0)
8 (6.6)
8 (14.3)
57 (8.6)
0.8
Piperacillin/tazobactam
1 (1.7)
4 (8.2)
1 (1.9)
8 (9.6)
6 (7.0)
4 (5.7)
5 (5.7)
2 (1.6)
2 (3.6)
33 (5)
0.4
Cefotaxime
11
2 (4.1)
0
2 (2.4)
3 (3.5)
5 (7.1)
3 (3.4)
12 (9.8)
4 (7.1)
31 (4.7)
0.001
ESBL production
0
0
0
2 (2.4)
3 (3.5)
3 (4.3)
2 (2.3)
9 (7.4)
3 (5.4)
22 (3.3)
0.002
MDR
4 (6.9)
4 (8.2)
5 (9.6)
9 (10.8)
9 (10.5)
12 (17.1)
15 (17.2)
17 (13.9)
12 (21.4)
87 (13.1)
0.006
Table 2.
Number, yearly percentages, and P values for temporal trend of non-susceptible cases of E. coli bacteraemia.
6. Evaluation
The sepsis’ diagnosis confirmation is done from the evaluation of the clinical status of the patient, analyzing some criteria. For adult patients, it is confirmed or a diagnosis of sepsis is made when two criteria are present: hyperthermia>38.3 °C or hypothermia <36°C, tachycardia>90 bpm, leukocytosis (>12,000 μL-1) or leukopenia (<4000 μL-1) or >10% bands, acutely altered mental status, tachypnea > 20 bpm, hyperglycemia (>120 mg/dl) in the absence of diabetes [56].
7. Clinical assessment and patient presentations
7.1 History and physical examination
Collect a careful history from patient, addressing information such as previous illnesses, surgeries, how long ago the symptoms started, if there are comorbidities, if it have traveled to a place recently and other details, added to a complete physical examination, which provides very relevant information and leads to a line of rationality, it is extremely important to start the development of a preliminary differential diagnosis of the patient’s complaints.
All this information collected is recorded and saved in medical records, more recently, electronics, which are more organized, more readable and allows a better comparison, in relation to written records [57].
Some of the most frequent reasons that lead patients to go to a medical consultation are dyspnea, cough with or without hemoptysis and chest pain, as these symptoms can be indications of serious illnesses, it shows the importance of asking questions and exams in a way attentive and careful [58].
7.2 Presentations
7.2.1 Pneumonia
Ventilator-associated pneumonia (VAP) is the most common fatal hospital infection [59]. One of the bacteria most involved in the clinical picture in question is Enterobacteriaceae Escherichia coli [60, 61] and there is little awareness when it comes to the pathophysiology of E. coli pneumonia.
Studies show that these E. coli pathogenic islands (PAIs) are involved differently in the pathogenicity of the lung compared to those present in urinary tract and bloodstream infections [62]. In addition, research on mice has also shown that these isolated strains are highly virulent extra-intestinal pathogens that express virulence factors, representing potential targets for new therapy. A French national study also demonstrated that, despite the genomic and phylogenetic characteristics of E. coli pneumonia isolates from critically ill patients, they belong to the same extra-intestinal pathogen as E. coli, they have specific distinct characteristics when lungs [63].
7.2.2 Acute-bacterial meningitis
E. coli meningitis is rare in adult forms of the disease [64, 65, 66], but it is a frequent pathogen in the pediatric field [67]. Despite its rarity, it has a serious clinical course [64, 65, 66]. It is usually diagnosed based on clinical signs and cerebrospinal fluid (CSF) analysis.
Due to the severity of the disease, early diagnosis, adequate antibiotic treatment and hemodynamic control are essential [68].
E. coli meningitis follows a high degree of bacteraemia and invasion of the blood–brain barrier. With mortality rates ranging from 15 to 40%, Meningitis due to this bacterium leaves approximately 50% of survivors with some type of neurological sequelae [69, 70, 71, 72, 73, 74, 75, 76, 77, 78].
Although the process is unknown, it is known that, for the onset of the disease, it is necessary to have an invasion of the blood–brain barrier by E. coli, which requires specific microbial and host factors such as specific signaling molecules for microbes and hosts. Thus, blocking these microbial and host factors that contribute to the invasion of the blood–brain barrier by E. coli is effective in preventing the penetration of E. coli into the brain.
With the complete discovery of this mechanism, it is likely that new targets for the prevention and therapy of Escherichia coli meningitis will be achieved [79].
Regarding treatment, it is currently known only that antimicrobial chemotherapy has limited efficacy [79, 80, 81].
7.2.3 Intra-abdominal infections
Intra-abdominal infections (IAI) are invasive and bacterial multiplications in the hollow organ walls and beyond. Usually, it is located in the abdominal cavity, in the retroperitoneum and in the abdominal organs, being a common complication in the post-surgical period [82]. In addition, they have a wide variety of pathological conditions, from appendicitis to fecal peritonitis, which makes IAI generally have a poor prognosis (especially in high-risk patients) and is an important cause of morbidity [83]. Mostly, the most common source of this infection is the appendix, followed by gastroduodenal perforations. The Gram-negative bacteria E. coli is the most common causative agent of IAI. Therefore, it is important to know that they have great sensitivity to imipenem, meropenem, mainly, and to amoxi-clavulanate, amikacin and piperacillin-tazobactam, next [84, 85]. However, amici-clavulanate is prescribed as a first-line drug in developing countries, due to cost factors [86].
7.2.4 Enteric infections
Although E. coli strains have been isolated as part of the normal beneficial flora of the intestine, some strains have developed pathogenic mechanisms to cause disease in humans and animals. One of these strains capable of causing diseases is enteric Escherichia coli (E. coli), comprising important pathogens, since they cause significant morbidity and mortality worldwide. Traditionally enteric E. coli was divided into 6 pathotypes, however two other divisions were proposed by several studies (as mentioned individually in topic 4) [87].
Although there are many etiological agents responsible for diarrhea, pathogenic E. coli is a major contributor. On the other hand, the onset and complications of enteric E. coli vary significantly, despite there are many common features in the pathogenic process of colonizing the intestinal mucosa and the onset of disease [88].
Outbreaks are common all over the world, with fatal consequences mainly in children under 5 years of age living in underdeveloped countries, where diarrheal diseases can lead to death more frequently [89].
The transmission of enteric E. coli is also a public health concern, related to the development of countries, since its transmission is through contaminated water and food. Thus, the seriousness in relation to the microorganism can be exemplified by national and international surveillance programs, created by developed countries that aim to constantly monitor outbreaks [90]. In developing countries ETEC, EPEC and EAEC are considered to be the main causes of childhood diarrhea, and when left untreated, they have potentially fatal consequences. However. in developed countries, these infections are mild and self-limiting, with EHEC and, more recently, EAEC and STEAEC being the main E. coli pathotypes associated with food poisoning outbreaks [91, 92].
7.2.5 UTI
Among the most common types of bacterial infections that occur both in the community and in hospitals, urinary tract infections (UTI) stand out. Urinary tract infections can be associated with the hospital (HAUTIs) and the community (CAUTIs). In the case of CAUTIs, it is known whether women are the predominant group of patients.
Although the UTI is multifactorial, the main bacteria related to the diagnosis is E. coli, predominant in both community and nosocomial UTIs [93].
Co-trimoxazole (trimethoprim/sulfamethoxazole), nitrofurantoin, ciprofloxacin and ampicillin are the antibiotics commonly recommended for the treatment of UTIs. However, there is an overall increase in antibiotic resistance among pathogens in the urinary tract, which is a limitation on treatment options [94, 95].
Since the evidence suggests a significant relationship between the extensive use of antibiotics and antimicrobial resistance, it is necessary to prescribe and use antibiotics in order to reduce their complications and costs [96].
For this reason, in order to guide the selection of empirical therapy, surveillance of antibiotic resistance is crucial for determining the pattern of antimicrobial resistance [97].
8. Workup
8.1 Urine culture
It aims to check the presence of fungi and bacteria in the urine, being carried out from a urine sample, which was placed in Petri dishes. The urine culture is placed in an incubator (1–2 days) and if there is any microorganism in the tested material, colonies grow and are visible on the plate. When the result is positive for some bacteria, a test antibiogram is performed, which determines the type of antibiotic needed to act against the pathogen [98].
The culture of urine is important precisely because it allows the precise recognition of the bacteria and, consequently, the best antibiotic to be used [99].
As urine culture is most frequently requested when UTI is suspected, the most common bacteria found are Escherichia coli (between 47.5% and 56.4% of all urine culture) [100, 101].
8.2 Blood culture
Blood culture is part of the routine assessment of patients with suspected bloodstream infection, and is crucial to guide therapeutic intervention. The ideal method for collecting blood culture is venepuncture, since it increases diagnostic yield, and has lower rates of contamination, according to some studies [102].
Since the timing of blood culture collection does not influence the detection of clinically relevant microorganisms, most authorities recommend collecting several sets simultaneously or for a short period of time, with the exception of patients with endovascular infection who need documented continuous bacteremia [103, 104].
Two to four sets of blood samples should be collected, whenever possible, at independent locations [103, 104, 105, 106]. For adults, the volume required for the examination varies between 40 and 160 mL of blood, and for babies and children, the volume is age-based and does not exceed 1% of the patient’s total blood volume [103, 107].
The importance of blood culture, as well as urine, is related to the determination of the bacteria and the antibiogram, which directs the treatment to the best antibiotic to be used [108].
8.3 Localization of underlying abnormality
In some cases, it is possible to suspect a complicated urinary tract infection/urosepsis without being serious urological abnormalities. In such cases, there are some screening options that can be performed to assist in the management of the patient. Thus, simple abdominal radiography, intravenous urography, ultrasound, computed tomography and magnetic resonance imaging are cited [109].
8.4 Imaging exams
The anatomical identification of most areas of infection has become common with the development of high resolution cross-sectional images, which allow visualization of bacterial and viral metabolism, early diagnosis and treatment. Thus, the cross-sectional image was included as part of the routine investigation of unidentified infection sites and sources of sepsis. The trend is that the use of these images will become increasingly widespread and become part of standard clinical care in the near future [110].
8.4.1 Ultrasonography
When abdominal sepsis is suspected, ultrasound is a valuable tool. As it is a portable scanning technique, it is ideal for clinically unstable patients who cannot be transported to an examination room [110].
Ideal for the diagnosis of liver sepsis and gallbladder, ultrasound identifies and indicates the presence and location of intra-abdominal fluids (subphrenic space, in pericological calculations or pelvis) [110, 111, 112, 113]. Intrahepatic fluids are also well visualized, and can even be drained percutaneously with ultrasound guidance [110].
The main obstacle for ultrasound responses is air interference, highlighted in loop regions of the intestine with intraluminal gas, since the USG image is darkened and makes it difficult to visualize interloop abscesses or peri-pancreatic collections. The intestine in patients with disease due to sepsis or recent intra-abdominal surgery is also capable of compromising the quality of the ultrasound [114].
8.4.2 CT scanning
The availability of CT scanners with multiple detectors allows rapid acquisition of images, making this method the most common in the diagnosis and detection of intra-abdominal abscesses [114, 115]. It is an interesting option especially for sick patients who have difficulty holding their breath, obese or with abdominal or chest bandages.
In addition, CT is essential in the diagnosis of interloop and retroperitoneal pathologies (including retroperitoneal abscesses or pancreatitis or intra-biliary stones), in addition to being highly sensitive in the detection of chest pathologies (pneumonia, pleural effusion and localized collections) [113, 115, 116, 117]. For intra-abdominal fluids and abscesses, CT showed a sensitivity of 90–100%, while ultrasound showed sensitivity between 80% and 85% [115, 118, 119].
Due to the contemporary contrast protocols available, it is possible to identify by CT even small infected collections [110].
8.4.3 Hybrid PET/MRI systems
With the development of hybrid cameras, the combination of PET and magnetic resonance imaging was introduced, which despite having interesting advantages and clinical applications, is still such an expensive tool.
The simultaneous acquisition of PET and magnetic resonance imaging can provide quantitative molecular functional information about the inflammatory lesion and precise location, in addition to anatomical changes with movement correction, improving the differential diagnosis and guiding anti-inflammatory treatment strategies.
Since MRI cannot visualize all parts of the body at once, the new hybrid technique may require collaboration between radiologists and nuclear medicine doctors to interpret the image and can be more expensive than PET/CT (capital and operational costs).
The functional image of inflammation and infection was mainly restricted to the flat image and SPECT, however, with the increasing development of PET radiopharmaceuticals, the detection and quantification of specific aspects of inflammatory processes became more sensitive. Precisely for this reason, there is an interesting potential in the application of hybrid whole body PET/MRI in the context of the investigation of infectious and inflammatory diseases [120].
8.5 Biologic scanning
Imaging technique that uses biological radionuclides to track hidden infections and improve the specificity of the infection diagnosis that allows the detection of early pathophysiological changes even when there are no apparent anatomical changes. When compared to ex vivo techniques (blood culture), in vivo biological screening is preferred since it is accurate, does not require a sterile environment and does not expose the health team to the risk of contamination by blood-borne pathogens.
This type of tool is used mainly in patients suspected of infection or abscess, but who have had negative results for the cross-sectional image. Thus, the use of marked leukocyte traffic allows a response to hidden sites, based on the recognition of white blood cells marked with radionuclides. The marked leukocytes travel to the infection sites and allow noninvasive images in areas of hidden infection, such as osteomyelitis, orthopedic prosthesis, endocarditis or inflammation and intestinal disease [110].
9. General management of sepsis and septic shock
9.1 Hemodynamic support
Adequate organ perfusion must be ensured. Hypotension should be managed initially with intravenous fluid administration and the goal should be maintenance of pulmonary capillary wedge pressure at 12–16 mm Hg or central venous pressure at 8–12 cm H2O. Urine output rate should be kept at greater than 0.5 mL/kg/hr. A mean arterial blood pressure of greater than 65 mmHg (systolic blood pressure greater than 90 mmHg) and a cardiac index of greater than or equal to 4 L/min/m2 should be maintained. Vasopressor therapy should be initiated in the event of failure to achieve these goals with iv fluids alone. These include dopamine, dobutamine and norepinephrine [109].
9.2 Respiratory support
Ventilatory support should be provided for patients with progressive hypoxemia, hypercapnia, altered sensorium or respiratory muscle fatigue. A study of “early goal directed therapy” (EGDT) found that prompt resuscitation to maintain SvO2 > 70% was associated with improved survival in patients of severe sepsis [121]. In this study, failure to maintain saturation after fluids and vasopressors was followed by erythrocyte infusion to raise hematocrit to 30%. Patients requiring mechanical ventilation should be adequately sedated and stress ulcer prophylaxis should be administered.
9.3 Metabolic support
Blood glucose levels should be maintained at less than 150 mg/dL during initial few days of severe sepsis and normoglycemic range could be targeted later. Frequent blood glucose monitoring should be done to avoid hypoglycemia in patients on intensive insulin therapy. Multi-organ dysfunction, if any should be managed. Disseminated intravascular coagulation, if accompanied by major bleeding, should be treated with fresh-frozen plasma and platelet transfusion. Hypercatabolic individuals with acute renal failure benefit substantially from hemodialysis or hemofiltration. Prophylaxis for deep vein thrombosis and nutritional supplementation should be undertaken [109].
10. Treatment of carbapenem-resistant Enterobacteriaceae
10.1 Monotherapy vs. combination therapy for treatment
Considering the limited knowledge about the combination of antibiotics, the susceptibility of these pathogens to drugs and the lack of evidence to support the routine use of combined antimicrobial therapy, the decision regarding the ideal therapy is the responsibility of medical professionals [122]. Regarding the most appropriate approach, it is prioritized in the literature that the optimization of antimicrobial therapy includes adaptation of the appropriate antibiotics in terms of class, dose, frequency, route and duration [123].
The combination of different antibiotics has been widely used by large centers when it comes to invasive infections by multi-resistant Gram-negative bacteria [122].
10.1.1 Positive and negative aspects of combination therapy for treatment
The various positive and negative aspects of combination therapy are depicted in Table 3.
Positive aspects of combination therapy for treatment
Negative aspects of combination therapy for treatment
1. Greater probability of choosing an effective agent and well-founded theoretical reasons to support its use 2. Considering the increase in mortality related to the delay in the establishment of treatment and delays in appropriate and effective antimicrobial treatment, it is prudent to initiate empirical broad-spectrum antimicrobial treatment in the first suspected infection in critically ill patients 3. Indicated for patients with compromised immune systems, previous ICU admissions or who have recently received broad-spectrum antibiotics [124]
1. Increased toxicity in treatment by combining antibiotics (nephrotoxicity and ototoxicity). In such cases, it is suggested to discontinue the old therapy and introduce a new one, based on the clinical evolution of the patient and the results of the culture and susceptibility profile 2. This type of therapy has not been shown to be effective by clinical data (meta-analyses performed with the evaluation of randomized clinical trials demonstrate that there was no difference in clinical results between the two strategies for definitive treatment of Gram-negative bacteria infections) [124]
Table 3.
Comparison of positive and negative aspects of combination therapy.
10.2 Colistin
Antibiotics such as colistin are the last resort to deal with infections by carbapenem-resistant Enterobacteriaceae (CREB), and when the pathogen does not respond to colistin, therapeutic options are severely restricted. Thus, it becomes necessary to restore the sensitivity of the pathogen to the drug [125].
The combination of colistin + salicylate + potent efflux pump inhibitor (BC1) has been documented with highly positive results, providing a connection between colistin and the efflux pump inhibitor (BC1), which prevents extrusion of colistin [126].
The reduction in affinity between the drug and Gram-negative bacteria is due to the modification of lipid A, linked to the appearance of the gene that confers resistance to bacteria, which is present in animals that receive colistin and are part of human food. Despite this, there is still no complete explanation of the mutation and resistance of Gram-negative bacteria (especially Enterobacteriaceae) in patients who received administered colistin [127].
10.3 Carbapenems
Due to the increased resistance of bacteria to cephalosporin (and aminopenicillins), the use of narrow-spectrum β-lactamases, especially carbapenems, has increased considerably, being the only β-lactamase antibiotics with proven effectiveness in serious infections due to ESBL-producing bacteria [128, 129, 130].
With the discovery of E. coli isolates capable of producing new b-lactamases, a new strain of E. coli was found capable of resisting the action of carbapenems, mediated by plasmids.
These enzymes are able to confer resistance to drugs of the class b-lactamases, and in relation to E. coli specifically, the main types of enzymes are CMY, CTX-M and NDM of b-lactamase [131].
10.4 Tigecycline and other tetracyclines
Tigecycline is a new expanded-spectrum antimicrobial agent in the glycylcycline class. Developed with the objective of overcoming the most common processes of bacterial resistance, the drug has emerged as a great therapeutic option in the treatment of serious infections, which endanger the patient’s life, and which no longer respond to traditional antibiotics. The use of tigecycline is mainly interesting for the initial therapy of major infections, and is largely effective in the action against multi-resistant Gram-negative bacteria [132].
10.5 Aminoglycosides
Aminoglycosides are natural or semi-synthetic drugs obtained from actinomycetes, used as an antibiotic since the beginning of bacterial treatment. As it was replaced in the 1980s by cephalosporins, carbapenems and fluoroquinolones, aminoglycosides had little use.
With the increase in the number of cases of multidrug-resistant bacteria, aminoglycosides were again considered for their ability to synergize with a variety of other classes of antibacterials, improving the safety and effectiveness of the class through optimized dosing regimens, being broad-spectrum and quickly bactericidal.
Enzymatic modification by acetylation of an amino group, impaired uptake and phosphorylation of aminoglycosides are the most commonly reported processes that confer resistance to bacteria in relation to aminoglycosides [133].
10.6 Fosfomycin
Fosfomycin is an antibiotic from the 1969s, prescribed mainly in its oral form for the treatment of uncomplicated urinary tract infections (UTI), and considered as an option in the treatment of bacteria with advanced resistance, causing serious infections [134].
For E. coli NDM-producing strains, fosfomycin, colistin and tigecycline are more effective than other antibiotics [135].
The best pharmacological approach to E. coli infections resistant to carbapenems is still an obstacle to be overcome, since patients infected with this type of bacteria have more limited clinical results and when compared to patients infected with bacteria susceptible to drugs [136].
10.7 Duration of therapy
The duration of treatment for infection caused by Escherichia coli varies in the literature, but most patients require treatment for about 14–21 days [109]. For E. coli perinephric abscesses or prostatitis, it is recommended that the minimum antibiotic use time should be 6 weeks, intra-abdominal infections 14–21 days, and pneumonia 14 days (Table 4) [137].
Condition
General
Perinephric abscesses
Prostatitis
Intra-abdominal infections
Pneumonia
Duration
14–21 days
42 days
42 days
14–21 days
14 days
Table 4.
Recommended duration of antibiotic therapy depending upon the type of infection.
11. Special considerations
11.1 Urinary infections in diabetes mellitus
In general, infectious diseases occur more frequently and cause greater concern when dealing with diabetic patients. This occurs because the environment offered by the organism is rich in glucose, which favors immune dysfunction, including decreasing the antibacterial activity of the urine and its motility [138].
Moreover, when comparing E. coli isolated in the urine of diabetics and non-diabetics, the same virulence factors and the same resistance to antimicrobials are found, inferring that there is no difference in the causative bacteria. This way, what makes the prevalence of urinary infections to be higher in diabetic patients is the greater adhesion of E. coli bacteria to diabetic uroepithelial cells, the reduction of urinary cytokine secretion and the number of leukocytes [139].
Hence, to treat the disease, the most commonly prescribed antimicrobials are used—amoxicillin, nitrofurantoin, trimethoprim/sulfamethoxazole (TMP/SMX) and ciprofloxacin. It is understood that the same treatment choice used by nondiabetic patients can be made, depending only on the local resistance patterns of the commonly found uropathogens [140, 141].
Generally, most uropathogens have a high resistance to TMP/SMX, in addition, this antimicrobial can cause hypoglycemia, which makes it not a good first choice of treatment for this portion of patients [142].
As for the treatment, it is recommended to consider the urinary tract infection complicated, it is advisable to keep the treatment for a period of 7 to 14 days [143].
11.2 Acute pyelonephritis
Acute pyelonephritis is an infection located in the upper urinary tract, which accommodates either parenchyma and renal pelvis, with Escherichia coli being the most common etiological agent [144, 145].
Approximately 250,000 cases of this disease are reported each year, with more than 100,000 eventually requiring hospitalization [146].
In order to confirm the diagnosis of the disease, the patient’s urine culture is performed before the start of antibiotic therapy [147]. In addition, it is recommended to perform a microbial susceptibility test in order to select the most appropriate antimicrobial regimen [148, 149].
If the diagnosis is uncertain or the patient is immunocompromised and suspected of having a hematogenic infection, blood culture analysis is requested [150, 151].
In the last few decades, there has been an increasing rate of resistance of E. coli bacteria to beta-lactam antibiotics of extended spectrum [152]. Thus, for patients with mild and uncomplicated acute pyelonephritis, fluoroquinolone is a good choice for initial outpatient antibiotic therapy, if the drug resistance rate is 10% or less in the community [153].
On the other hand, in cases of complicated infections, sepsis or failed outpatient treatment, hospital treatment is best indicated [154]. After antibiotic therapy, urine culture should be performed again after 1–2 weeks to conclude whether the treatment was successful or not [155].
11.3 Emphysematous pyelonephritis
Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal parenchyma and its surrounding tissues—resulting in the presence of gas in the renal parenchyma, collecting system or perinephric tissue—and is caused in 70% of cases by Escherichia coli (isolated in cultures of urine or pus from patients with the condition) [156].
The clinical evolution of EPN when not recognized and treated immediately can be serious and pose a risk to the patient’s life. Another fact that should be mentioned is that up to 95% of the cases of EPN are underlyingly associated with uncontrolled diabetes mellitus [157, 158].
In addition to the risk of developing EPN primarily, the risk of developing secondary to an obstruction of the urinary tract is considerably relevant, about 25–40% can be considered as positive findings in EPN [159, 160].
The combination of percutaneous drainage (PCD) and medical management (MM) revealed a significant reduction in mortality rates [161, 162]. Thus, it is recommended that PCD be performed in patients with localized areas of gas and the presence of functional renal tissue. Another approach that can be used in association with treatment is emergency nephrectomy, classified as simple, radical or laparoscopic [163].
11.4 Renal abscess
Being caused by kidney stones, structural abnormality, history of urological surgery, trauma or any other cause of obstruction, renal abscess can also be related to pathogens [164]. The predominant organisms causing renal abscesses are Gram-negative organisms, and the most common is Escherichia coli [165, 166, 167].
Among the various intra-abdominal abscesses, renal abscess is a rare entity, especially in children and accounts for a number of cases of “missed diagnoses” [166, 168].
With regard to the symptoms of pediatric patients, the presentation of fever, flank pain, with or without a palpable mass, has been established in the literature; increased leukocyte count and increased erythrocyte sedimentation rate [169].
Early diagnosis is a key factor in the management of these patients, which can be aided by Ultrasound (USG). Drainage of pus and appropriate antibiotic therapy is the gold standard for treatment, being able to treat a great amount of cases. Thereby, the most successful combination of antibiotics was ceftriaxone, being associated with amikacin. Cases that cannot be resolved by the conventional approach can be treated with surgery, such as nephrectomy. Thus, complications such as extension of the peritoneal cavity, skin or chest can be avoided [166, 167].
11.5 Perinephric abscess
Perinephric abscess results from perirenal fatty necrosis, usually a complication of urological infection (more than 75%) [170]. Most of these abscesses have Escherichia coli as the main responsible, about 51.4% [171]. Perinephric abscess, when more diffuse, is capable of affecting the renal capsule and also Gerota’s fascia [170]. Since the condition has an insidious onset of nonspecific protein symptoms, it is necessary for a clinical physician to maintain a high level of attention to avoid possible delay in diagnosis, since perinephric abscesses are associated with significant morbidity and mortality [172].
11.6 Renal papillary necrosis
Renal papillary necrosis (NPN) is a condition defined as ischemic necrobiosis of the papilla in the kidney medulla. Among several etiological factors important for the involvement of papillary necrosis, pyelonephritis due to bacterial uropathogens such as E. coli is one of those mentioned in the literature [173].
In order to improve the prognosis of the disease and reduce morbidity, the ideal is that the diagnosis of the disease is as early as possible. In this sense, it is clear that the radiological image is able to offer an early diagnosis and guidance in relation to the immediate treatment of papillary necrosis, thus minimizing the decline in renal function [174].
11.7 Prostatic abscess
Failure to respond to standard therapy for acute bacterial prostatitis can lead to complications, such as prostate abscess or fistula [175].
Acute bacterial prostatitis is a common and clinically important genitourinary disorder that has a higher incidence in patients with diabetes, cirrhosis and suppressed immune system. Usually caused by an ascending infection, it can also be triggered by organisms that cause other common genitourinary infections that may also be responsible for acute bacterial prostatitis. Being introduced during transrectal prostate biopsy, the clinical presentation ranges from mild symptoms of the lower urinary tract to total sepsis, and Escherichia coli is one of the main bacteria related to the clinical picture.
Regarding the therapeutic approach, oral or intravenous antibiotics are most effective in curing the infection. In this sense, the progression to chronic bacterial prostatitis is uncommon. It should be noted that special attention is needed in relation to immunosuppressed patients, whereas bacterial prostatitis in these patients may be caused by atypical infecting organisms and, therefore, may require additional therapies [176].
12. Prevention
It is already known that iron is an essential micronutrient for most bacteria and hosts, in this thought line, it is also known that there are relatively rare classical siderophilic pathogens that cause an increase in hepcidin in the body, responsible for the sequestration of iron for macrophages and enterocytes and, consequently hypoferremia [177, 178, 179, 180]. So, current studies investigate if this mechanism used by the body against rare siderophilic bacteria, it also works for a wider set of bacteria. Results of these studies are shown to be positive, by demonstrating that excess iron allows rapid bacterial replication and spread, which means a susceptibility to infection caused by E. coli and that hepcidin is essential to protect against infections caused by Escherichia coli. [181, 182]. Thus, the use of hepcidin agonists promises to be an effective early intervention in patients with infections and dysregulated iron metabolism to avoid complications.
With regard to urinary tract infection, an effective preventive measure is the characterization and correction of the underlying genitourinary abnormalities that promote the infection. Another alternative mentioned in the literature is the future development of catheters whose material limits the growth of biofilm [109].
13. Conclusion
Early symptom recognition, followed by appropriate investigations, accurate diagnosis and early goal-directed therapy, is essential to improve results. Patient management includes an interprofessional team approach, with microbiologists, radiologists, surgeons and intensive care physicians [109].
\n',keywords:"bacteremia, septicemia, septic shock, antimicrobial therapy",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/72979.pdf",chapterXML:"https://mts.intechopen.com/source/xml/72979.xml",downloadPdfUrl:"/chapter/pdf-download/72979",previewPdfUrl:"/chapter/pdf-preview/72979",totalDownloads:205,totalViews:0,totalCrossrefCites:0,dateSubmitted:"April 29th 2020",dateReviewed:"June 8th 2020",datePrePublished:"August 14th 2020",datePublished:"September 30th 2020",dateFinished:null,readingETA:"0",abstract:"E. coli\ufeff is the most common cause of urinary tract infections (UTIs) in humans and is a leading cause of enteric infections and systemic infections. The systemic infections include bacteremia, nosocomial pneumonia, cholecystitis, cholangitis, peritonitis, cellulitis, osteomyelitis, and infectious arthritis. E. coli\ufeff is also the leading cause of neonatal meningitis.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/72979",risUrl:"/chapter/ris/72979",signatures:"Akshay Kumar, Ana Francesca Vommaro Leite, Lais Sanches Maekawa, Roopvir Kaur, Silas Jose Braz Filo, Purnadeo Persaud, Juber Dastagir Shaikh, Asim Kichloo and Nimisha Shiwalkar",book:{id:"8722",title:"E. Coli Infections",subtitle:"Importance of Early Diagnosis and Efficient Treatment",fullTitle:"E. Coli Infections - Importance of Early Diagnosis and Efficient Treatment",slug:"e-coli-infections-importance-of-early-diagnosis-and-efficient-treatment",publishedDate:"September 30th 2020",bookSignature:"Luis Rodrigo",coverURL:"https://cdn.intechopen.com/books/images_new/8722.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"73208",title:"Prof.",name:"Luis",middleName:null,surname:"Rodrigo",slug:"luis-rodrigo",fullName:"Luis Rodrigo"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"320940",title:"M.D.",name:"Akshay",middleName:null,surname:"Kumar",fullName:"Akshay Kumar",slug:"akshay-kumar",email:"drakshay82@gmail.com",position:null,institution:{name:"Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College",institutionURL:null,country:{name:"India"}}},{id:"321764",title:"Dr.",name:"Nimisha",middleName:null,surname:"Shiwalkar",fullName:"Nimisha Shiwalkar",slug:"nimisha-shiwalkar",email:"dr.nimisha4u@gmail.com",position:null,institution:{name:"The University of Texas Health Science Center at Houston",institutionURL:null,country:{name:"United States of America"}}},{id:"321765",title:"Dr.",name:"Ana",middleName:null,surname:"Francesca Vommaro Leite",fullName:"Ana Francesca Vommaro Leite",slug:"ana-francesca-vommaro-leite",email:"francescavommaroleite@gmail.com",position:null,institution:null},{id:"321766",title:"Dr.",name:"Lais",middleName:null,surname:"Sanches Maekewa",fullName:"Lais Sanches Maekewa",slug:"lais-sanches-maekewa",email:"laisanchesm@gmail.com",position:null,institution:null},{id:"321767",title:"Dr.",name:"Silas",middleName:null,surname:"Jose Braz Filho",fullName:"Silas Jose Braz Filho",slug:"silas-jose-braz-filho",email:"silasbrazf@gmail.com",position:null,institution:null},{id:"321768",title:null,name:"Purnadeo",middleName:"Narpaul",surname:"Persaud",fullName:"Purnadeo Persaud",slug:"purnadeo-persaud",email:"narpaulpersaud@hotmail.com",position:null,institution:{name:"Kansas City University of Medicine and Biosciences",institutionURL:null,country:{name:"United States of America"}}},{id:"323418",title:"Dr.",name:"Roopvir",middleName:null,surname:"Kaur",fullName:"Roopvir Kaur",slug:"roopvir-kaur",email:"roopvirsaini@gmail.com",position:null,institution:{name:"Government Medical College, Amritsar",institutionURL:null,country:{name:"India"}}},{id:"323419",title:"Dr.",name:"Asim",middleName:null,surname:"Kichloo",fullName:"Asim Kichloo",slug:"asim-kichloo",email:"kichlooasim@gmail.com",position:null,institution:null},{id:"327610",title:"Dr.",name:"Juber Dastagir",middleName:null,surname:"Shaikh",fullName:"Juber Dastagir Shaikh",slug:"juber-dastagir-shaikh",email:"jubershaikh703@gmail.com",position:null,institution:{name:"Mahatma Gandhi Mission Medical College and Hospital",institutionURL:null,country:{name:"India"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Epidemiology",level:"1"},{id:"sec_3",title:"3. Risk factors",level:"1"},{id:"sec_4",title:"4. Pathogenesis",level:"1"},{id:"sec_4_2",title:"4.1 Intestinal",level:"2"},{id:"sec_4_3",title:"4.1.1 EPEC",level:"3"},{id:"sec_5_3",title:"4.1.2 ETEC",level:"3"},{id:"sec_6_3",title:"4.1.3 EHEC",level:"3"},{id:"sec_7_3",title:"4.1.4 EIEC",level:"3"},{id:"sec_8_3",title:"4.1.5 DAEC",level:"3"},{id:"sec_10_2",title:"4.2 Extraintestinal",level:"2"},{id:"sec_10_3",title:"4.2.1 Urosepsis",level:"3"},{id:"sec_13",title:"5. Antimicrobial resistance",level:"1"},{id:"sec_14",title:"6. Evaluation",level:"1"},{id:"sec_15",title:"7. Clinical assessment and patient presentations",level:"1"},{id:"sec_15_2",title:"7.1 History and physical examination",level:"2"},{id:"sec_16_2",title:"7.2 Presentations",level:"2"},{id:"sec_16_3",title:"7.2.1 Pneumonia",level:"3"},{id:"sec_17_3",title:"7.2.2 Acute-bacterial meningitis",level:"3"},{id:"sec_18_3",title:"7.2.3 Intra-abdominal infections",level:"3"},{id:"sec_19_3",title:"7.2.4 Enteric infections",level:"3"},{id:"sec_20_3",title:"7.2.5 UTI",level:"3"},{id:"sec_23",title:"8. Workup",level:"1"},{id:"sec_23_2",title:"8.1 Urine culture",level:"2"},{id:"sec_24_2",title:"8.2 Blood culture",level:"2"},{id:"sec_25_2",title:"8.3 Localization of underlying abnormality",level:"2"},{id:"sec_26_2",title:"8.4 Imaging exams",level:"2"},{id:"sec_26_3",title:"8.4.1 Ultrasonography",level:"3"},{id:"sec_27_3",title:"8.4.2 CT scanning",level:"3"},{id:"sec_28_3",title:"8.4.3 Hybrid PET/MRI systems",level:"3"},{id:"sec_30_2",title:"8.5 Biologic scanning",level:"2"},{id:"sec_32",title:"9. General management of sepsis and septic shock",level:"1"},{id:"sec_32_2",title:"9.1 Hemodynamic support",level:"2"},{id:"sec_33_2",title:"9.2 Respiratory support",level:"2"},{id:"sec_34_2",title:"9.3 Metabolic support",level:"2"},{id:"sec_36",title:"10. Treatment of carbapenem-resistant Enterobacteriaceae",level:"1"},{id:"sec_36_2",title:"10.1 Monotherapy vs. combination therapy for treatment",level:"2"},{id:"sec_36_3",title:"Table 3.",level:"3"},{id:"sec_38_2",title:"10.2 Colistin",level:"2"},{id:"sec_39_2",title:"10.3 Carbapenems",level:"2"},{id:"sec_40_2",title:"10.4 Tigecycline and other tetracyclines",level:"2"},{id:"sec_41_2",title:"10.5 Aminoglycosides",level:"2"},{id:"sec_42_2",title:"10.6 Fosfomycin",level:"2"},{id:"sec_43_2",title:"10.7 Duration of therapy",level:"2"},{id:"sec_45",title:"11. Special considerations",level:"1"},{id:"sec_45_2",title:"11.1 Urinary infections in diabetes mellitus",level:"2"},{id:"sec_46_2",title:"11.2 Acute pyelonephritis",level:"2"},{id:"sec_47_2",title:"11.3 Emphysematous pyelonephritis",level:"2"},{id:"sec_48_2",title:"11.4 Renal abscess",level:"2"},{id:"sec_49_2",title:"11.5 Perinephric abscess",level:"2"},{id:"sec_50_2",title:"11.6 Renal papillary necrosis",level:"2"},{id:"sec_51_2",title:"11.7 Prostatic abscess",level:"2"},{id:"sec_53",title:"12. Prevention",level:"1"},{id:"sec_54",title:"13. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'Foxman B. The epidemiology of urinary tract infection. Nature Reviews. Urology. 2010;7:653-660'},{id:"B2",body:'Kaper JB, Nataro JP, Mobley HL. Pathogenic Escherichia coli. Nature Reviews. Microbiology. 2004;2:123-140'},{id:"B3",body:'Kim KS. Current concepts on the pathogenesis of Escherichia coli meningitis: Implications for therapy and prevention. Current Opinion in Infectious Diseases. 2012;25:273-278'},{id:"B4",body:'Leimbach A, Hacker J, Dobrindt U. E. coli\ufeff as an all-rounder: The thin line between commensalism and pathogenicity. Current Topics in Microbiology and Immunology. 2013;358:3-32'},{id:"B5",body:'Berg RD. The indigenous gastrointestinal microflora. Trends in Microbiology. 1996;4:430-435'},{id:"B6",body:'Gordon DM, Cowling A. The distribution and genetic structure of Escherichia coli in Australian vertebrates: Host and geographic effects. Microbiology. 2003;149:3575-3586'},{id:"B7",body:'Wasiński B. Extra-intestinal pathogenic Escherichia coli-threat connected with food-borne infections. Annals of Agricultural and Environmental Medicine. 2019;26(4):532-537'},{id:"B8",body:'Donnenberg MS. Capítulo 220: Enterobacteriaceae. In: Mandell GL, Bennett JE, Dolin R, Blase MJ, editors. Mandell, Douglas y Bennett. Enfermedades Infecciosas. Principios y Práctica. 8va Edición ed. España: Elsevier; 2016. pp. 2640-2655'},{id:"B9",body:'Artico MJ, Rocchi M, Gasparotto A, Ocaña Carrizo V, Navarro M, Mollo V, et al. Bacteriemias de origen comunitario en pacientes adultos que acuden al servicio de urgencias de un hospital universitario. Revista Argentina de Microbiología. 2012;44(1):10-15'},{id:"B10",body:'Salyers AA, Whitt DD. Bacterial Pathogenesis: A Molecular Approach. Washington, DC: ASM Press; 2002'},{id:"B11",body:'Bertani B, Ruiz N. Function and biogenesis of lipopolysaccharides. EcoSal Plus. 2018;8(1)'},{id:"B12",body:'Mora-Rillo M, Fernández-Romero N, Navarro-San Francisco C, Díez-Sebastián J, Romero-Gómez MP, Fernández FA, et al. Impact of virulence genes on sepsis severity and survival in Escherichia coli bacteremia. Virulence. 2015;6(1):93-100'},{id:"B13",body:'Biran D, Ron EZ. Extraintestinal pathogenic Escherichia coli. Current Topics in Microbiology and Immunology. 2018;416:149-161'},{id:"B14",body:'Mendoza-Palomar N, Balasch-Carulla M, González-Di Lauro S, et al. Escherichia coli early-onset sepsis: Trends over two decades. European Journal of Pediatrics. 2017;176(9):1227-1234'},{id:"B15",body:'Peralta G, Sanchez MB, Garrido JC, et al. Impact of antibiotic resistance and of adequate empirical antibiotic treatment in the prognosis of patients with Escherichia coli bacteraemia. The Journal of Antimicrobial Chemotherapy. 2007;60:855-863'},{id:"B16",body:'Melzer M, Petersen I. Mortality following bacteraemic infection caused by extended spectrum beta-lactamase (ESBL) producing E. coli compared to non-ESBL producing E. coli\ufeff. The Journal of Infection. 2007;55:254-259'},{id:"B17",body:'Gransden WR, Eykyn SJ, Phillips I, Rowe B. Bacteremia due to Escherichia coli: A study of 861 episodes. Reviews of Infectious Diseases. 1990;12:1008-1018'},{id:"B18",body:'Laupland KB, Gregson DB, Church DL, Ross T, Pitout JD. Incidence, risk factors and outcomes of Escherichia coli bloodstream infections in a large Canadian region. Clinical Microbiology and Infection. 2008;14(11):1041-1047'},{id:"B19",body:'Jackson LA, Benson P, Neuzil KM, Grandjean M, Marino JL. Burden of community-onset Escherichia coli bacteremia in seniors. The Journal of Infectious Diseases. 2005;191:1523-1529'},{id:"B20",body:'Katouli M. Population structure of gut Escherichia coli and its role in development of extra-intestinal infections. Iranian Journal of Microbiology. 2010;2(2):59'},{id:"B21",body:'Thursby E, Juge N. Introduction to the human gut microbiota. Biochemical Journal. 2017;474(11):1823-1836'},{id:"B22",body:'Kaper JB, Nataro JP, Mobley HL. Pathogenic Escherichia coli. Nature Reviews. Microbiology. 2004;2:123-140'},{id:"B23",body:'Croxen MA, Finlay BB. Molecular mechanisms of Escherichia coli pathogenicity. Nature Reviews. Microbiology. 2010;8:26-38'},{id:"B24",body:'Trabulsi LR, Keller R, Tardelli Gomes TA. Typical and atypical enteropathogenic Escherichia coli. Emerging Infectious Diseases. 2002;8:508-513'},{id:"B25",body:'Bieber D, Ramer SW, Wu CY, Murray WJ, Tobe T, Fernandez R, et al. Type IV pili, transient bacterial aggregates, and virulence of enteropathogenic Escherichia coli. Science. 1998;280:2114-2118'},{id:"B26",body:'Frankel G, Phillips AD, Rosenshine I, Dougan G, Kaper JB, Knutton S. Enteropathogenic and enterohaemorrhagic Escherichia coli: More subversive elements. Molecular Microbiology. 1998;30:911-921'},{id:"B27",body:'Gomez-Duarte OG, Kaper JB. A plasmid-encoded regulatory region activates chromosomal eaeA expression in enteropathogenic Escherichia coli. Infection and Immunity. 1995;63:1767-1776'},{id:"B28",body:'Hu J, Torres AG. Enteropathogenic Escherichia coli: Foe or innocent bystander? Clinical Microbiology and Infection. 2015;21(8):729-734'},{id:"B29",body:'Gomes TAT, Elias WP, Scaletsky ICA, Guth BEC, Rodrigues JF, Piazza RMF, et al. Diarrheagenic Escherichia coli. Brazilian Journal of Microbiology. 2016;47(Suppl. 1):3-30'},{id:"B30",body:'Diepold A, Armitage JP. Type III secretion systems: The bacterial flagellum and the injectisome. Philosophical Transactions of the Royal Society, B: Biological Sciences. 2015;370(1679):20150020'},{id:"B31",body:'Berkes J, Viswanathan VK, Savkovic SD, Hecht G. Intestinal epithelial responses to enteric pathogens: Effects on the tight junction barrier, ion transport, and inflammation. Gut. 2003;52(3):439-451'},{id:"B32",body:'Madhavan TP, Sakellaris H. Colonization factors of enterotoxigenic Escherichia coli. Advances in Applied Microbiology. 2015;90:155-197. DOI: 10.1016/bs.aambs.2014.09.003'},{id:"B33",body:'Loos M, Geens M, Schauvliege S, Gasthuys F, van der Meulen J, Dubreuil JD, et al. Role of heat-stable enterotoxins in the induction of early immune responses in piglets after infection with enterotoxigenic Escherichia coli. PLoS One. 2012;7:e41041'},{id:"B34",body:'Beltran AR, Carraro-Lacroix LR, Bezerra CN, Cornejo M, et al. Escherichia coli heat-stable enterotoxin mediates Na+/H+ exchanger 4 inhibition involving cAMP in T84 human intestinal epithelial cells. PLoS One. 2015;10:e0146042'},{id:"B35",body:'Dorsey FC, Fischer JF, Fleckenstein JM. Directed delivery of heat-labile enterotoxin by enterotoxigenic Escherichia coli. Cellular Microbiology. 2006;8(9):1516-1527'},{id:"B36",body:'Sears CL, Kaper JB. Enteric bacterial toxins: Mechanisms of action and linkage to intestinal secretion. Microbiological Reviews. 1996;60(1):167'},{id:"B37",body:'Ceponis PJ, Riff JD, Sherman PM. Epithelial cell signaling responses to enterohemorrhagic Escherichia coli infection. Memórias do Instituto Oswaldo Cruz. 2005;100:199-203'},{id:"B38",body:'Boyer O, Niaudet P. Hemolytic uremic syndrome: New developments in pathogenesis and treatment. International Journal of Nephrology. 2011'},{id:"B39",body:'Polito MG, Kirsztajn GM. Microangiopatias trombóticas: púrpura trombocitopênica trombótica e síndrome hemolítico-urêmica. Brazilian Journal of Nephrology. 2010;32(3):303-315'},{id:"B40",body:'Ud-Din A, Wahid S. Relationship among Shigella spp. and enteroinvasive Escherichia coli (EIEC) and their differentiation. Brazilian Journal of Microbiology. 2014;45(4):1131-1138'},{id:"B41",body:'Tulloch EF, Ryan KJ, Formal SB, Franklin FA. Invasive enteropathic Escherichia coli dysentery: An outbreak in 28 adults. Annals of Internal Medicine. 1973;79(1):13-17'},{id:"B42",body:'Jafari A, Aslani MM, Bouzari S. Escherichia coli: A brief review of diarrheagenic pathotypes and their role in diarrheal diseases in Iran. Iranian Journal of Microbiology. 2012;4(3):102'},{id:"B43",body:'Mansan-Almeida R, Pereira AL, Giugliano LG. Diffusely adherent Escherichia coli strains isolated from children and adults constitute two different populations. BMC Microbiology. 2013;13(1):22'},{id:"B44",body:'Sarowska J, Futoma-Koloch B, Jama-Kmiecik A, Frej-Madrzak M, Ksiazczyk, et al. Virulence factors, prevalence and potential transmission of extraintestinal pathogenic Escherichia coli isolated from different sources: Recent reports. Gut Pathogens. 2019;11(1):10'},{id:"B45",body:'Smith JL, Fratamico PM, Gunther NW. Extraintestinal pathogenic Escherichia coli. Foodborne Pathogens and Disease. 2007;4(2):134-163'},{id:"B46",body:'Areda MA, Bailey CR, O’Mara D, Weiss CR. Transplant uretero-inguinal hernia resulting in urosepsis. Radiology Case Reports. 2019;14(1):14-17'},{id:"B47",body:'Thornton HV, Hammond A, Hay AD. Urosepsis: A growing and preventable problem? The British Journal of General Practice. 2018;68(675):493-494'},{id:"B48",body:'Fadel MG, Louis C, Tay A, Bolgeri M. Obstructive urosepsis secondary to ureteric herniation into the sciatic foramen. BML Case Reports. 2018 27;2018'},{id:"B49",body:'Scotland KB, Lange D. Prevention and management of urosepsis triggered by ureteroscopy. Research and Reports in Urology. 2018;10:43-49'},{id:"B50",body:'Heppner HJ, Yapan F, Wiedemann A. Urosepsis in geriatric patients. Aktuelle Urologie. 2016;47(1):54-59'},{id:"B51",body:'Goveas B. Urosepsis: A simple infection turns toxic. The Nurse Practitioner. 2017;42(7):53-54'},{id:"B52",body:'Porat A, Kesler S. Urosepsis. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2020'},{id:"B53",body:'Vila J, Sáez-López E, Johnson JR, et al. Escherichia coli: An old friend with new tidings. FEMS Microbiology Reviews. 2016;40(4):437-463'},{id:"B54",body:'World Health Organization. Antimicrobial Resistance Global Report on Surveillance; 2014'},{id:"B55",body:'Friedman S, Shah V, Ohlsson A, Matlow AG. Neonatal Escherichia coli infections: Concerns regarding resistance to current therapy. Acta Paediatrica. 2000;89(6):686-689'},{id:"B56",body:'Stony Brook Medicine. Severe Sepsis/Septic Shock Recognition and Treatment Protocols. Surviving Sepsis Campaign. Society of Critical of Medicine. 2013'},{id:"B57",body:'Tsai J, Bond G. A comparison of electronic records to paper records in mental health centers. International Journal for Quality in Health Care. 2008;20:136-143'},{id:"B58",body:'Davis JL, Murray JF. History and physical examination. Murray and Nadel’s Textbook of Respiratory Medicine. 2016;263'},{id:"B59",body:'Timsit JF, Esaied W, Neuville M, Bouadma L, Mourvllier B. Update on ventilator-associated pneumonia. F1000Research. 2017;6:2061'},{id:"B60",body:'Chastre J, Fagon JY. Ventilator-associated pneumonia. American Journal of Respiratory and Critical Care Medicine. 2002;165:867-903'},{id:"B61",body:'Messika J, Magdoud F, Clermont O, et al. Pathophysiology of Escherichia coli ventilator-associated pneumonia: Implication of highly virulent extraintestinal pathogenic strains. Intensive Care Medicine. 2012;38(12):2007-2016'},{id:"B62",body:'Phillips-Houlbracq M, Ricard JD, Foucrier A, Yoder-Himes D, Gaudry S, et al. Pathophysiology of Escherichia coli pneumonia: Respective contribution of pathogenicity islands to virulence. International Journal of Medical Microbiology. 2018;308(2):290-296'},{id:"B63",body:'La Combe B, Clermont O, Messika J, Eveillard M, Kouatchet A, Lasocki S, et al. Pneumonia-specific Escherichia coli with distinct phylogenetic and virulence profiles, France, 2012-2014. Emerging Infectious Diseases. 2019;25(4):710-718'},{id:"B64",body:'Sule AA, Tai D. Spontaneous Escherichia coli meningitis in an adult. Critical Care and Shock. 2007;10:148-150'},{id:"B65",body:'Mofredj A, Guerin JM, Leibinger F, Mamoudi R. Spontaneous Escherichia coli meningitis in an adult. Scandinavian Journal of Infectious Diseases. 2000;32:699-700'},{id:"B66",body:'Abhilash K, Gigin SV. A rare manifestation of Escherichia coli septicemia. International Journal of Research in Medical Sciences. 2013;1:299-300'},{id:"B67",body:'Shrestha RG, Tandukar S, Ansari S, Subedi A, Shrestha A, Poudel R, et al. Bacterial meningitis in children under 15 years of age in Nepal. BMC Pediatrics. 2015;15:94'},{id:"B68",body:'Ishida K, Noborio M, Nakamura M, Ieki Y, Sogabe T, Sadamitsu D. Spontaneous Escherichia coli bacterial meningitis mimicking heatstroke in an adult. Clinical Case Reports. 2016;4(4):323-326'},{id:"B69",body:'Chang CJ, Chang WN, Huang LT, Huang SC, Chang YC, et al. Bacterial meningitis in infants: The epidemiology, clinical features, and prognostic factors. Brain & Development. 2004;26:168-175'},{id:"B70",body:'Dawson KG, Emerson JC, Burns JL. Fifteen years of experience with bacterial meningitis. The Pediatric Infectious Disease Journal. 1999;18:816-822'},{id:"B71",body:'de Louvois J, Halket S, Harvey D. Neontal meningitis in England and Wales: Sequelae at 5 years of age. European Journal of Pediatrics. 2004;7:730-734'},{id:"B72",body:'Doctor BA, Newman N, Minich NM, Taylor HG, Fanaroff AA, Hack M. Clinical outcomes of neonatal meningitis in very-low birth-weight infants. Clinical Pediatrics (Phila). 2001;40:473-480'},{id:"B73",body:'Gladstone IM, Ehrenkranz RA, Edberg SC, Baltimore RS. A ten-year review of neonatal sepsis and comparison with the previous fifty-year experience. The Pediatric Infectious Disease Journal. 1990;9:819-825'},{id:"B74",body:'Holt DE, Halket S, de Louvois J, Harvey D. Neonatal meningitis in England and Wales: 10 years on. Archives of Disease in Childhood. Fetal and Neonatal Edition. 2001;84:F85-F89'},{id:"B75",body:'Kim KS. Acute bacterial meningitis in infants and children. The Lancet Infectious Diseases. 2010;10:32-42'},{id:"B76",body:'Klinger G, Chin C-N, Beyene J, Perlman M. Predicting the outcome of neonatal bacterial meningitis. Pediatrics. 2000;106:477-482'},{id:"B77",body:'Stevens JP, Eames M, Kent A, Halket S, Holt D, Harvey D. Long term outcome of neonatal meningitis. Archives of Disease in Childhood. Fetal and Neonatal Edition. 2003;88:F179-F184'},{id:"B78",body:'Unhanand M, Mustafa MM, McCracken GH Jr, Nelson JD. Gram-negative enteric bacillary meningitis: A twenty-one-year experience. The Journal of Pediatrics. 1993;122:15-21'},{id:"B79",body:'Kim KS. Comparison of cefotaxime, imipenem-cilastatin, ampicillin-gentamicin, and ampicillin chloramphenicol in the treatment of experimental Escherichia coli bacteremia and meningitis. Antimicrobial Agents and Chemotherapy. 1985;28:433-436'},{id:"B80",body:'McCracken GH Jr, Threlkeld N, Mize S, Baker CJ, Kapal SL, Fraingezicht I, et al. Moxalactam therapy for neonatal meningitis due to gram-negative sepsis enteric bacilli. Journal of the American Medical Association. 1984;252:1427-1432'},{id:"B81",body:'Kim KS. Human meningitis-associated Escherichia coli. EcoSal Plus. 2016;7(1). DOI: 10.1128/ecosalplus.ESP-0015-2015'},{id:"B82",body:'Bodmann KF. Complicated intra-abdominal infections: Pathogens, resistance. Recommendations of the Infectliga on antbiotic therapy. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 2010;81(1):38-49'},{id:"B83",body:'Sartelli M. A focus on intra-abdominal infections. World Journal of Emergency Surgery. 2010;5(1):9'},{id:"B84",body:'Chaithanya J, Ashwini RK, Rajagopalan S. Clinical and microbiological profile in intra-abdominal infection. International Surgery Journal. 2019;6(10):3608-3613'},{id:"B85",body:'Ruppé É, Woerther PL, Barbier F. Mechanisms of antimicrobial resistance in Gram-negative bacilli. Annals of Intensive Care. 2015;5:61'},{id:"B86",body:'Kot B. Antibiotic resistance among uropathogenic Escherichia coli. Polish Journal of Microbiology. 2019;68(4):403-415'},{id:"B87",body:'Clements A, Young JC, Constantinou N, Frankel G. Infection strategies of enteric pathogenic Escherichia coli. Gut Microbes. 2012;3(2):71-87'},{id:"B88",body:'Croxen MA, Law RJ, Scholz R, Keeney KM, Wlodarska M, Finlay BB. Recent advances in understanding enteric pathogenic Escherichia coli. Clinical Microbiology Reviews. 2013;26(4):822-880'},{id:"B89",body:'World Health Organization. World Health Statistics 2012. Geneva, Switzerland: WHO Press; 2012'},{id:"B90",body:'Croxen MA, Law RJ, Scholz R, Keeney KM, Wlodarska M, Finlay BB. Recent advances in understanding enteric pathogenic Escherichia coli. Clinical Microbiology Reviews. 2013;26(4):822-880'},{id:"B91",body:'Clements A, Young JC, Constantinou N, Frankel G. Infection strategies of enteric pathogenic Escherichia coli. Gut Microbes. 2012;3(2):71-87'},{id:"B92",body:'Berger CN, Sodha SV, Shaw RK, Griffin PM, Pink D, Hand P, et al. Fresh fruit and vegetables as vehicles for the transmission of human pathogens. Environmental Microbiology. 2010;12:2385-2397'},{id:"B93",body:'Car J. Urinary tract infections in women: Diagnosis and management in primary care. BMJ. 2006;332(7533):94-97'},{id:"B94",body:'Alanazi MQ , Alqahtani FY, Aleanizy FS. An evaluation of E. coli\ufeff in urinary tract infection in emergency department at KAMC in Riyadh, Saudi Arabia: Retrospective study. Annals of Clinical Microbiology and Antimicrobials. 2018;17(1)'},{id:"B95",body:'Lee JB, Neild GH. Urinary tract infection. Medicine. 2007;35(8):423-428'},{id:"B96",body:'Foxman B et al. Urinary tract infection: Self-reported incidence and associated costs. Annals of Epidemiology. 2000;10(8):509-515'},{id:"B97",body:'Leekha S, Terrell CL, Edson RS. General principles of antimicrobial therapy. Mayo Clinic Proceedings. 2011;86(2):156-167. DOI: 10.4065/mcp.2010.0639'},{id:"B98",body:'Understanding urine tests.InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006. 2010 Jul 27 [Updated 2019 Oct 24].'},{id:"B99",body:'Schmiemann G, Kniehl E, Gebhardt K, Matejczyk MM, Hummers-Pradier E. The diagnosis of urinary tract infection: A systematic review. Deutsches Ärzteblatt International. 2010;107(21):361-367'},{id:"B100",body:'Fonseca FLA, Santos PM, Belardo TMG, Fonseca ALA, Caputto LZ, Alves BCA. Análise de leucócitos em urina de pacientes com uroculturas positivas. Revista Brasileira de Análises Clínicas. 2016;48(3):258-261'},{id:"B101",body:'de Oliveira LCA. Prevalência de infecção do trato urinário em pacientes ambulatoriais e sua relação com os valores de nitrito e leucócitos. Revista Brasileira de Análises Clínicas. 2018;50(3):237-243'},{id:"B102",body:'Bryant JK, Strand CL. Reliability of blood cultures collected from intravascular catheter versus venipuncture. American Journal of Clinical Pathology. 1987;88:113-116'},{id:"B103",body:'Wilson M. Clinical and Laboratory Standards Institute. Principles and Procedures for Blood Cultures: Approved Guideline. Wayne, PA: Clinical and Laboratory Standards Institute; 2007'},{id:"B104",body:'Cockerill FR III, Wilson JW, Vetter EA, Goodman KM, Torgerson CA, Harmsen WS, et al. Optimal testing parameters for blood cultures. Clinical Infectious Diseases. 2004;38(12):1724-1730'},{id:"B105",body:'Lee A, Mirrett S, Reller LB, Weinstein MP. Detection of bloodstream infections in adults: How many blood cultures are needed? Journal of Clinical Microbiology. 2007;45(11):3546-3548'},{id:"B106",body:'Washington JA 2nd. Blood cultures: Principles and techniques. Mayo Clinic Proceedings. 1975;50(2):91'},{id:"B107",body:'Gaur AH, Giannini MA, Flynn PM, Boudreaux, et al. Optimizing blood culture practices in pediatric immunocompromised patients: Evaluation of media types and blood culture volume. The Pediatric Infectious Disease Journal. 2003;22(6):545-552'},{id:"B108",body:'Kirn TJ, Weinstein MP. Update on blood cultures: How to obtain, process, report, and interpret. Clinical Microbiology and Infection. 2013;19(6):513-520'},{id:"B109",body:'Kalra OP, Raizada A. Approach to a patient with urosepsis. Journal of Global Infectious Diseases. 2009;1(1):57-63'},{id:"B110",body:'Ady J, Fong Y. Imaging for infection: From visualization of inflammation to visualization of microbes. Surgical Infections. 2014;15(6):700-707'},{id:"B111",body:'Jones MW, Ferguson T. Gallbladder Imaging. In: StatPearls. StatPearls Publishing; 2019'},{id:"B112",body:'Doust BD, Quiroz F, Stewart JM. Ultrasonic distinction of abscesses from other intra-abdominal fluid collections. Radiology. 1977;125:213-218'},{id:"B113",body:'Korobkin M, Callen PW, Filly RA, et al. Comparison of computed tomography, ultrasonography, and gallium-67 scanning in the evaluation of suspected abdominal abscess. Radiology. 1978;129:89-93'},{id:"B114",body:'Filly RA. Detection of fetal malformations with ultrasonic B-scans. Birth Defects Original Article Series. 1979;15:45-49'},{id:"B115",body:'Wolverson MK, Jagannadharao B, Sundaram M, et al. CT as a primary diagnostic method in evaluating intraabdominal abscess. American Journal of Roentgenology. 1979;133:1089-1095'},{id:"B116",body:'Haaga JR, Alfidi RJ, Havrilla TR, et al. CT detection and aspiration of abdominal abscesses. American Journal of Roentgenology. 1977;128:465-474'},{id:"B117",body:'Silverstein W, Isikoff MB, Hill MC, Barkin J. Diagnostic imaging of acute pancreatitis: Prospective study using CT and sonography. American Journal of Roentgenology. 1981;137:497-502'},{id:"B118",body:'Knochel JQ , Koehler PR, Lee TG, Welch DM. Diagnosis of abdominal abscesses with computed tomography, ultrasound, and 111In leukocyte scans. Radiology. 1980;137:425-432'},{id:"B119",body:'Roche J. Effectiveness of computed tomography in the diagnosis of intra-abdominal abscess: A review of 111 patients. The Medical Journal of Australia. 1981;2:85-88'},{id:"B120",body:'Glaudemans AW, Quintero AM, Signore A. PET/MRI in Infectious and Inflammatory Diseases: Will it be a Useful Improvement? 2012'},{id:"B121",body:'Otero RM, Nguyen HB, Huang DT, Gaieski DF, Goyal M, Gunnerson KJ, et al. Early goal directed therapy in severe sepsis and septic shock revisited: Concepts, controversies, and contemporary findings. Chest. 2006;130:1579-1595'},{id:"B122",body:'Tamma PD, Cosgrove SE, Maragakis LL. Combination therapy for treatment of infections with gram-negative bacteria. Clinical Microbiology Reviews. 2012;25(3):450-470'},{id:"B123",body:'Leekha S, Terrell CL, Edson RS. General principles of antimicrobial therapy. Mayo Clinic Proceedings. 2011;86(2):156-167. DOI: 10.4065/mcp.2010.0639'},{id:"B124",body:'Salomão R, Diament D, Rigatto O, Gomes B, Silva E, Carvalho NB, et al. Diretrizes para tratamento da sepse grave/choque séptico: Abordagem do agente infeccioso-controle do foco infeccioso e tratamento antimicrobiano. Revista Brasileira de Terapia Intensiva. 2011;23(2):145-157'},{id:"B125",body:'Sheu CC, Chang YT, Lin SY, Chen YH, Hsueh PR. Infections caused by carbapenem-resistant Enterobacteriaceae: An update on therapeutic options. Frontiers in Microbiology. 2019;10:80'},{id:"B126",body:'Sundaramoorthy NS, Suresh P, Ganesan SS, GaneshPrasad A, Nagarajan S. Restoring colistin sensitivity in colistin-resistant E. coli\ufeff: Combinatorial use of MarR inhibitor with efflux pump inhibitor. Scientific Reports. 2019;9(1):1-13'},{id:"B127",body:'Ezadi F, Ardebili A, Mirnejad R. Antimicrobial susceptibility testing for polymyxins: Challenges, issues, and recommendations. Journal of Clinical Microbiology. 2019;57(4)'},{id:"B128",body:'Hawkey Peter M, Livermore DM. Carbapenem antibiotics for serious infections. BMJ. 2012;344:e3236'},{id:"B129",body:'Shaikh S, Fatima J, Shakil S, Rizvi SM, Kamal MA. Antibiotic resistance and extended spectrum beta-lactamases: Types, epidemiology and treatment. Saudi Journal of Biological Sciences. 2015;22(1):90-101'},{id:"B130",body:'Pitout JD. Extraintestinal pathogenic Escherichia coli: An update on antimicrobial resistance, laboratory diagnosis and treatment. Expert Review of Anti-Infective Therapy. 2012;10:1165-1176'},{id:"B131",body:'Rossi F, Andreazzi D. Overview of tigecycline and its role in the era of antibiotic resistance. Brazilian Journal of Infectious Diseases. 2006;10(3):203-216'},{id:"B132",body:'Krause KM, Serio AW, Kane TR, Connolly LE. Aminoglycosides: An overview. Cold Spring Harbor Perspectives in Medicine. 2016;6(6):a027029'},{id:"B133",body:'Falagas ME, Vouloumanou EK, Samonis G, Vardakas KZ. Fosfomycin. Clinical Microbiology Reviews. 2016;29(2):321-347'},{id:"B134",body:'Ku YH, Chen CC, Lee MF, Chuang YC, Tang HJ, Yu WL. Comparison of synergism between colistin, fosfomycin and tigecycline against extended-spectrum β-lactamase-producing Klebsiella pneumoniae isolates or with carbapenem resistance. Journal of Microbiology, Immunology and Infection. 2017;50(6):931-939'},{id:"B135",body:'Zhou YF, Liu P, Zhang CJ, Liao XP, Sun J, Liu YH. Colistin combined with tigecycline: A promising alternative strategy to combat Escherichia coli harboring blaNDM–5 and mcr-1. Frontiers in Microbiology. 2020;10:2957'},{id:"B136",body:'Hamza NS, Khalil A. Resistant Gram-negative urinary tract bacterial infections. In: Urinary Tract Infection—The Result of the Strength of the Pathogen, or the Weakness of the Host. IntechOpen; 2017'},{id:"B137",body:'Giamarellou H. Multidrug-resistant Gram-negative bacteria: How to treat and for how long. International Journal of Antimicrobial Agents. 2010;36(Suppl 2):S50-S54'},{id:"B138",body:'Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian Journal of Endocrinology and Metabolism. 2012;16(Suppl. 1):S27'},{id:"B139",body:'Geerlings SE. Urinary tract infections in patients with diabetes mellitus: Epidemiology, pathogenesis and treatment. International Journal of Antimicrobial Agents. 2008;31:54-57'},{id:"B140",body:'Fair WR, Crane DB, Peterson LJ, Dahmer C, Tague B, Amos W. Three-day treatment of urinary tract infections. The Journal of Urology. 1980;123:717-721'},{id:"B141",body:'Kavatha D, Giamarellou H, Alexiou Z, Vlachogiannis N, et al. Cefpodoxime-proxetil versus trimethoprim-sulfamethoxazole for short-term therapy of uncomplicated acute cystitis in women. Antimicrobial Agents and Chemotherapy. 2003;47:897-900'},{id:"B142",body:'Grigoryan L, Nash S, Zoorob R, et al. Qualitative analysis of primary care provider prescribing decisions for urinary tract infections. Antibiotics (Basel, Switzerland). 2019;8(2)'},{id:"B143",body:'Kang CI, Kim J, Park DW, Kim BN, et al. Clinical practice guidelines for the antibiotic treatment of community-acquired urinary tract infections. Infection & Chemotherapy. 2018;50(1):67-100'},{id:"B144",body:'Bass PF 3rd, Jarvis JA, Mitchell CK. Urinary tract infections. Primary Care. 2003;30:41-61'},{id:"B145",body:'Stamm WE, Hooton TM. Management of urinary tract infections in adults. The New England Journal of Medicine. 1993;329:1328-1334'},{id:"B146",body:'Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated urinary tract infection. Infectious Disease Clinics of North America. 1997;11:551-581'},{id:"B147",body:'Ramakrishnan K, Scheid DC. Diagnosis and management of acute pyelonephritis in adults. American Family Physician. 2005;71(5):933-942'},{id:"B148",body:'Johnson JR. Treatment and prevention of urinary tract infections. In: Mobley HLT, Warren JW, editors. Urinary Tract Infections: Molecular Pathogenesis and Clinical Management. Washington, DC: American Society for Microbiology Press; 1996. pp. 95-118'},{id:"B149",body:'Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated urinary tract infection. In: Moellering RC Jr, Andriole VT, eds. Infectious Disease Clinics of North America. 1997;11:551-581'},{id:"B150",body:'McMurray BR, Wrenn KD, Wright SW. Usefulness of blood cultures in pyelonephritis. The American Journal of Emergency Medicine. 1997;15:137-140'},{id:"B151",body:'Velasco M, Martinez JA, Moreno-Martinez A, Horcajada JP, Ruiz J, Barranco M, et al. Blood cultures for women with uncomplicated acute pyelonephritis: Are they necessary? Clinical Infectious Diseases. 2003;37:1127-1130'},{id:"B152",body:'Zahar JR, Lortholary O, Martin C, Potel G, Plesiat P, Nordmann P. Addressing the challenge of extended-spectrum beta-lactamases. Current Opinion in Investigational Drugs. 2009;10(2):172-180'},{id:"B153",body:'Colgan R, Williams M, Johnson JR. Diagnosis and treatment of acute pyelonephritis in women. American Family Physician. 2011;84(5):519-526'},{id:"B154",body:'Ramakrishnan K, Scheid DC. Diagnosis and management of acute pyelonephritis in adults. American Family Physician. 2005;71(5):933-942'},{id:"B155",body:'Delzell JEJR, Fitzsimmons A. Urinary tract infection. In: Reference Guide. 7th ed. The American Board of Family Practice; 2001'},{id:"B156",body:'Ubee SS, McGlynn L, Fordham M. Emphysematous pyelonephritis. BJU International. 2011;107(9):1474-1478'},{id:"B157",body:'Wan YL, Lee TY, Bullard MJ, Tsai CC. Acute gas-producing bacterial renal infection: Correlation between imaging findings and clinical outcome. Radiology. 1996;198:433-438'},{id:"B158",body:'Falagas ME, Alexiou VG, Giannopoulou KP, Siempos II. Risk factors for mortality in patients with emphysematous pyelonephritis: A meta-analysis. The Journal of Urology. 2007;178:880-885'},{id:"B159",body:'Michaeli J, Mogle S, Perlberg S, Heiman S, Caine M. Emphysematous pyelonephritis. The Journal of Urology. 1984;131:203-207'},{id:"B160",body:'Godec CJ, Cass AS, Berkseth R. Emphysematous pyelonephritis in a solitary kidney. The Journal of Urology. 1980;124:119-121'},{id:"B161",body:'Khaira A, Gupta A, Rana DS, Gupta A, Bhalla A, Khullar D. Retrospective analysis of clinical profile, prognostic factors and outcomes of 19 patients of emphysematous pyelonephritis. International Urology and Nephrology. 2009;41:959-966'},{id:"B162",body:'Narlawar RS, Raut AA, Nagar A, Hira P, Hanchate V, Asrani A. Imaging features and guided drainage in emphysematous pyelonephritis: A study of 11 cases. Clinical Radiology. 2004;59:192-197'},{id:"B163",body:'Somani BK, Nabi G, Thorpe P, et al. Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis? Evidence from a systematic review. The Journal of Urology. 2008;179:1844-1849'},{id:"B164",body:'Laufer J, Grisaru-Soen G, Portnoy O, Mor Y. Bilateral renal abscesses in a healthy child. The Israel Medical Association Journal. 2002;4(12):1150-1151'},{id:"B165",body:'Bhat YR. Renal subcapsular abscess. Indian Pediatrics. 2001;44:546-547'},{id:"B166",body:'Paul B, Agrawal A, Goyal RK. Renal abscess: A case of missed diagnosis. Journal of Indian Academy of Clinical Medicine. 2001;2(1):91-92'},{id:"B167",body:'Rai RS, Karan SC, Kayastha A. Renal & perinephric abscesses revisited. Medical Journal, Armed Forces India. 2007;63(3):223-225'},{id:"B168",body:'Baradkar VP, Mathur M, Kumar S. Renal abscess due to Escherichia coli in a child. Saudi Journal of Kidney Diseases and Transplantation. 2011;22(6):1215'},{id:"B169",body:'Chen CY, Kuo HT, Chang YJ, Wu KH, Yang WC, Wu HP. Clinical assessment of children with renal abscesses presenting to the pediatric emergency department. BMC Pediatrics. 2016;16(1):189'},{id:"B170",body:'Okafor CN, Onyeaso EE. Perinephric abscess. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2020'},{id:"B171",body:'Liu XQ , Wang CC, Liu YB, Liu K. Renal and perinephric abscesses in West China hospital: 10-year retrospective-descriptive study. World Journal of Nephrology. 2016;5(1):108-114'},{id:"B172",body:'Tsukagoshi D, Dinkovski B, Dasan S, Jethwa J. Perinephric abscess secondary to a staghorn calculus presenting as a subcutaneous abscess. Canadian Journal of Emergency Medicine. 2006;8(4):285-288'},{id:"B173",body:'Geller SA, de Campos F. Renal papillary necrosis. Autopsy & Case Reports. 2013;3(4):69-71'},{id:"B174",body:'Sutariya HC, Pandya VK. Renal papillary necrosis: Role of radiology. Journal of Clinical and Diagnostic Research. 2016;10(1):TD10-TD12'},{id:"B175",body:'Reddivari AKR, Mehta P. Prostate abscess. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2020'},{id:"B176",body:'Brede CM, Shoskes DA. The etiology and management of acute prostatitis. Nature Reviews. Urology. 2011;8(4):207-212'},{id:"B177",body:'Ganz T, Nemeth E. Regulation of iron acquisition and iron distribution in mammals. Biochimica et Biophysica Acta. 2006;1763:690-699'},{id:"B178",body:'Ganz T, Nemeth E. Iron homeostasis in host defence and inflammation. Nature Reviews. Immunology. 2015;15:500-510'},{id:"B179",body:'Stefanova D, Raychev A, Deville J, Humphries R, Campeau S, Ruchala P, et al. Hepcidin protects against lethal Escherichia coli sepsis in mice inoculated with isolates from septic patients. Infection and Immunity. 2018;86(7):e00253-18'},{id:"B180",body:'Rodriguez R, Jung CL, Gabayan V, Deng JC, Ganz T, Nemeth E, et al. Hepcidin induction by pathogens and pathogen-derived molecules is strongly dependent on interleukin-6. Infection and Immunity. 2014;82:745-752'},{id:"B181",body:'Stefanova D, Raychev A, Deville J, Humphries R, Campeau S, Ruchala P, et al. Hepcidin protects against lethal Escherichia coli sepsis in mice inoculated with isolates from septic patients. Infection and Immunity. 2018;86(7):e00253-18'},{id:"B182",body:'Bulut Y. Abstract PCCLB-21: HEPCIDIN DEFICIENCY AND IRON OVERLOAD POTENTLY PROMOTE E. COLI SEPSIS IN MOUSE MODELS BUT THE HEPCIDIN AGONIST PR-73 IS PROTECTIVE. Pediatric Critical Care Medicine. 2018;19(6S):249'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Akshay Kumar",address:"drakshay82@gmail.com",affiliation:'
University of Texas Southwestern Medical Center, United States
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