E. coli

Emery Haley, PhD, Scientific Writer

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Clinical Summary

C. koseri is recognized as a classical gram-negative, urease-variable, biofilm-forming uropathogen. 
C. koseri is associated with complicated UTI in older adult and pediatric populations. 
In symptomatic UTI patients, C. koseri: 
- Is not a contaminant (is found in catheter-collected urine specimens). 
- Is viable (can grow out on culture). 
- Is pathogenic (associated with elevated urine biomarkers of infection). 
Reported severe complications of C. koseri UTI include pyelonephritis, polymicrobial bacteremia, and urosepsis. 
Multidrug-resistant C. koseri (especially among hospital-acquired UTIs) is a significant global health threat.

Bacterial Characteristics

Gram-stain

Gram-negative

Morphology

Bacillus

Growth Requirements

Non-fastidious (grows well in standard urine culture conditions)
Facultative anaerobe

Nitrate Reduction

Yes

Urease

Variable

Biofilm Formation

Yes

Pathogenicity

Colonizer or Pathobiont

Clinical Relevance in UTI

C. koseri is a urease-variable microorganism [1] capable of forming biofilms. C. koseri is typically considered to be among the common classical uropathogens in older adults,[2]  but is also being increasingly recognized as common in pediatric UTIs.[3]

In a study of older adult males and females with clinically suspected complicated UTI, C. koseri was detected in both midstream voided and in-and-out-catheter collected specimens indicating that it was truly present in the bladder, not simply a contaminant picked up during voiding.[4]  Furthermore, elevated markers of immune system activation in the urinary tract have been measured from the same clinical urine specimens in which C. koseri was detected, indicating that the presence of C. koseri was associated with an immune response to urinary tract infection.[5–7]   Hospital-acquired C. koseri UTIs pose a particularly serious threat, as these infections increasingly display multidrug- or pandrug-resistance.[8]  Severe complications of C. koseri UTI, including pyelonephritis, polymicrobial bacteremia, and urosepsis, have been reported.[9–11]

Hospital-acquired C. koseri UTIs pose a particularly serious threat, as these infections increasingly display multidrug- or pandrug-resistance.[8]  Although not considered one of the six highest priority “ESKAPE” pathogens, The World Health Organization (WHO) has included this organism in the 2024 Bacterial Priority Pathogens List (BPPL).[111] Severe complications of C. koseri UTI, including pyelonephritis, polymicrobial bacteremia, and urosepsis, have been reported.[9–11] 

Together, these findings indicate that C. koseri should be seriously considered as a uropathogen and demonstrate the value of detecting this organism, particularly in individuals with recurrent UTI and/or risk factors for persistent or complicated UTI.

Treatment

Evidence of Efficacy (Checkmarks): Amoxicillin/Clavulanate, Ampicillin/Sulbactam, Cefaclor, Cefazolin, Cefepime, Cephalexin, Ceftazidime, Ceftriaxone, Ciprofloxacin, Gentamicin, Levofloxacin, Meropenem, Nitrofurantoin, Piperacillin/Tazobactam, Sulfamethoxazole/Trimethoprim, and Trimethoprim.

References

1. Gaston, J.R.; Johnson, A.O.; Bair, K.L.; White, A.N.; Armbruster, C.E. Polymicrobial Interactions in the Urinary Tract: Is the Enemy of My Enemy My Friend? Infect Immun 2021, 89, doi:10.1128/iai.00652-20.
2. Yoo, J.-J.; Shin, H.B.; Song, J.S.; Kim, M.; Yun, J.; Kim, Z.; Lee, Y.M.; Lee, S.W.; Lee, K.W.; Kim, W.B.; et al. Urinary Microbiome Characteristics in Female Patients with Acute Uncomplicated Cystitis and Recurrent Cystitis. J. Clin. Med. 2021, 10, 1097, doi:10.3390/jcm10051097.
3. Goode, O.; Smith, A.; Zarkan, A.; Cama, J.; Invergo, B.M.; Belgami, D.; Caño-Muñiz, S.; Metz, J.; O’Neill, P.; Jeffries, A.; et al. Persister Escherichia Coli Cells Have a Lower Intracellular PH than Susceptible Cells but Maintain Their PH in Response to Antibiotic Treatment. mBio 2021, 12, 10.1128/mbio.00909-21, doi:10.1128/mbio.00909-21.
4. Robino, L.; Sauto, R.; Morales, C.; Navarro, N.; González, M.J.; Cruz, E.; Neffa, F.; Zeballos, J.; Scavone, P. Presence of Intracellular Bacterial Communities in Uroepithelial Cells, a Potential Reservoir in Symptomatic and Non-Symptomatic People. BMC Infect. Dis. 2024, 24, 590, doi:10.1186/s12879-024-09489-5.
5. Abell-King, C.; Pokhrel, A.; Rice, S.A.; Duggin, I.G.; Söderström, B. Multispecies Bacterial Invasion of Human Host Cells. Pathog. Dis. 2024, 82, ftae012, doi:10.1093/femspd/ftae012.
6. Zagaglia, C.; Ammendolia, M.G.; Maurizi, L.; Nicoletti, M.; Longhi, C. Urinary Tract Infections Caused by Uropathogenic Escherichia Coli Strains—New Strategies for an Old Pathogen. Microorganisms 2022, 10, 1425, doi:10.3390/microorganisms10071425.
7. Yoo, J.-J.; Song, J.S.; Kim, W.B.; Yun, J.; Shin, H.B.; Jang, M.-A.; Ryu, C.B.; Kim, S.S.; Chung, J.C.; Kuk, J.C.; et al. Gardnerella Vaginalis in Recurrent Urinary Tract Infection Is Associated with Dysbiosis of the Bladder Microbiome. 2021, doi:10.21203/rs.3.rs-1108904/v1.
8. Morrill, S.; Gilbert, N.M.; Lewis, A.L. Gardnerella Vaginalis as a Cause of Bacterial Vaginosis: Appraisal of the Evidence From in Vivo Models. Front. Cell. Infect. Microbiol. 2020, 10, 168, doi:10.3389/fcimb.2020.00168.
9. Wang, D.; Haley, E.; Luke, N.; Mathur, M.; Festa, R.; Zhao, X.; Anderson, L.A.; Allison, J.L.; Stebbins, K.L.; Diaz, M.J.; et al. Emerging and Fastidious Uropathogens Were Detected by M-PCR with Similar Prevalence and Cell Density in Catheter and Midstream Voided Urine Indicating the Importance of These Microbes in Causing UTIs. Infect. Drug Resist. 2023, Volume 16, 7775–7795, doi:10.2147/idr.s429990.
10. Haley, E.; Luke, N.; Mathur, M.; Festa, R.A.; Wang, J.; Jiang, Y.; Anderson, L.A.; Baunoch, D. The Prevalence and Association of Different Uropathogens Detected by M-PCR with Infection-Associated Urine Biomarkers in Urinary Tract Infections. Res. Rep. Urol. 2024, 16, 19–29, doi:10.2147/rru.s443361.
11. Akhlaghpour, M.; Haley, E.; Parnell, L.; Luke, N.; Mathur, M.; Festa, R.A.; Percaccio, M.; Magallon, J.; Remedios-Chan, M.; Rosas, A.; et al. Urine Biomarkers Individually and as a Consensus Model Show High Sensitivity and      Specificity for Detecting UTIs. BMC Infect Dis 2024, 24, 153, doi:10.1186/s12879-024-09044-2.
12. Parnell, L.K.D.; Luke, N.; Mathur, M.; Festa, R.A.; Haley, E.; Wang, J.; Jiang, Y.; Anderson, L.; Baunoch, D. Elevated UTI Biomarkers in Symptomatic Patients with Urine Microbial Densities of 10,000 CFU/ML Indicate a Lower Threshold for Diagnosing UTIs. MDPI 2023, 13, 1–15, doi:10.3390/diagnostics13162688.
13. 2024 WHO Bacterial Priority Pathogens List (WHO BPPL) Available online: https://iris.who.int/bitstream/handle/10665/376776/9789240093461-eng.pdf?sequence=1 (accessed on 18 March 2025).
14. Parente, G.; Gargano, T.; Pavia, S.; Cordola, C.; Vastano, M.; Baccelli, F.; Gallotta, G.; Bruni, L.; Corvaglia, A.; Lima, M. Pyelonephritis in Pediatric Uropathic Patients: Differences from Community-Acquired Ones and Therapeutic Protocol Considerations. A 10-Year Single-Center Retrospective Study. Children 2021, 8, 436, doi:10.3390/children8060436.
15. Sachdeva, S.; Rosett, H.A.; Krischak, M.K.; Weaver, K.E.; Heine, R.P.; Denoble, A.E.; Dotters-Katz, S.K. Urinary Tract Infection and Progression to Pyelonephritis: Group B Streptococcus versus E. Coli. Am. J. Perinatol. Rep. 2023, 14, e80–e84, doi:10.1055/s-0044-1779031.
16. Peralta, D.P.; Chang, A.Y. Escherichia Coli: A Rare Cause of Prosthetic Valve Endocarditis. Cureus 2023, 15, e38402, doi:10.7759/cureus.38402.
17. Benaissa, E.; Yasssine, B.L.; Chadli, M.; Maleb, A.; Elouennass, M. Infective Endocarditis Caused by Escherichia Coli of a Native Mitral Valve. IDCases 2021, 24, e01119, doi:10.1016/j.idcr.2021.e01119.
18. Kamat, S.; Sagar, V.V.S.S.; Akhil, C.V.S.; Acharya, S.; Shukla, S.; Kumar, S. Escherichia Coli Urosepsis Leading to Native Valve Endocarditis. J. Pr. Cardiovasc. Sci. 2022, 8, 42–44, doi:10.4103/jpcs.jpcs_7_22.
19. Karunathilake, P.; Kularatne, W.; Bowaththage, S.; Kobbegala, K.; Fasrina, M.; Nasim, F.N.; Costa, M.; Jezeema, Z.; Rajapaksha, R.; Ranawaka, R. Infective Endocarditis with Escherichia Coli Secondary to Urosepsis. 2022, doi:10.21203/rs.3.rs-1879210/v1.
20. Wu, Y.; Li, P.; Huang, Z.; Liu, J.; Yang, B.; Zhou, W.; Duan, F.; Wang, G.; Li, J. Four-Year Variation in Pathogen Distribution and Antimicrobial Susceptibility of Urosepsis: A Single-Center Retrospective Analysis. Ther. Adv. Infect. Dis. 2024, 11, 20499361241248056, doi:10.1177/20499361241248058.
21. Shahab, K.; Mufti, A.Z.; Iqbal, M.A.; Roghani, M.; Zeb, F.; Amin, U. Assessment of Microbial Diversity Pattern of Sensitivity and Antimicrobial Susceptibility in Patients Admitted with Urosepsis. Ann. PIMS-Shaheed Zulfiqar Ali Bhutto Méd. Univ. 2023, 19, 339–345, doi:10.48036/apims.v19i3.924.

About the Author

Dr. Emery Haley is a scientific writing specialist with over ten years of experience in translational cell and molecular biology. As both a former laboratory scientist and an experienced science communicator, Dr. Haley is passionate about making complex research clear, approachable, and relevant. Their work has been published in over 10 papers and focuses on bridging the gap between the lab and real-world patient care to help drive better health outcomes.

Urologists

Primary Care Physicians

Gastroenterologists

Gynecologists

Medical Directors

Post-Acute Care

Healthcare at Home

Urology Clinic

Immediate Care/Urgent Care

Telemedicine

E. coli

CHECK BACK SOON FOR OUR FULL BLOG ON THE IMPORTANCE OF ESCHERICHIA COLI

Clinical Summary

Bacterial Characteristics

Gram-stain

Morphology

Growth Requirements

Nitrate Reduction

Urease

Biofilm Formation

Pathogenicity

Clinical Relevance in UTI

Treatment

References

About the Author

Urologists

Primary Care Physicians

Gastroenterologists

Gynecologists

Medical Directors

Post-Acute Care

Healthcare at Home

Urology Clinic

Immediate Care/Urgent Care

Telemedicine

CHECK BACK SOON FOR OUR FULL BLOG ON THE IMPORTANCE OF ESCHERICHIA COLI

Clinical Summary

Bacterial Characteristics

Gram-stain

Morphology

Growth Requirements

Nitrate Reduction

Urease

Biofilm Formation

Pathogenicity

Clinical Relevance in UTI

Treatment

References

About the Author

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