Extra-intestinal pathogenic Escherichia coli (ExPEC): Disease, carriage and clones

Adam P. Dale*, Neil Woodford

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

77 Citations (Scopus)


Extra-intestinal pathogenic Escherichia coli (ExPEC) have a complex phylogeny, broad virulence factor (VF) armament and significant genomic plasticity, and are associated with a spectrum of host infective syndromes ranging from simple urinary tract infection to life-threatening bacteraemia. Their importance as pathogens has come to the fore in recent years, particularly in the context of the global emergence of hyper-virulent and antibiotic resistant strains. Despite this, the mechanisms underlying ExPEC transmission dynamics and clonal selection remain poorly understood. Large-scale epidemiological and clinical studies are urgently required to ascertain the mechanisms underlying these processes to enable the development of novel evidence-based preventative and therapeutic strategies. In the current review, we provide a concise summary of the methods utilised for ExPEC phylogenetic delineation before exploring in detail the associations between ExPEC VFs and site-specific disease. We then consider the role of ExPEC as an intestinal colonist and outline known associations between ExPEC clonal variation, specific disease syndromes and antibiotic resistance.

Original languageEnglish
Pages (from-to)615-626
Number of pages12
JournalJournal of Infection
Issue number6
Publication statusPublished - Dec 2015

Bibliographical note

Funding Information:
NW acknowledges the support of the National Institute for Health Research (NIHR) through the NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial resistance at Imperial (Grant number: HPRU-2012-10047 ). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England.

Publisher Copyright:
© 2015 The British Infection Association.


  • Clones
  • Escherichia coli
  • ExPEC
  • Virulence factors


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