Global Extraintestinal Pathogenic Escherichia coli (ExPEC) Lineages.

Area of Science:

• Microbiology
• Infectious Diseases
• Genomics

Background:

• Extraintestinal pathogenic Escherichia coli (ExPEC) cause significant global health burdens.
• Limited systematic surveillance exists for tracking dominant ExPEC strains.
• Understanding ExPEC epidemiology is crucial for developing effective interventions.

Purpose of the Study:

• To systematically review and meta-analyze existing data on ExPEC lineages.
• To identify the most prevalent ExPEC sequence types (STs) responsible for infections.
• To analyze geographic and temporal trends in ExPEC ST distribution.

Main Methods:

• Systematic review and meta-analysis of 217 studies (1995-2018).
• Inclusion of studies using multilocus sequence typing or whole-genome sequencing.
• Analysis of E. coli isolates from extraintestinal infections and gut reservoirs.

Main Results:

• Twenty major ExPEC STs accounted for 85% of isolates studied.
• ST131 emerged as the most common ExPEC ST globally from 2000 onwards.
• Geographic variations in ST distribution were observed, with divergence in Asian and African studies compared to European and North American ones.

Conclusions:

• A small number of ExPEC lineages dominate global infections.
• ST131 is a key global ExPEC clone requiring targeted surveillance.
• Further unbiased tracking of ExPEC lineages is essential for improved treatment and prevention strategies.