Epidemiology and Infection

Review Article

A systematic review of outbreak and non-outbreak studies of extraintestinal pathogenic Escherichia coli causing community-acquired infections

D. B. GEORGEa1 and A. R. MANGESa1 c1

a1 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec


A systematic review of outbreak and non-outbreak studies of infections caused by extraintestinal pathogenic Escherichia coli (ExPEC) was conducted. This review examines the epidemiology, seasonality, source or mode of transmission, and temporal changes, based on E. coli serogroup, in ExPEC causing sporadic vs. outbreak-associated infections. Twelve outbreak and 28 non-outbreak studies were identified. The existence of ExPEC outbreaks was well supported. Three of four outbreak reports indicated peak periods during the winter months. Serogroups associated with outbreak infections ranged from 1% to 26% (average 11·4%) vs. (range 1–15%, average 3·5%) for serogroups associated with sporadic infections; the distribution of serogroups also differed for outbreak and non-outbreak infections. Study authors indicated that the outbreaks may have resulted from foodborne transmission, but direct evidence was unavailable. This review provides evidence that the epidemiology of endemic vs. epidemic ExPEC infections differs; however, study reporting quality limited epidemiological inferences.

(Accepted June 09 2010)

(Online publication July 20 2010)


c1 Author for correspondence: A. R. Manges, M.P.H., Ph.D., Department of Epidemiology, Biostatistics & Occupational Health, 1020 Pine Avenue West, McGill University, Montréal, QC, Canada H3A 1A2. (Email: amee.manges@mcgill.ca)